• #2-2. 1064nm Q-switched Nd:YAG Laser Toning


    ▶ Previous Artlcle: http://2-1-1064nm-q-switched-ndyag-laser-toning


    As we have discussed in the previous issue, the SPTL concept is no longer theoretically viable, at least in the field of pigment removal. For safe and effective pigment removal procedures, a toning laser with 532nm and 10~20Hz, not 1064nm, would be appropriate as a standard. I do not understand why the manufacturer chose 1064nm rather than the much safer 532nm with fewer side effects even in Caucasians.


    As we now have sufficient clinical knowhow of Korean aesthetic clinicians who have been performingmany laser toning procedures in the past decade, I felt it would help to take an in-depth look at laser toning to answer some of the following questions.


    Why should laser toning use large spot size?


    As clinicians are more familiar with the efficacy, side effects and complications of laser toning, let us briefly cover the basics of laser toning.


    Efficacy of laser toning: removal of pigmented lesions such as melasma


    Side effects of laser toning: worsening of melasma


    Complications of laser toning: hypopigmentation, hyperpigmentation


    [Ad. ▶Aileen(Nd:YAG) - Manufacturer: FineMEC(www.finemec.net)

    [Ad. ▶ COPPER BROMID(Yellow/Green Laser) – Manufacturer: BISON(www.bisonmedical.com)]


    Let me ask this question: Are the post-treatment problems caused by the patient or doctor? Or are theydue to mechanical malfunction of the laser device or doctor’s lack of experience?


    I do use Korean devices in some procedures, but for most of laser toning procedures, I use imported devices. I find the stable power supply and the fact that it takes a long time to heat up the crystal moretrustworthy. The treatment room should be warm for the laser device to quickly produce enough heat to oscillate laser. However, some devices produce laser even in a few seconds on a very cold winter day. I am doubtful that they can actually oscillate laser in such a short period of time in such low ambient temperatures.


    The spot size is actually not a very important parameter. As we all know, a larger spot size means deeper delivery and excess accumulation of energy. Most laser toning devices cannot produce spot size larger than 10mm and even if they can, the clinical effect is negligible.This was because at the time, there was no consensus among aesthetic dermatologists regarding the most efficacious and safest spot size and fluence. I hope the readers try to find their own answer to the question “is a larger spot size better for laser toning?”


    Is laser toning really a simple procedure?


    In some practices, I see the head doctor perform minimally invasiveprocedures and the salaried doctor perform laser toning all day. I find this very worrisome. Leaving only salaried doctors who are less experienced than the head doctor to perform laser toning is dangerous. Delegating such an important procedure to younger doctors is due to not understanding the science of laser. Irradiating laser for 2-3 minutes using an8mm spot size until the skin turns bright red without correct understanding of pigmented lesions or laser therapy would not make a good treatment.


    It would only result in worsened melasma. This is why we often see no improvement in pigmented lesions even after 30 laser toning treatments. Some of these doctors only charge KRW 10,000 to 20,000 per laser toning treatment and obviously you get what you pay for. The current trend of patients crowding private practices that offer very cheap laser toning procedures was created by doctors, not patients. This dumping of medical treatments and cut-throat competition are of our own making.


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