PicoSure® is a 755nm alexandrite picosecond laser developed by Cynosure, Inc. (USA). Since FDA approval in 2012, multiple peer-reviewed prospective trials targeting tattoo removal, acne scars, and nevus of Ota have been published, demonstrating superiority over conventional Q-switch (nanosecond) lasers. This article explains the efficacy and safety of PicoSure based on evidence from those papers.
What is PicoSure?
PicoSure® is a 755nm alexandrite laser developed by Cynosure, Inc. (Massachusetts, USA), with a pulse width as short as 750 picoseconds (750 trillionths of a second). While conventional Q-switch lasers use pulses of several nanoseconds to tens of nanoseconds, PicoSure delivers pulses 100 to 1,000 times shorter.
Due to the short pulse, energy concentrates on pigment particles before diffusing as heat into surrounding tissue, making the photoacoustic effect (photothermal acoustic effect) the primary mechanism rather than photothermal effect. This mechanical shattering force enables finer fragmentation of pigment particles and faster clearance compared to conventional lasers.
Mechanism of action
Selective photothermal lysis and photoacoustic effect
The 755nm wavelength matches the absorption peak of melanin pigment. With picosecond pulses, the exposure time is far shorter than the thermal relaxation time of melanosomes, so thermal damage does not spread to surrounding tissue and pigment particles are selectively shattered. Saedi et al. (2012) stated that "pulse width shorter than thermal relaxation time is the key to selective photothermal lysis," explaining the mechanistic difference from conventional Q-switch lasers.
Focus Lens Array (FLA) and LIOB
When equipped with a fractional handpiece (Focus Lens Array), it induces LIOB (Laser-Induced Optical Breakdown) at the epidermal-dermal junction. Histological analysis by Brauer et al. (JAMA Dermatology 2014) confirmed extension and increased density of elastic fibers, and increased dermal collagen and mucin after six treatments, demonstrating the mechanism contributing to lifting acne scars.
Clinical evidence
Below is an overview of four major papers. All are published in peer-reviewed English journals and support the efficacy and safety of PicoSure.
| Author, Journal (Year) | Study Design | Subject / Sample Size | Main Results |
|---|---|---|---|
| Brauer et al. Arch Dermatol 2012 | Prospective case series | Blue and green tattoo pigment | 1–2 treatments achieved ≥75% clearance in all cases. Over 2/3 achieved nearly 100% clearance. Minimal thermal injury to surrounding tissue. |
| Saedi et al. Arch Dermatol 2012 | Prospective trial | 15 cases (dark tattoos) | 12/15 cases (80%) achieved ≥75% clearance. Mean number of treatments: 4.25. Patient satisfaction: 100%. Adverse effects limited to transient pain and edema. |
| Brauer et al. JAMA Dermatol 2014 | Prospective single-center trial | 20 cases (acne scars / Fitzpatrick I–V) | 6 treatments resulted in 24.3% improvement in scar volume (maintained at 3 months post-treatment). Histology confirmed increases in collagen and elastic fibers. Mean pain: 2.8/10. |
| Chesnut et al. Dermatol Surg 2015 | Case series | 3 cases (Ota nevus refractory to QS laser) | Cases plateaued on QS laser showed marked improvement with 2–3 picosecond treatments. No repigmentation at 2–7 months post-treatment. |
Treatable concerns and recommended number of treatments
We have organized indications and expected effects reported in the literature. The number of treatments is merely a guideline and varies depending on pigment depth, type, and skin condition.
| Concern | Expected Results | Recommended Frequency | Research Reference |
|---|---|---|---|
| Age spots, Freckles (Solar lentigo, PIH) | Fading/elimination of pigmentation, skin tone uniformity | 2–4 sessions | Selective photothermal lysis principle (Freedman 2014) |
| Acne scars (Atrophic scars) | 24% scar volume improvement, enhanced texture and appearance | 6 sessions | Brauer et al. JAMA Dermatol 2014 |
| Tattoo removal (Blue, green, dark tones) | 75%+ clearance (achievable in 1–2 sessions) | 1–4 sessions | Brauer 2012, Saedi 2012 |
| Nevus of Ota (QS laser-resistant, plateau cases) | Breakthrough of QS laser plateau, marked improvement | 2–3 sessions | Chesnut et al. Dermatol Surg 2015 |
| Skin dullness, Skin quality improvement | LIOB-induced collagen regeneration, enhanced radiance | 4–6 sessions | Brauer 2014 histological findings |
Safety for Asian skin
Asians, including Japanese, frequently have Fitzpatrick skin types III–IV, and post-inflammatory hyperpigmentation (PIH) after treatment was a concern with conventional lasers. The acne scar trial by Brauer et al. (2014) targeted all Fitzpatrick types I–V, and the results showing average pain score 2.83/10 (mild) with no serious adverse events demonstrate safety across diverse skin types. However, thermal stimulation does occur even briefly, so post-treatment UV protection (SPF 30 or higher sunscreen) is essential.
For melasma, the risk of PIH induction by Q-switch lasers is well known, and PicoSure also requires a cautious approach using low-fluence settings. A test treatment to confirm response is recommended on the first visit.
Treatment procedure
One treatment takes approximately 40–60 minutes from anesthetic cream (lidocaine) application to irradiation. Transient erythema and edema may occur immediately after irradiation, but according to Saedi et al. (2012), "pain resolves immediately after irradiation, and edema and blisters subside within one week." Multiple treatments at standard intervals of 4–8 weeks are typical, with Brauer 2014 evaluating six treatments as one course (6 months total).
PicoSure at Zetis
At Zetis Beauty Clinic, we carefully confirm the type of concern, pigment depth, and skin type through thorough counseling, then select the appropriate handpiece and parameters. For age spots and dullness we choose flat-top handpiece; for acne scars we use Focus Lens Array (FLA); for difficult cases such as nevus of Ota we select higher-fluence settings—providing individualized treatment according to the condition. Please feel free to consult with us.