• #4-3. Treating Melasma





    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.


    Many doctors use the long-pulsed alexandrite Laser in such cases. This Laser is generally used for treating hair loss but The Gentle LASE by Cyneron-Candela was very popular and its indications were expanded to conditions outside hair loss. Unlike other Lasers indicated for hair loss, the long pulsed alexandrite Laser has a short pulse duration of only 3ms. This gives it a higher peak power which is suitable for melanin removal.


    Use the output generally used in hair loss treatments to irradiate over the entire face. Then, use a smaller spot size with the cooling unit (DCD) turned off to irradiate on melasma lesions. Be careful to use a punched card with a hole the same size as the irradiation width to protect the surrounding tissues.


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    The pulse duration is in milliseconds which provides effects closer to cauterization rather than photothermal destruction. It is similar to IPL in many aspects but can be irradiated over the entire face in a much shorter period of time.


    IPL allows a much more focused treatment of melasma. Many devices adjust the melanin absorption rate by changing the filter and emits the wavelengths, output and pulse duration suitable ror the skin condition. In Japan, Sciton’s BBL has the most favorable performance reviews among IPL devices used in melasma. Jeisys’s IPL device is also popular due to its excellent performance and affordability.


    Cynosure’s ICON (MaxG handpiece) is also rapidly increasing in market share. ICON produces two peaks, one for high absorption in melanin and one in the near infrared range. A single irradiation can be absorbed in both melanin and water, bringing overall rejuvenation of the face. It was originally developed as a vascular Laser (similar to combining the dye Laser and long-pulsed Nd:YAG Laser) but in practice, it is more suitable for rejuvenation treatments. 


    -To be continued

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