Many patients walk into the clinic specifically asking for the Pico laser to treat their pigmentation—largely influenced by its aggressive marketing and widespread brand recognition. While the technology behind Pico lasers is proven, the reality is that it may not always be the most clinically appropriate choice depending on the type, depth, and cause of pigmentation.
Pigmentation is one of the most common skin concerns, particularly in Asia, where an even, radiant complexion is often associated with beauty and desirability. To address it effectively, we must first understand what pigmentation truly is—its underlying causes, how it develops, and why it varies from person to person. More importantly, can pigmentation be completely removed with treatment? Here’s a deep dive into what really works, what doesn’t, and why a personalised approach matters.
Melanocytes are located between the epidermis and dermis layer (i.e. the first and second layer of our skin). Some of these melanosomes are transferred to skin cells called keratinocytes. The transfer of melanosomes, and therefore melanin, to the different layers of the skin will determine the type of pigmentation you have, and which pigmentation removal treatment in Singapore will be most effective for you.
In general, there are two main categories of pigmentation: epidermal (first layer of the skin) and dermal (second layer) pigmentation. From a layman’s perspective, we can identify most of them by the naked eye upon close-up examination.
Epidermal pigmentations are usually more distinct, darker in colour, and the borders/edges of the spots are defined and can be seen clearly.
We can further classify epidermal pigmentation as superficial epidermal pigments (on the surface of the skin) and intraepidermal pigments (inside the first layer of the skin). This is because treatments for these two types are different.
Dermal pigmentations (deeper) usually appear as slightly blurry, hazy patches on the skin. This type of colouration is typically lighter, and the borders/edges of the spots are less clear than epidermal pigmentation.
At Mizu, we also utilise a computerised software with the VISIA machine to identify the type of spots and the depth of the pigmentation in the skin. This allows the doctor to further confirm the diagnosis and choose the most appropriate treatment for different conditions, as well as to monitor progress over subsequent visits.
Most pigmentation can be effectively treated with a combination of topical creams and laser treatments, and sometimes oral medication. The most important part is to prevent them from returning and to prevent any undesired side effects. Identifying the type of spot you have is the most crucial step in the pigmentation removal and treatment process, as it determines the type of medication, creams, and lasers that will be effective for you.
Topical Creams
The most common topical cream we prescribe at Mizu for pigmentation removal is a custom-formulated Hydroquinone-based cream.
Hydroquinone is a mainstay in skin pigmentation treatment and it works by blocking the production of melanin in the skin. Hydroquinone is known by some as a ‘bleaching cream’. It may sound scary, but on the contrary, it does not bleach the skin and also does not remove pigmentation. Instead, hydroquinone lightens it by reducing the amount of pigments (melanin) being produced by the skin.
For some conditions, especially epidermal pigmentations, it may be recommended to start on a course of hydroquinone for 2-4 weeks before any laser treatments, as this can help to decrease the chances of any spots reoccurring. Hydroquinone as a stand-alone treatment may not remove pigmentation as effectively as a combination treatment. Hydroquinone is usually used for 3-6 months, and no more than that, as it may cause side effects.
A steroid cream is also sometimes used in conjunction with laser treatments. This is used to prevent Post-inflammatory Hyperpigmentation (PIH) which can happen with some laser treatments when there is scabbing of the skin involved. A steroid cream is usually used for 1 week post-laser treatments.
Laser Treatments
In recent years, the quickest and most effective way to treat and remove pigmentation is by laser treatments. Laser technologies are constantly evolving, but that doesn’t mean that older technologies are no longer as effective. We have several types of laser machines in Mizu that we use for different types of spots. They are the Pico laser, Yellow laser, Ruby laser, and the Q-switched laser.
I started my career doing plenty of lasers and learning their quirks and capabilities – and over time, I chose these four stalwarts to maximise the efficacies of my treatment. As a trainer for the Pico, Ruby and Yellow lasers, I selected the different lasers according to the different pigmentation conditions and the depths the lasers can reach. Sometimes, I incorporate different lasers for a course of treatment, as both epidermal and dermal pigmentations can both be present simultaneously.
The reason for choosing the different laser types is because they provide different wavelengths of laser energy to target the different pigmentation situated in the various skin layers.
At 1064nm wavelength, the Q-switched laser is most suited to target dermal pigmentations. The Q-switched laser has been a mainstay in the aesthetics industry for many years. At Mizu, the Q-switched laser is still frequently used as it helps to rejuvenate the skin (with heat energy) while removing pigmentation at the same time. The Q-switched laser is effective in reducing brown acne marks as it not only fades pigments, it also treats and reduces acne and pore size. Read more about the Q-switched laser here.
As a maintenance treatment, the Q-switched laser is also often used to prevent pigmentation from reappearing after treatment.
At 577nm wavelength, the Yellow laser is particularly useful for epidermal pigmentation such as superficial freckles, some sun spots, age spots, and stubborn conditions such as vascular melasma. Vascular melasma is a multi-layer pigmentation condition that results from an increase in blood vessels under the skin. These blood vessels are reduced with the Yellow laser which, in turn, reduces pigmentation.
Like the Q-switched laser, the Yellow laser is versatile. It can be used for a variety of conditions such as melasma, sun/age spots, freckles, facial flushing, acne, post-acne redness, skin rejuvenation and brightening. The Yellow laser’s energy is absorbed by both pigmentation and the underlying blood vessels. This results in the breakdown of pigmentation and at the same time, reduces the blood supply to the skin cells that produce these pigments. Not only is this an effective pigmentation removal treatment in Singapore, but it also prevents these skin cells from producing pigments and ensures longer-lasting results.
The Pico comes in 3 different wavelengths – 532nm, 1064nm and 694nm wavelength. Each wavelength is used to target different pigmentations at different layers of the skin, therefore removing pigmentation effectively and quickly. It is also often used for tattoo removal.
Pico-second is a measure of time. 1000 pico-seconds = 1 nano-second. The pico laser delivers ultrashort picosecond pulses, compared to the longer nanosecond pulses. The pulse duration (how much time one laser shot stays on the skin) of a picosecond laser is 100 times shorter, allowing more shots to be delivered in the same amount of time. This means the skin heats up less, which may reduce the risk of hyperpigmentation sometimes associated with laser procedures.
The Ruby laser, at 694nm wavelength, is used to treat epidermal pigmentation, such as freckles, sun spots, lentigos, and age spots, as well as some dermal pigmentation such as melasma.
Clinical studies suggest that pigmented lesions in Asian skin should be treated with high energy densities, making the ruby laser a suitable treatment. The ruby laser can effectively reduce pigmentation with fewer side effects due to its high absorption rate by melanin and low absorption rate by other skin components.
As one of the few clinics in Singapore to have a ruby laser, I have developed specific settings for the ruby laser, combined with components from the pico laser, unique to Mizu for treating specific pigmentation conditions.
Maintenance, Prevention and Oral Medication (occasionally)
Sunscreen is a crucial step before and after laser treatments. Although non-ablative lasers do not thin the skin, the skin can be more susceptible to sun damage for 1-2 weeks after a laser treatment. It is advised that adequate sun protection is observed before and after a laser treatment.
Sometimes, oral medication such as tranexamic acid can be prescribed for certain conditions. Tranexamic acid helps reduce hypervascularity (blood vessels) and also blocks the production of melanin. A good skincare routine should also be observed.
Lasers utilise either photo-acoustic energy (pico laser) or photo-thermal energy (q-switched, yellow laser, ruby laser, etc.) to break the pigmentation in the skin into smaller fragments which are cleared off by the skin's immune system.
Another common question I always get from patients is "Will there be scabbing and can my pigmentation be burnt off?", thinking that they will have to take time off for treatment. The answer is, you don’t need to!
The downtime for non-ablative lasers is very minimal.
Scabbing usually occurs only when there is damage to the skin. Technically, in order to reduce side-effects, the laser should be administered in a way that there is minimal scabbing and slight darkening of the pigmentation. This darkening will fade over the next 1-2 weeks. Scabbing is not encouraged as it might result in hyperpigmentation (more pigments), especially for dermal pigmentations on Asian skin.
Only a few conditions are suitable for scabbing; such as superficial freckles, solar lentigos (age/sun spots), and some skin tags.
Not all pigmentation can be removed completely. Certain superficial ones can be completely removed, but others, such as melasma or other dermal pigmentation usually only get reduced by 70-90%.
The most important thing to note about pigmentation removal treatment is to properly identify the type of pigment(s) and choose an appropriate laser with the right settings. In experienced hands, most pigmentation conditions can be treated very effectively without undesirable side effects.
Typically, the interval between each pigmentation removal treatment is about 3-4 weeks. Depending on the type of pigmentation, a longer interval might be required if a strong laser setting is used. It usually takes between 2-8 sessions of laser treatments to significantly reduce pigmentation, depending on the condition. After pigmentation reduction, a laser treatment once every few months would be beneficial to maintain the results and reduce any surfacing pigmentation.
Some pigmentation may seem to “come back” after treatment. However, with good sun protection and proper skin care, these can take years to resurface. Adequate sun protection also ensures that new pigments do not form.
New spots can surface due to existing melanocytes that are not destroyed by the laser as they are part of the skin structure. These melanocytes can produce pigmentation when triggered by factors such as damage from the sun, hormonal changes (such as during pregnancy and menopause), or even stress.
After treating your pigmentation, the occasional laser treatment can also help prevent new spots from forming. Maintenance laser treatments can remove it before it resurfaces on the skin.
However, with time, the effects of hormones, ageing skin, and accumulated sun damage can still result in some spots forming.
Contrary to common myths, a pigmentation removal laser WILL NOT thin the skin. In fact, these lasers help rejuvenate the skin and stimulate collagen production to some extent.
However, pigmentation laser treatments do temporarily render the skin more sensitive to sun damage. Prolonged sun exposure should be avoided 1 week before and at least 1 week after treatment to prevent hyperpigmentation from occurring.
Hyperpigmentation (darkening of the pigments) can also occur if unsuitable laser settings are used. Therefore, identifying what type of pigmentation you have and treating it with the right laser and settings is crucial in getting good results, as well as preventing unwanted side effects.
The good news is that hyperpigmentation usually resolves by itself. However, it can take a very long time, from 2 months to 1 year in some cases. Fortunately, this can usually be hastened with the help of topical creams such as hydroquinone or arbutin-containing skincare products. A laser treatment with a slightly lower power setting can also help reduce hyperpigmentation over time.
The best way to treat hyperpigmentation is to avoid it. Therefore, measures to prevent hyperpigmentation such as using topical creams before laser treatments are very important. Not all pigmentation is alike, and not all laser treatments are suitable for just any kind of spots or marks. Avoid hyperpigmentation by also making sure your condition is properly identified by your doctor to ensure the right laser and treatment is used for you.
As a regional trainer for the Pico, Ruby and Yellow lasers, Dr YZ Tan has met and trained many doctors in the use of these lasers, as well as done over 30,000 laser treatments (and counting) over the span of his career.
Having treated various types of pigmentation issues, he has harnessed the capabilities of the lasers and is continuously improving and fine-tuning his laser treatments in search of the best way to remove pigmentation. Most of the patients he meets for the first time have the same common misconception about lasers, which is how this post came about!
Expect a personalised experience, with settings adjusted to exactly what your skin requires to be clearer, radiant and glowing.
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