Asian people are always cared about the pigmented spots on their faces. Since the ancient China, various names for the pigments are found. Although there were no lasers during this period of time, different topical regimens for the treatments of hyperpigmented spots can be found in the old literature. There were no effective treatments for the pigmented spots until the introduction of lasers recently.

Traditionally, the effect of laser is based on the concept of selective photothermolysis, which means the absorption of laser energy is correlated to the thermal relaxation time of the target molecules inside the skin. Therefore, the selection of wave length, energy or fluence, pulse duration, and pulse interval becomes the key factors to perform a successful laser treatment.

 

Based on this concept, the 532nm, 694nm, 755nm, or 1,064nm lasers became the dominant standard lasers for treatment of hyperpigmented lesions. Due to the high possibility of post-inflammatory hyperpigmentation in Asian people, it is difficult to say which laser is better for the treatment of pigmented spots in Asians. Also, the traditional endpoint of faint white frosting on the pigmented lesions after treatment is sometimes difficult to see on faint hyperpigmented areas or melasma. Therefore, a different way of approach called laser toning or soft peel laser was brought up in the recent 10 years.

 

HELIOSⅡ/LOTUSⅡ/HYPERION – Manufacturer: LASEROPTEK(www.laseroptek.com)

 

The Concept

 

The laser toning or soft peel laser was initially introduced to Taiwan from South Korea in about 2005. During that time, people in Taiwan usually received chemical peels or use topical Kligman’s triple combination formula (5% hydroquinone, 0.1% tretinoin, and 0.1% dexamethasone) for the treatment of melasma. Although effective, the melasma tends to recur after discontinuation of topical or peeling agents.

The concept of laser toning is to treat the uneven tones and facial irregular hyperpigmented lesions through repeated multiple passes of large spot sized laser beams with suboptimal lower energy or fluence to avoid post-inflammatory hyperpigmentation and achieve a shorter period of downtime with minimal erythema on face.

 

Q-switched Nd-YAG Laser is traditionally used to treat tattoos (1,064 nm), and some superficial pigment (532 nm). A new generation of Nd-YAG laser machines can adjust the spot size. Many physicians tried to use large spot size treatment to reduce the peak energy on the whole face to achieve the similar effect of superficial resurfacing peels.

It seemed quite reasonable and quite fancy to perform this procedure during that time. This new approach soon got its popularity and became the dominant procedure for almost any kind of hyperpigmented lesions. 

 

-To be continued