PicoWay®: High Peak Power and Shortest Pulse Durations for Efficacy and Comfort

The PicoWay picosecond laser is an excellent system for a busy aesthetic practice. PicoWay is FDA-cleared for several conditions, including benign pigmented lesions and tattoo removal, as well as acne scars and wrinkles with the PicoWay Resolve handpieces. PicoWay treatments are typically quick to administer and require little patient follow-up due to the minimal downtime following treatment.

Figure 1. Two treatments with the 532nm handpiece, 2mm spot, 1.7 J/cm2 treatment of brown spots (lentigines and macular seborrheic keratosis) on face.

Figure 2. Three treatments with the 1064nm handpiece, 8mm. Treatment of diffuse facial pigmentation (melasma and post-inflammatory pigmentation).

The PicoWay system uses high pulse energy with extremely short durations, in the range of 300-450 picoseconds, creating a photoacoustic approach that avoids skin overheating, minimizing side effects.

The versatile device is capable of operation at three picosecond wavelengths of 1064nm, 785nm, and 532nm. Repetition rates range up to 10Hz with a broad range of spot sizes from 2-10mm in diameter.

PicoWay is equipped with multiple handpieces for tailored treatments of conditions and patients. The three wavelengths allow physicians to treat a wide range of tattoo colors and types. PicoWay was the first in the aesthetic market to offer the 785nm wavelength, utilizing a titanium sapphire laser, for removal of resistant blue and green tattoos.

Figure 3. Tattoo removal with PicoWay Zoom 1064nm, 5mm, 90J, one pass and post four treatments.
Photos courtesy of Todd Howen, MD

The PicoWay Resolve handpieces use beam-splitter technology to create LIOBs (Laser Induced Optical Breakdown). Laser irradiation is selectively absorbed with minimal effect on the surrounding tissue. This creates miniscule voids in the skin while leaving the top layer of the epidermis intact, resulting in efficacious treatment that improves the appearance of acne scars and wrinkles across a wide range of skin types with minimal downtime.

The PicoWay's ease of use and the versatility of its handpieces and wavelengths are reasons why I chose this system for my practice.

PicoWay in Practice

I've been using PicoWay and PicoWay Resolve for several months, primarily for tattoos and patchy or lentiginous hyperpigmentation. PicoWay has offered excellent results for patients in my practice for the treatment of lentigines, macular seborrheic keratosis, melasma, and post-inflammatory pigmentation. (See Figures) I've found the wavelengths on the PicoWay complement the brownish color of the targeted facial lesions of these conditions.

Figure 4. Before and seven weeks post two treatments.
Photos courtesy of David Freedman, MD

Treatments are typically fast—five to 10 minutes—a positive for patients and treating physicians. Usually two to four treatments are needed at intervals of about four weeks. Patients should be told that their results will continue to improve for a few months after the last treatment.

Treatments are also comfortable with little to no downtime, which is a benefit for patients. Patients may experience some puffiness and some tiny red marks or petechiae. But this is not a bad thing—it is evidence that the laser is making injuries in the dermis—tiny, tiny injuries—which is a nice endpoint to look for as a treating physician to know the treatment is working.

Post-treatment, I do typically have patients apply a mild potency topical steroid after the treatment to suppress any treatment erythema and minimize the possibility of post-inflammatory hyperpigmentation, especially in darker skin patients.