THEMED ISSUE – LASERS IN DERMATOLOGY: CURRENT STATUS
Copyright © 2017 Saki N. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0
International License (http://creativecommons.org/licenses/by-nc/4.0/), permitting all non-commercial use, distribution, and reproduction in any me-
dium, provided the original work is properly cited. 1
Picosecond laser applications in aesthetic dermatology
Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
he time needed for a tissue to cool halfway down
to its initial temperature is the thermal relaxation
time (TRT) of that tissue. In order to reach the
goal of selective photothermolysis, tissue ablation by
laser beam should be fast with pulse duration shorter
than or nearly equal to the TRT of the skin targets. The
introduction of concept-selective photothermolysis by
pulsed lasers was a breakthrough in laser surgery by
minimizing the risks of dyspigmentation and scarring
associated with old continuous wave lasers.
Q-switched (QS) lasers are defined by extremely short,
nanosecond pulses that induce photomechanical and
photoacoustic tissue interactions. This short pulse dura-
tion limits the damage to the lysosome . QS Lasers with
pulse duration of 5 to 100 ns have been the main lasers
for tattoo removal since the 1980s. Since most tattoo
particles’ size are approximately 100 nm, corresponding
to a thermal relaxation time of less than 10 ns, picose-
cond (PS) lasers could be more effective than QS lasers,
theoretically. Clinical trials have reported the efficacy
and safety of PS lasers in the treatment of multicolored
and recalcitrant tattoos .
Reiter et al. in 2016 designed a great systematic
review regarding the use of PS lasers for tattoo removal.
They concluded that using a PS laser causes a drastic
photoacoustic effect that may be beneficial for the
removal of a wider variety of tattoo colors, in theory. The
ability of PS lasers to remove multicolored tattoos was
shown for green, yellow, red, and purple tattoos.
However, the findings was not directly compared with
the results of the traditional QS lasers.
As a new technology, PS lasers are receiving more
attention in aesthetic dermatology, and their application
for other cosmetic problems, beyond tattoos, are being
investigated by many dermatologists.
Brauer et al. in 2015 demonstrated favorable results in
acne scar treatment with the 755-picosecond laser plus
diffractive lens array. Improvements in texture and
pigmentation of the surrounding skin were also noted,
suggesting there may be favorable results for indications
other than scarring.
In another study by Petersen et al. in 2016, wound
healing after incision with a novel picosecond infrared
laser (PIRL) was compared with different surgical
techniques in a rat skin model. They concluded that PIRL
results in minimal scarring and improves aesthetic
outcomes. The resection of skin neoplasms, hypertrophic
scars and keloids, particularly, could be interesting fields
for PIRL application.
Ohshiro et al. in 2016 designed a retrospective study
investigating the results of PS laser for the treatment of
dermal melanocytosis in Asians. They concluded that PS
lasers, both the 1064-nm Nd:YAG and the 755-nm
alexandrite, are beneficial for the removal of dermal
melanocytosis with minimal side effects.
The effectiveness of the PS 755-nm alexandrite laser
in the treatment of benign pigmentary lesions, especially
Nevus of Ota, was also shown by Chan et al. It was
demonstrated that PS laser is associated with a lower risk
of post-inflammatory hyperpigmentation in Asians.
In 2017, Weiss et al. designed an interesting prospec-
tive, blinded study investigating the effectiveness of a
novel diffractive lens array using a PS 755-nm alexan-
drite laser in the treatment of facial wrinkles. They have
found it safe and highly effective for the improvement of
rhytides and other signs of skin aging.
In summary, PS lasers have been introduced as a
novel modality mostly as a treatment for challenging
pigmented lesions or tattoos. Nevertheless, their spec-
trum of beneficial effects in cosmetic dermatology seems
to go further day by day.
However, there are still some controversies regarding
their cost and efficacy, and further well-designed studies
are needed to evaluate the efficacy of this novel
Picosecond laser applications in aesthetic dermatology
Conflict of interest
The author declares no potential conflict of interest with
respect to the research, authorship, and/or publication of
1. Sakamoto FH, Avram MM, Anderson RR. Lasers and
other energy technologies principles and skin interactions.
3rd ed. In: Bolognia JL, Jorizzo JL, Schaffer JV, (edi-
tors). Dermatology. Spain: Mosby Elsevier; 2012. p.
2. Zachary CB, Rofagha R. Laser therapy. 3rd ed. In Bo-
lognia JL, Jorizzo JL, Schaffer JV (editors). Dermatology.
Spain: Mosby Elsevier; 2012. p. 2267–2268.
3. Reiter O, Atzmony L, Akerman L, Levi A, Kershenovich
R, et al. Picosecond lasers for tattoo removal: A system-
atic review. Lasers Med Sci 2016; 31(7): 1397–1405. doi:
4. Brauer JA, Kazlouskaya V, Alabdulrazzaq H, Bae YS,
Bernstein LJ, et al. Use of a picosecond pulse duration
laser with specialized optic for treatment of facial acne
scarring. JAMA Dermatol 2015; 151(3): 278–284. doi:
5. Petersen H, Tavakoli F, Kruber S, Münscher A, Gliese A,
et al. Comparative study of wound healing in rat skin
following incision with a novel picosecond infrared laser
(PIRL) and different surgical modalities. Lasers Surg
Med 2016; 48(4): 385–391. doi: 10.1002/lsm.22498.
6. Ohshiro T, Ohshiro T, Sasaki K, Kishi K. Picosecond
pulse duration laser treatment for dermal melanocytosis
in Asians: A retrospective review. Laser Ther 2016; 25(2):
99–104. doi: 10.5978/islsm.16-OR-07.
7. Chan JC, Shek SY, Kono T, Yeung CK, Chan HH. A ret-
rospective analysis on the management of pigmented le-
sions using a picosecond 755-nm alexandrite laser in
Asians. Lasers Surg Med 2016; 48(1): 23–29. doi:
8. Weiss RA, McDaniel DH, Weiss MA, Mahoney AM,
Beasley KL, et al. Safety and efficacy of a novel diffrac-
tive lens array using a picosecond 755 nm alexandrite
laser for treatment of wrinkles. Lasers Surg Med 2017;
49(1): 40–44. doi: 10.1002/lsm.22577.
Keywords: Picosecond laser; dermatology, aesthetic
Citation: Saki N. Picosecond laser applications in aesthetic dermatology. J Surg Dermatol 2017; 2(T1):
Received: 2nd March 2017; Published Online: 15th March 2017
Correspondence to: Nasrin Saki, Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,