PicoSure Pro

Sun spots (solar lentigines) are focal, sun-induced collections of pigment. They sit in the upper skin, which makes them the most laser-responsive pigment there is. Picosecond lasers clear most spots in one to three sessions, with less downtime and less post-inflammatory darkening than older nanosecond lasers, particularly in Asian skin.

The key is diagnosis. Sun spots often sit alongside melasma, seborrhoeic keratoses (age warts) and freckles. They look similar and behave differently. Treating melasma as if it were a sun spot is one of the most common mistakes I see.

Negishi K, Akita H, Matsunaga Y. Prospective study of removing solar lentigines in Asians using a novel dual-wavelength and dual-pulse width picosecond laser. Lasers Surg Med 2018;50(8):851–858.

Vachiramon V, Iamsumang W, Triyangkulsri K. Q-switched double frequency Nd:YAG 532-nm nanosecond laser vs. double frequency Nd:YAG 532-nm picosecond laser for the treatment of solar lentigines in Asians. Lasers Med Sci 2018;33(9):1941–1947.

Guss L, Goldman MP, Wu DC. Picosecond 532 nm neodymium-doped yttrium aluminium garnet laser for the treatment of solar lentigines in darker skin types: safety and efficacy. Dermatol Surg 2017;43(3):456–459.

Melasma is a chronic pigment condition driven by hormones, light and genetics. Heat is one of its triggers, which is why IPL and aggressive heat-based lasers so often make it worse. A low-energy picosecond laser breaks up pigment with very little heat, and is my workhorse for melasma: around four sessions, no downtime, and 80–85% clearance when protection and topicals are in place.

The laser accelerates clearance. It does not cure the tendency. Most melasma returns when sun protection and maintenance stop, so the laser sits in the middle of a staged plan, never at the start of it.

Lee YJ, Shin HJ, Noh TK, Choi KH, Chang SE. Treatment of melasma and post-inflammatory hyperpigmentation by a picosecond 755-nm alexandrite laser in Asian patients. Ann Dermatol 2017;29(6):779–781.

Chalermchai T, Rummaneethorn P. Effects of a fractional picosecond 1,064 nm laser for the treatment of dermal and mixed type melasma. J Cosmet Laser Ther 2018;20(3):134–139.

Hang X, Lim DS. Hypopigmentation following picosecond laser treatment for melasma: a case series. Lasers Surg Med 2025;57:777–787.

Chan NPY, Ho SGY, Shek SYN, Yeung CK, Chan HH. A case series of facial depigmentation associated with low fluence Q-switched 1,064 nm Nd:YAG laser for skin rejuvenation and melasma. Lasers Surg Med 2010;42(8):712–719.

Post-inflammatory hyperpigmentation (PIH) is the brown mark left behind by acne, eczema, injury or a previous procedure. Most PIH fades on its own with sun protection and pigment inhibitors, but slowly, often over six to twelve months.

A picosecond laser can shorten that time. Because it relies on pressure rather than heat, it is far less likely than older lasers to re-inflame the skin and deepen the pigment it is meant to treat. Re-injury, including over-enthusiastic treatment, is what keeps PIH going.

Lee YJ, Shin HJ, Noh TK, Choi KH, Chang SE. Treatment of melasma and post-inflammatory hyperpigmentation by a picosecond 755-nm alexandrite laser in Asian patients. Ann Dermatol 2017;29(6):779–781.

Kim S, Cho KH. Treatment of facial postinflammatory hyperpigmentation with facial acne in Asian patients using a Q-switched neodymium-doped yttrium aluminum garnet laser. Dermatol Surg 2010;36(9):1374–1380.

Wu DC, Goldman MP, Wat H, Chan HHL. A systematic review of picosecond laser in dermatology: evidence and recommendations. Lasers Surg Med 2021;53(1):9–49.

In Asian, South Asian, Middle Eastern, African and olive skin, pigment cells react quickly to heat and injury. That is why the wrong laser so often leaves darker skin worse than it started. Picosecond lasers deliver their energy in a fraction of the time, with far less heat, and studies in Fitzpatrick skin types IV to VI show a favourable safety profile.

Safety still depends on the operator. Settings, spacing between sessions and skin preparation matter more than the machine. Most problems I see in darker skin come from treating too hard, too often, without preparation.

Levin MK, Ng E, Bae YS, Brauer JA, Geronemus RG. Treatment of pigmentary disorders in patients with skin of color with a novel 755 nm picosecond, Q-switched ruby, and Q-switched Nd:YAG nanosecond lasers. J Cosmet Laser Ther 2016;18(1):20–24.

Haimovic A, Brauer JA, Bae YS, Geronemus RG. Safety of a picosecond laser with diffractive lens array (DLA) in the treatment of Fitzpatrick skin types IV to VI: a retrospective review. J Am Acad Dermatol 2016;74(5):931–936.

Wu DC, Goldman MP, Wat H, Chan HHL. A systematic review of picosecond laser in dermatology: evidence and recommendations. Lasers Surg Med 2021;53(1):9–49.

"Dark circles" is a description, not a diagnosis. Under that one complaint sit pigment, blood vessels, allergy and rubbing, genetics and tear-trough shadowing, often several at once. A pigment laser only helps the pigment.

Inflammatory pigment around the eyes, from eczema, allergy or rubbing, responds well, with marked improvement over six to twelve months. Genetic (constitutional) pigment is honest bad news: only 10–15% respond to picosecond laser, typically over four to six sessions.

Sarkar R, Ranjan R, Garg S, Garg VK, Sonthalia S, Bansal S. Periorbital hyperpigmentation: a comprehensive review. J Clin Aesthet Dermatol 2016;9(1):49–55.

Vrcek I, Ozgur O, Nakra T. Infraorbital dark circles: a review of the pathogenesis, evaluation and treatment. J Cutan Aesthet Surg 2016;9(2):65–72.

Wu DC, Goldman MP, Wat H, Chan HHL. A systematic review of picosecond laser in dermatology: evidence and recommendations. Lasers Surg Med 2021;53(1):9–49.

Pigmented birthmarks, including café-au-lait macules, naevus of Ota and Becker naevus, are made of pigment and need short-pulse pigment lasers. Picosecond lasers clear naevus of Ota in fewer sessions than older Q-switched lasers, and are effective for many café-au-lait macules.

The numbers deserve to be said out loud. Around 80% of café-au-lait-type lesions respond to short-pulse lasers, and 20% do not, even with the best technology. Some recur after clearing. Lesions with sharp, well-defined borders tend to respond better than those with jagged edges.

Belkin DA, Neckman JP, Jeon H, Friedman P, Geronemus RG. Response to laser treatment of café au lait macules based on morphologic features. JAMA Dermatol 2017;153(11):1158–1161.

Artzi O, Mehrabi JN, Koren A, Niv R, Lapidoth M, Levi A. Picosecond 532-nm neodymium-doped yttrium aluminium garnet laser: a novel and promising modality for the treatment of café-au-lait macules. Lasers Med Sci 2018;33(4):693–697.

Ge Y, Yang Y, Guo L, et al. Comparison of a picosecond alexandrite laser versus a Q-switched alexandrite laser for the treatment of nevus of Ota: a randomized, split-lesion, controlled trial. J Am Acad Dermatol 2020;83(2):397–403.

Iron staining (haemosiderin) is the brown-orange discolouration left after bruising, sclerotherapy for leg veins, filler bruising or chronic leg swelling. It is iron from red blood cells, deposited in the skin, and it can persist for months to years.

Short-pulse lasers break up these deposits so the body can clear them. Evidence comes mainly from case series with Q-switched and picosecond lasers. Results are real but gradual, and staining from ongoing vein disease will keep returning unless the cause is treated.

Tafazzoli A, Rostan EF, Goldman MP. Q-switched ruby laser treatment for postsclerotherapy hyperpigmentation. Dermatol Surg 2000;26(7):653–656.

Wu DC, Goldman MP, Wat H, Chan HHL. A systematic review of picosecond laser in dermatology: evidence and recommendations. Lasers Surg Med 2021;53(1):9–49.

There is published evidence for picosecond lasers with a focusing or diffractive lens in acne scarring. Studies show modest improvement in shallow rolling and boxcar scars, with little downtime and a good safety record in darker skin.

In my practice, it sits at the end of the list for scars. The improvement is real but small, and it does little for tethered, deep boxcar or ice-pick scars. Those need procedures that work at the level of the scar: subcision, TCA CROSS, punch techniques and resurfacing. I use PicoSure Pro for scars mainly where brown marks and fine texture sit alongside them, or where downtime is not possible.

Brauer JA, Kazlouskaya V, Alabdulrazzaq H, 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.

Dierickx C. Using normal and high pulse coverage with picosecond laser treatment of wrinkles and acne scarring: long term clinical observations. Lasers Surg Med 2018;50(1):51–55.

Kwon HH, Yang SH, Cho YJ, et al. Comparison of a 1064-nm neodymium-doped yttrium aluminum garnet picosecond laser using a diffractive optical element vs. a nonablative 1550-nm erbium-glass laser for the treatment of facial acne scarring in Asian patients: a 17-week prospective, randomized, split-face, controlled trial. J Eur Acad Dermatol Venereol 2020;34(12):2907–2913.