Picosure has made its mark in the tattoo removal industry, but is now being sought for its success in skin rejuvenation.
The innovative FOCUS Lens Array handpiece for PicoSure is the next generation for skin revitalisation treatments, delivering 20 times the power of the original PicoSure device.
The addition of the FOCUS Lens Array handpiece to PicoSure’s picosecond technology, allows treatment of wrinkles and acne scarring, pigmentation and significant overall skin rejuvenation like no other.
Brisbane dermatologist Dr Davin Lim from Westside Cosmetic Laser Clinic, has been impressed with the mechanism behind PicoSure’s FOCUS Lens hand piece.
“With old technology (nanosecond Q-switched laser), clearance of melasma is slow. Patients typically undertake 8 to 10 treatments spaced two weeks apart. With the advent of picosecond lasers, especially one which has attenuation of energy levels using a FOCUS lens, it makes sense that the efficacy and safety profile is there to begin with,” says Dr Lim.
“The FOCUS Lens Array handpiece extends the use of PicoSure to beyond treating tattoo ink only. This enables me to treat conditions such as acne scarring, melasma, actinic pigmentation and also photorejuvenation, especially in ethnic skin types. Most importantly there is little, if any, downtime.”
FOCUS Lens Array in action
The FOCUS optic lens harnesses the PicoSure shockwaves to create a high-energy, spatially confined injury to the epidermis, referred to as an area of Laser Induced Optical Breakdown (LIOB).
In the LIOB reaction, a vacuole is created by high pressure, causing a chain reaction in the dermal architecture and resulting in epidermally driven collagen remodelling. In this way, improvement of fine lines and wrinkles, normalisation of pigment and improvement of scars are achieved.
The FOCUS Lens Array handpiece delivers 20 times the power of the original PicoSure by microscopically concentrating the PicoSure pulse to a precise depth. Reaction at the treatment site significantly heightens the photomechanical response.
Pigmentation in darker skin types
The toning effect of the FOCUS handpiece in combination with the picosecond pulse duration is effective in treating epidermal pigmentation. The dual mechanism both heats and fractures melanosomes to diminish pigmentation.
“I typically treat darker skin types, as this laser preselects melanin as the chromophore. I normally would recommend other fractionated devices for type I and type II skin, but PicoSure is my laser of choice for type III skin and beyond,” says Dr Lim.
“There is no other laser on the market that can give such marked dermal remodelling with a huge safety margin and minimal downtime in these skin types.”
Science behind FOCUS
The FOCUS Lens Array is designed to redistribute the light energy intoa multitude of high fluence, tightly focused spots, embedded in a low fluence background. This is designed to make treatment more efficacious and increase safety.
“This lens basically attenuates laser energies by approximately 90 percent and fractionates or diffuses the laser into fractions which are at different levels. This allows a higher safety margin. The lens itself can be adjusted from 6mm spot size through to an 8mm and a 10mm spot size. Accordingly, the fluence or energy levels can be varied within each spot size,” Dr Lim explains.
The FOCUS exposes up to 10 percent of the tissue to high fluence on each pass. This makes multiple passes possible and reduces the risk of post-inflammatory hyperpigmentation in darker skin types.
In using a Q-switched laser in skin toning, results can be improved by increasing the fluence or number of passes, but this can lead to increased downtime and possible hypopigmentation and small areas of textural changes, particularly in patients with skin types III-IV.
Patient selection & protocol
Although patients have noticed moderate to significant improvement in their skin condition following PicoSure FOCUS treatment, Dr Lim explains that he is very careful in patient selection in regards to optimal outcomes. Patients who have a higher melanin content in their skin, namely skin types III and beyond, will achieve a better result compared to skin type I and skin type II.
“I would normally see a marked reduction in pore size after two treatments of PicoSure, using the 6mm spot size,” he explains.
“Additionally, dermal remodelling can typically be seen after only one treatment, and there is usually a marked reduction in fine wrinkling together with a decrease of skin pigmentation with only one treatment. Most importantly, the risk of dyspigmenataion is extremely low.”
In the context of melasma, Dr Lim believes that PicoSure FOCUS clears up this condition three times quicker than nanosecond technology. The number of treatments will depend on the patient’s expectations and also the condition being treated.
“For remodelling of collagen and reduction of pore size, only one to two treatments are needed for ethnic skin types, whereas the treatment of melasma may involve three to four treatments between two to four weeks apart,” says Dr Lim.
“In the context of acne scarring, most patients require at least three to four treatments. Most often with acne scar treatments, we have a decrease in melanin after the second or third treatment and hence, I cease treatments at that point.
“This is due to the fact that melanin is minimal and hence, cytokine and growth factor release will be reduced and further treatments will not result in as dramatic a change compared to the first few treatments.”
Dr Lim says that his protocol varies from patient to patient, depending on the skin type (ethnic skin type of the patient) and also the skin condition.
“For acne scarring, I always use the 6mm spot size with the FOCUS handpiece and I would dwell on areas to create both bulk heating of tissue (safe in lighter skin types) but I would also listen carefully for the photoaccoustic effects,” explains Dr Lim.
“Typically I would perform 2,500 shots on darker skin types but may extend it to 5,500 shots using the 6mm handpiece at a 0.71J setting if I am treating acne scarring.”
Using PicoSure with the FOCUS Lens array, typical patients are pink for two hours post-treatment, have a sunburn sensation and are normal the next day, without swelling. Downtime is minimal.
Dr Lim has used the FOCUS Lens array on himself and is impressed by the lack of downtime. “I often have my nurses perform this particular laser procedure on me in between patients. There is only slight erythema post procedure, which is gone within six to 12 hours post PicoSure FOCUS,” Dr Lim says.
“It is my laser of choice which I personally use for my photorejuvenation, as my skin type enables the laser to deliver its full efficacy with minimal downtime.”
First-hand experience: Picosure FOCUS in your practice
Dr Lim believes PicoSure FOCUS Lens Array is a valuable investment for practitioners, and says it is his laser of choice.
“This is an extremely versatile instrument. In my setting as a specialist dermatologist who only performs laser and aesthetic procedures, this is an invaluable asset for my practice. It is used on a daily basis for the treatment of dyschromia, pigmentation disorders and for early remodelling of acne scars,” says Dr Lim
“The PicoSure FOCUS laser is really the landmark laser for the treatment of ethnic skin types. It’s a standout laser in the sense of delivering excellent, safe and predictable results with little or no downtime.”
Additionally the device does not have to be administered by a doctor or nurse, meaning treatments can be easily incorporated into a clinic using existing staff. However, Dr Lim says that in context of melasma, acne scarring and other more complex skin conditions, it is the role of the doctor to administer this laser.
Cynosure is at the forefront of laser technology. With the addition of the FOCUS Lens, PicoSure has become a widely applicable device – suitable for treating several indications in skin rejuvenation, delivering previously unseen results.
The potential for FOCUS Lens Array is exciting. It is the first device utilising a new tissue reaction and offering a new set of possibilities.
The PicoSure with FOCUS Lens Array is a “sure” investment for now and in the future.
For enquiries contact Cynosure on 1300 CYNOSURE (2966 7873) or email infoaustralia@cynosure.com
