Since its inception in 1997, Lutronic Global (Boston, Massachusetts, U.S.), has been striving to facilitate the goals of its physician partners who labor to deliver exceptional outcomes to their patients. Lutronic’s focus on developing smarter energy-based medical technologies that benefit physicians and patients worldwide has been unwavering.
Beginning with FDA approval for its Spectra-VRM device in 2000, and now featuring frontline technologies such as PicoPlus, eCO2 and LaseMD, among others, Lutronic has become a global leader in the aesthetic space.
The latest addition to Lutronic’s family of intelligent energy-based skin treatment devices is PicoPlus, the cutting-edge picosecond/nanosecond laser known for its dual pulse duration and high power. PicoPlus offers wide-ranging, but precise fluence control, making it versatile enough to blast deep tattoo pigment, gently dissolve low-contrast pigmentation, such as melasma with minimal risk of post-inflammatory hyperpigmentation (PIH), and yield excellent skin rejuvenation results with extremely low discomfort or downtime. This robust and ergonomically-designed platform is also reliable and easy to use.
“For me, it is about high power and dramatically reduced thermal impact,” said Laurence Imhof, M.D., of the department of dermatology and director of the laser unit at University Hospital Zurich (Zurich, Switzerland).
“This is safer and more ethical to use because it is less injurious – with a better side effect profile – and more comfortable for the patient during and after treatment,” Dr. Imhof continued. “Compared to fractional CO2 lasers and other non-ablative lasers, such as IPL for skin rejuvenation, downtime is significantly lower. Increased power also means that you can treat using larger spot sizes for faster treatments.”
According to Zena Gabriel, M.D., dermatologist and founder of Zena Medical in Newport Beach, California, U.S., “When you think lasers, you think in terms of three parameters: wavelength, pulse width and fluence. By shortening the pulse duration to the picosecond level, you achieve a paradigm shift from the principal of selective photothermolysis, which aesthetic skin revision has been based on for decades. The concept is to harness the photoacoustic effect for more efficacious treatments on difficult-to-clear pigment.”
Laser energy, used in this way, creates what has been termed Laser-Induced Optical Breakdown (LIOB), a purely photomechanical trauma that occurs beneath the surface and does not disrupt barrier function.
As laser energy passes through the skin, it causes acoustic stress as a microburst of plasma is created. There is explosive expansion as the resultant plasma absorbs any remaining laser energy, creating a cavitation bubble beneath the surface, as well as a shockwave that provides additional localized acoustic trauma. This initiates a wound response with resultant inflammation and activation of fibroblasts.
“This causes stimulation of collagen production and shatters pigment particles, which are removed by the body over time,” Dr. Imhof explained. At lower energies, a more diffuse effect without LIOB formation is induced, which may be more effective for skin rejuvenation.
Dr. Gabriel agreed. “Picosecond lasers completely destroy pigment in low-contrast lesions such as light brown spots and difficult-to-resolve small particle tattoos – which long-pulse lasers have trouble with. And in darker skin, because you’re not going for a photothermal effect, you have a significantly reduced chance of PIH,” she stated.
“In other words, if you are treating something like melasma, you are careful not to make it worse, which can happen if you are not using the right tool for the job,” Dr. Gabriel continued. “PicoPlus , at low energies, is the safest option for dabbling in what otherwise seems like dangerous territory, because it is gentle and non-thermal, but also causes a significant effect on pigment and collagen.”
In Dr. Imhof’s opinion, what separates PicoPlus from other picosecond laser platforms are the shorter pulse widths, sufficient power with multiple available wavelengths and precision of parameter adjustment. “There is a great deal of control when you use PicoPlus,” she said.
“High power means more energy delivered in shorter pulses, which is important because at this pulse duration the beam tends to be less stable. Thus, power is very important, especially considering spot size,” Dr. Gabriel elaborated.
“For any given spot size the energy delivered by PicoPlus will be greater than that of another device because of the high peak power. And it will be more stable, so you have a greater effective range of fluences. Where one device may have a minimum effective fluence of 1.0 J/cm2, PicoPlus could go as low as 0.2 J/cm2 because the beam is more stable,” said Dr. Gabriel.
“This is incredibly important when dealing with diffuse low-contrast lesions, something like melasma, where you want to start conservatively,” she added. “If you are dealing with solar lentigines on the face of an Asian patient, you need high performance at the lower end of the fluence spectrum.”
PicoPlus comes with five handpieces. The Zoom and Pico Toning Collimated handpieces can be used with its 1064 nm and 532 nm wavelengths, and three specialty handpieces, which include Gold Toning (595 nm), RuVY Touch (660 nm) and the new Dual Focused Dots (1064 and 532 nm).
“The new dual focused dots handpiece is optimized specifically for creating LIOBs, with three-step adjustable microbeam focus depth and scan size adjustable between 4 mm and 10 mm, in 1 mm steps,” Dr. Gabriel shared. This is just another way Lutronic innovation improves on existing modalities and therapies.
Dr. Imhof most commonly uses PicoPlus for tattoos and pigmentary issues such as melasma, as well as for skin rejuvenation when patients present with mild-to-moderate pigmentation and wrinkling.
“I use PicoPlus when the rejuvenation patient has some age spots and small wrinkles,” she expressed. “Treatment provides a refreshing effect for skin as well. This device is especially helpful for treating darker-skinned patients because the mechanism of action is non-thermal, so you have less concern about the higher concentrations of melanin versus using a traditional nanosecond laser.”