In my practice, I use both the Q-switched ruby Laser and Q-switched alexandrite Laser.

 

In melasma treatment, the recommended output level is the level where immediately whitening phenomenon (IWP) is seen. This applies to the ruby Laser but not to alexandrite Laser. When the pigmented lesion is light in color, it is also very difficult to confirm IWP. Personally, I use the output level that causes slight reaction.

 

 

Unfortunately, melasma is very difficult to treat regardless of the level of the Laser output. As the crust forms for about a week and protective bandages should be worn after treatment (Thanks to the recent development, very thin, clear tape is applied over the skin which allows make-up and application of anti-inflammatory concealer). After about 3-6 months of the PIH period (PIH rate differs depending on the study but is generally about 40%) passes, melasma improves in most cases.

 

Let us now discuss how each of the Q-switched ruby and Q-switched alexandrite Lasers can be used in different types of melasma. The ruby Laser has higher melanin absorption. In other words, it is more effective in lighter melasma. The alexandrite Laser has slightly lower melanin absorption but can irradiate at５Hz, which makes it effective in cheek freckles or extensive melasma lesions. With a lower absorption rate and longer pulse duration than the ruby Laser, it is able to primarily select dark melasma with photo-acoustic waves even at lower output. Post-treatment PIH is similar between the two Lasers, although it tends to be more sallow with the alexandrite Laser.

 

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

 

I once attended a user meeting of a Korean Laser manufacturer. It was interesting to see the attendees’ surprised reaction when I told them that the Q-switched ruby Laser is the gold standard of melasma treatment in Japan. This may be due to the fact that the ruby Laser was not produced in Korea for a long time, whereas the Nd:YAG Laser was widely distributed. But I hope that the benefits of ruby Laser is appreciated in Korea as well. 

 

Ruby was the medium used in the world’s first Laser and has a long history and data. This does not mean that the ruby Laser is antiquated technology and is less trendy. In Japan, it has long been the standard treatment of melasma. Among devices that have adequate photothermal relaxation time (PRT) for melasma, the ruby Laser produces wavelengths most significantly absorbed by melanin. This is a key benefit of the ruby Laser.

 

Superior Efficacy of IPL

 

Famous Japanese plastic surgeons advise using the Q-switched ruby Laser or Q-switched alexandrite Laser to clear away melasma lesions without complications. The Q-switched Laser’s narrow focus is not suitable for extensive melasma lesions. Despite its excellent efficacy, the Q-switched Laser does not allow consistent irradiation and is not suitable for dim lesions with blurry boundaries.

 

-To be continued