Introduction
Disease | Laser | Therapy parameters | Fitzpatrick scale | Number of cases | Clinical outcome | Adverse events | Reference |
---|---|---|---|---|---|---|---|
Facial rejuvenation | 755-nm picosecond laser with DLA | 8 mm spot, fluence of 0.4 J/cm2, 5 Hz pulse rate or 6 mm spot, fluence of 0.71 J/cm2, 10 Hz pulse for six treatments at 4-week intervals | III–IV | 18 | Skin texture and dyspigmentation scores improved significantly; however, in pore size or wrinkles, there was no significant improvements | Transient erythema and edema | [20] |
755-nm picosecond alexandrite lasers with DLA | 8-mm spot, fluence of 0.4 J/cm2, 750 ps pulse duration, 10 Hz pulse repetition for 3–5 treatment sessions at 4-week intervals | IV | 10 | Pores had improved at 12- and 20-week follow-up, while at 1-year follow-up, the score of pigmentation showed 38% improvement, and wrinkles improved significantly. | Mild erythema, itchiness, desquamation | [21] | |
755 nm picosecond alexandrite laser with a DLA | 8‐mm spot, 0.4 J/cm2, 10 Hz pulse repetition, and 750 ps pulse duration for 10 sessions at 2-week intervals | III–IV III (n = 2); IV (n = 8) | 11 (10 patients completed) | Pigmentation: compared with the control side, the improvement of the treated side reached statistical significance at follow‐up Wrinkles: the trend of improvement did not reach statistical significance at 6‐month follow‐ups | Transient erythema and edema, slight PIH | [22] | |
755 nm picosecond laser with DLA | 8 mm spot, 10 Hz, 0.4 J/cm2 or 10 mm spot, 10 Hz, 0.25 J/cm2 in just one treatment session | III–IV III (n = 29); IV (n = 17) | 46 | Wrinkles improved significantly, over half of patients showed improvement in pore size | Mild hyperpigmentation | [23] | |
Combination of the 1064 and 532-nm picosecond laser with a fractional handpiece | Total pulse energy: 350 mJ for the 1064-nm wavelength, 250 mJ for the 532-nm wavelength The 532-nm component followed the 1064-nm portion | I–III I (n = 2); II (n = 12); III (n = 4) | 18 (10 subjects completed) | At 1-month follow-up, 79% of patients had mild‐to‐moderate wrinkle improvement. 93%, 78%, and 87% of patients showed mild to significant mottled pigmentation improvement at 1-month, 3-month, and 6-month follow-up | Trace erythema | [24] | |
Wrinkles | 755 nm alexandrite picosecond laser with DLA | 6 mm spot, fluence of 0.57 J/cm2, 750 ps pulse duration, 10 Hz repetition rate for 5 treatments at 4-week intervals. Standard half face treatment: an average of 3301 + / − 155 pulses, the other half of face: an average of 5867 + / − 500 pulses | II–IV | 4 | Two treated sides had no significant difference. The standard pulse side had good to excellent improvement, and the high pulse side had very good to excellent improvement | Erythema and edema | [25] |
755 nm alexandrite picosecond laser with DLA | 6 mm spot, fluence of 0.71 J/ cm2, 750 ps pulse duration, 10 Hz pulse repetition for 4 treatments at 1 month intervals | I–IV I (n = 4); II and III (n = 34); IV (n = 2) | 40 | At the 6-month follow-up, the average Fitzpatrick wrinkle score was 3.47 (the baseline was 5.48). 31.6% of individuals were very much improved, 28.9% were much improved, and 28.9% were improved at 6-month follow-up. | Transient erythema, edema, bruising | [26] | |
Dyspigmentation (melasma) | 755 nm alexandrite picosecond laser with DLA | 8-mm spot size, fluence of 0.4 J/cm2, 750 ps for three treatment sessions at 4- to 6-week intervals | IV | 20 | The mean MASI score improved to 6.9 ± 3.7 after 3 sessions treatment with the baseline was 9.4 ± 4.7 | Erythema, pruritus, scaling, and only one developed mild PIH | [27] |
Fractional 1064-nm picosecond laser | 450 ps pulses with a maximum microbeam energy per pulse of 3 mJ | III–IV III (n = 2) IV (n = 8) | 10 | Compared with baseline, 7 patients showed moderate to marked improvement at 6 weeks post-treatment, and 5 patients showed sustained improvement | Erythema, edema, hyper/hypopigmentation | [28] | |
Dyspigmentation (PIH) | 755-nm alexandrite picosecond laser with DLA | 8 mm spot, fluence of 0.4 J/cm2, 750 ps, 10 Hz pulse repetition for three treatments at 1- to 2‐month intervals | III | 1 | At the 3-year follow-up, the PIH lesions had 50–75% improvement | Deepening of local skin lesions | [4] |
Facial pores | Picosecond 1064-nm laser with MLA | 8 mm spot, 0.8 J/cm2, 10 Hz for one session | III–IV | 59 | Compared to baseline, the number of enlarge pores decreased by 15.13%, while the diameter of face pores did not alter much | Mild erythema and folliculitis | [29] |
1064‐nm picosecond laser with MLA | 8 mm spot, fluence of 0.8 J/cm2, 5 Hz pulse repetition for three treatments at 4‐week intervals | III–IV III (n = 19) IV (n = 6) | 25 | Pore volumes had a significant reduction, with average pore size had shrunk by 30% at 6-month follow-up | Moderate erythema,mild‐to‐moderate swelling, acneiform eruptions | [30] | |
Atrophic acne scars | 755 nm alexandrite picosecond laser with DLA | fluence of 0.71 J/cm2, 6 mm spot, 750 ps pulse width, repetition rate of 5 Hz for 6 sessions at 4 to 8 weeks intervals | I–V I (n = 1) II (n = 7); III (n = 6); IV (n = 3) | 20 (17 patients completed) | Patients were satisfied with overall appearance and texture. scar volume improved 24.3% at the sixth treatment session | Transient erythema and edema | [15] |
755 nm alexandrite picosecond laser with DLA | 6 mm spot, fluence of 0.57 J/cm2, 750 ps pulse duration, 10 Hz repetition rate for 5 treatments at 4-week intervals. standard half face treatment: an average of 3301 + / − 155 pulses, the other half of face: an average of 5867 + / − 500 pulses | II-IV | 3 | Two treated sides had no significant difference. The standard pulse side had good to excellent improvement, and the high pulse side had very good to excellent improvement | Mild transient PIH, erythema, and edema | [25] | |
755-nm diffractive lens picosecond laser | Different sessions according to the patient’s condition | Not mentioned | 3 | Two cases improved > 75%, one improved 50–75% in skin texture | No | [31] | |
755 nm alexandrite picosecond laser with DLA | 6 mm spot, fluence of 0.71 J/cm2, 5‐Hz pulse repetition, and 750 ps pulse duration for 3 sessions at 4‐ to 6‐week intervals | III–IV III (n = 5); IV (n = 15) | 20 | After three picosecond laser treatments, the texture of acne scars and post-inflammatory erythema greatly improved | Transient and mild erythema, edema, and scabbing | [32] | |
1064 nm picosecond laser with MLA | Fluence of 1.0 J/cm2, 8 mm spot, repetition rate of 10 Hz for 6 treatments at 1-month intervals | III–IV | 26 | Skin surface roughness and scar showed significant improvement | Mild‐to‐moderate erythema and swelling; transient PIH | [33] | |
Picosecond 1064-nm laser with MLA | 8 mm spot, 0.8 J/cm2, 10 Hz for one treatment | III–IV | 59 | Compared to baseline, acne scar volume reduced significantly | Mild erythema and folliculitis | [29] | |
Striae distensae | 1064 nm picosecond laser and MLA | Fluence of 0.6 J/cm2, 8 mm spot, 750 ps pulse width, repetition rate of 10 Hz for 4 sessions at 4-week intervals | IV–V | 20 | Significant improvement in the skin texture; 6 patients improved 51–75%, and 12 patients improved 25–50% in striae with the 6-month follow-up | Transient PIH in two patients | [34] |
Histological characteristics and mechanisms
Skin rejuvenation
Wrinkles
Dyspigmentation disorders
Enlarged facial pores
Treatment for atrophic skin lesions
Atrophic acne scars
Striae distensae
Comparison of picosecond laser with other laser treatments
Disease | Laser | Therapy parameters | Fitzpatrick scale | Number of cases | Clinical outcome | Adverse events | Reference |
---|---|---|---|---|---|---|---|
Melasma | 755‐nm picosecond laser with DLA and with a fullbeam | Coupled with a DLA on one side of the face and without DLA (flat optics) on the other side: 8‐mm spot, fluence of 0.40 J/cm2, 2.5 Hz for five treatments at 1‐month intervals | IV–V | 18 (14 patients completed) | All patients had significant improvement in pigment clearance without significant differences in different treatment sides | Mild PIH and erythema | [36] |
Acne scar | NAFL and P-DOE | P-DOE side: a 450-ps pulse duration, 2-dimensional 10 × 10 mm2 array of pulses, fluence of 130–430 mJ/cm2, 5–10 Hz, 10-mm spot size the NAFL side: 25–35 J/cm2 at level 4–6 over four to eight passes | III–IV III (n = 12); IV (n = 13) | 25 | P-DOE provides better clinical results, fewer side effects, and more improvements at the follow-up visit | Erythema, oedema, dryness; mild hyperpigmentation only on the NAFL side | [37] |
Acne scar | The fractional Nd:YAG 1064-nm picosecond laser with FLA and fractional 1550-nm erbium fiber | The fractional Nd:YAG 1064-nm picosecond laser with FLA: spot size of 8 mm, fluence of 0.3–0.4 J, and frequency of 10 Hz for one pass; the fractional 1550-nm erbium fiber laser: 100–400 spots/cm2, energy of 25–30 J/cm2 for two passes total four times at 4-week intervals | III–IV III (n = 27); IV (n = 3) | 30 (27 patients completed) | Median scores of both devices were significantly improved from baseline, and no significant difference between the two devices | Erythema, hyperpigmentation, pinpoint bleeding, pain | [38] |
Acne scar | FxCO2 and FxPico | FxPico:8 mm spot size, a fluence of 0.8 J/cm2, 5 Hz repetitive rate; FxCO2: 3 ms pulse duration, a power of 10 W, depth of penetration about 350 to 400 mm | III–V | 25 | Both devices caused significant reduction in the scar volume without significant difference between them | Scarring, persistent erythema; PIH was only present in FxCO2 sides | [39] |
Combinations of picosecond laser with other treatments
Combination treatment for facial rejuvenation
Combination treatments for benign pigmented lesions
Combination treatments for scars
Conclusion
Disease | Laser | Therapy parameters | Fitzpatrick scale | Number of cases | Clinical outcome | Adverse events | Reference |
---|---|---|---|---|---|---|---|
Facial rejuvenation | 755-nm picosecond laser with DLA and botulinum toxin | Botulinum toxin: mean total units per treatment was 39.5 units | I–V I (n = 75); II (n = 76); III (n = 45); IV (n = 11); V (n = 1) | 208 | Combined therapy improved efficacy and introduce synergistic effects | No adverse events recorded | [40] |
755 nm picosecond laser with DLA and 1060 nm laser lipolysis | 755-nm picosecond laser with DLA: fluence of 0.71 J/cm2, 6 mm spot size for 3 Laser treatments and 2 lipolysis treatments at 2- to 8-week intervals | II–VI | 11 | Neck laxity improved in all subjects from baseline | Transient pain, nodule formation, dyspigmentation, tenderness, edema, roughness, and blister formation | [41] | |
Facial fillers and 755-nm picosecond laser with DLA | Soft tissue fillers; picosecond 755-nm alexandrite laser with DLA: the mean was 3,730.2 pulses | I–IV I (n = 71), II (n = 64), III (n = 38),IV (n = 10) | 183 | Single-session facial fillers and 755-nm picosecond laser with DLA was safe | No adverse events recorded | [42] | |
Melasma | Fractional picosecond 1064-nm laser and 4% hydroquinone | Fractional picosecond 1064-nm laser: fluence of 1.3–1.5 mJ per microbeam, pulse duration 450 ps, 4 Hz; daily application of 4% hydroquinone | III–IV III (n = 5), IV (n = 25) | 30 | The intervention side considerably reduced the melasma area severity index scores than 4% hydroquinone cream alone | Mild erythema,skin desquamation and burning sensation | [43] |
Tattoo | Fractionated 1064-nm picosecond lasers and unfractional 1064-nm picosecond lase | The 1064-nm picosecond laser: fluence of 1.5–7.24 J/cm2; spot size: 3–4.5 mm, 2- 5 Hz; fractionated 1064-nm picosecond lasers: fluence of 0.8 J/cm2; spot size: 8 mm, 2–5 Hz | III–V III–IV (n = 8) V (n = 3) | 11 | The combination side showed greater clearance scores and fewer adverse events than the side of unfractional 1064-nm picosecond laser alone | Temporary crusting, purpura, edema, erythema, burning, sensation, and petechiae | [44] |
Acne scars | 1064-nm MLA‐type picosecond lasers and HAF | Each scar was filled with 0.01–0.1 ml of HAF and MLA handpiece: 6 mm spot, fluence of 1.4 J/cm2, 5 Hz frequency; 450 ps pulse duration for two treatments at 4‐week intervals | III–IV | 36 | Acne scars improved significantly | Temporary pain, instant erythema, and flushing | [45] |
FxPico and IPL | FxPico: 6 mm spot size, energy of 1.5–2.5 mJ/microbeam, 3–4 passes IPL: 560- or 590-nm filter, pulse width of 3.5–4.0 ms, fluence of 15–19 J/cm2, 1 pass One half of the face treated by FxPico + IPL, and the other by IPL alone for five sessions of treatment | III–IV III (n = 13); IV (n = 2) | 17 (15 patients completed) | More pore count reduction and scar improvement were observed on the FxPico + IPL side | Mild‐to‐moderate pain, erythema, edema, petechiae, crusting, pruritus, and acneiform eruptions, | [46] | |
Full-thickness laceration scar | 1064-nm Nd:YAG laser with MLA and polynucleotide gel | 1064-nm Nd:YAG laser with MLA at fluence of 0.7 J/cm2, and then 20 mg/mL polynucleotide gel was injected | Not mentioned | 1 | Significant clinical improvement | pruritus | [47] |