Pigmentation issues, ranging from freckles to melasma, are by all accounts the most common skin problem faced by clinics like mine. They are common in part because of their huge variety. Everyone has at least a freckle or two.
Pigmentation is caused by an oversupply of melanin in a local area. Melanin itself is vital to our health: it absorbs and diffuses dangerous ultraviolet light, attacks free radicals in the skin, and even gives us our eye colour. Melanocytes, the cells which produce melanin, are prone to overproduction, which leads to skin pigmentation.
For some years, Q-switched lasers have been the standard therapy for pigmentation. They work by sending pulses of energy into the top layers of skin, where melanin collects. These pulses break melanin particles into tiny pieces, which are removed by macrophages, the cells that patrol the skin for unwanted materials and dispose of them.
What Exactly is a Q-Switched Laser?
Q-switching produces a pulsing beam of light every nanosecond, rather than a continuous stream. This produces peaks of much greater power than the same laser would be able to achieve when producing a constant output. These high-powered bursts allow doctors to target small abnormalities more precisely, and also minimizes any potential damage to healthy skin.
Treatment can range from $50 to $500 per session.
How Effective Are Q-Switched Lasers?
Q-switched lasers are still effective. But they are currently the ideal choice only for certain conditions. Because of their variety, pigmentation issues require a wide range of treatments, some but not all of which are best achieved by Q-switched laser therapy.
Easily Resolved Pigmentation Issues
Freckles are small brown marks that usually appear on sun-exposed areas. They are usually removed with 2-4 sessions of Q-switched laser treatment.
Solar lentigos, also known as sun-or-age spots, are larger than freckles and have more defined outlines. They usually arise in middle age and appear on sun-exposed areas. Like freckles, they are usually removed with 2-4 sessions of Q-switched laser therapy.
Post-inflammatory hyperpigmentation is seen after severe inflammation of the kind caused by acne or eczema; it can also appear after injury or infection. Some cases only last a few months; others become permanent until treated.
3-5 sessions of Q-switched laser therapy are usually required to resolve this issue.
More Challenging Cases: Melasma
Melasma is an entirely different category of pigmentation issue, and much more difficult to resolve. This is where Q-switched lasers tend to meet their match: even over repeated sessions, they are often unable to fully remove pigmentation caused by melasma.
Melasma is a catch-all term referring to conditions that produce symmetrical patches on the face. It is more common in women than in men and is also more prevalent among people with darker skin tones. Melasma is caused by a variety of factors, including pregnancy, hormone treatments or imbalances, and even extreme reactions to sun exposure.
Melasma is more difficult to treat than most other types of pigmentation. It can be slow to respond to treatment and may require more sessions than other conditions before progress is apparent. Once treatment is discontinued, melasma may still return.
Traditionally, patients with melasma had to choose between two options: cease treatment after achieving partial results and risk the return of the original condition, or continue indefinitely with monthly laser treatments to keep the melasma at bay. Obviously, neither of these is ideal.
The New Generation of Pigment Removal
In 2016, picosecond laser technology was approved for the removal of skin pigment. Picosecond lasers improve upon traditional Q-switching by pulsing approximately ten times faster (roughly every picosecond versus every nanosecond) and delivering much greater peak power for less time during each pulse. The benefits achieved by Q-switched lasers are dramatically enhanced by picosecond lasers: more precision, more power per pulse, greater protection for healthy skin, and much quicker recovery.
Picosecond lasers were initially developed to remove acquired pigments such as tattoos, but early models were adapted to treat natural pigment conditions like melasma. Second-generation picosecond lasers such as the Lutronic PicoPlus were developed expressly to treat naturally occurring pigment issues.
Recently, a top Taiwanese dermatology-research centre conducted a split-face, head-to-head research study comparing picosecond laser treatment with Q-switched laser treatment. The study proved that picosecond lasers produce better results, requiring fewer treatment sessions to achieve desired outcomes.
My own experience bears that out. In my clinical practice, I have observed that picosecond lasers achieve results approximately twice as quickly than Q-switched lasers in most situations, which means fewer treatment sessions for my patients.
Are Q-Switched Lasers Obsolete?
Although picosecond lasers improve in many ways over their predecessors, each still has a place in modern skin-treatment clinics. I and like-minded doctors have learned how the two technologies complement each other, and industry has taken notice: machines are now available that offer both nanosecond and picosecond pulses.
In a recently conducted Korean research study, nanosecond lasers were used as an initial measure, to shatter large pigments into smaller fragments. Picosecond lasers were then used to shatter these smaller fragments into tiny particles that were more easily removed by the subjects’ immune systems. The results were encouraging, and this is becoming a common technique among well-equipped clinics.
So the answer is no – Q-switched lasers are not obsolete. They have simply taken a different position among the options available to the most determined and forward-thinking doctors in the field.