Am I suitable for pico laser,
and which pico should I be asking about?

Who is suitable for pico laser, and which pigment responds?

A person is suitable for pico laser when the pigment is a deposit the laser can fragment: a sun spot, a freckle, a post-inflammatory mark whose cause has settled, or tattoo ink. The pico laser page explains what the picosecond pulse does; this page answers the two questions that follow, whether your own pigment qualifies and which platform, if any, you should be asking about.

Sun spots and freckles are the clearest match, because they are well-defined deposits that accumulate with ultraviolet exposure and do not have an active driver once the sun is controlled. Post-inflammatory hyperpigmentation can be treated once the cause, usually acne, is under control, using low-energy toning rather than aggressive spot treatment. Melasma is the exception: it is chronic, driven by hormones, vessels, heat and ultraviolet light, and heat provokes it, so laser has a conservative role within a longer plan built on photoprotection and topical therapy, never the main one. The melasma treatment page sets out that plan.

Pico laser is not a treatment for laxity, for redness from vessels or for active acne, and in fractional mode it works on the texture around pores rather than shrinking them. Being clear about what it is being asked to do is the first half of suitability.

Who should wait, and who is examined before any laser is considered?

People who should wait include anyone in an active melasma flare, because adding heat to inflamed, pigment-producing skin tends to darken it; anyone with a recent tan or sunburn, because tanned skin is more reactive and more likely to darken afterwards; and anyone recently on oral isotretinoin, where the skin's healing capacity is still recovering. The article on isotretinoin and laser timing explains why that decision is individual rather than a fixed waiting period.

Treatment is also deferred with active infection or inflammation in the area, with photosensitising medicines, in pregnancy, and reconsidered in people with a tendency to keloid scarring. Any pigmented lesion that is changing in size, shape or colour, bleeding, or unlike the others is examined with a dermatoscope and referred for dermatological assessment before a laser is discussed, because a laser directed at an unrecognised melanoma removes the warning sign and not the disease. Fitzpatrick III to V skin is not a reason to wait, but it is the reason settings are chosen for the skin rather than copied from a default, as the guide to pico laser on Asian skin explains.

“A pico laser breaks up pigment that is already there. It does nothing about the reason your skin made it — which is why melasma comes back and a sun spot usually does not.”

Dr Sin YongOn the pico laser Singapore page

Which pico: what differs between PicoSure, PicoWay, Pico Plus, Discovery Pico and the DEKA TORO?

The platforms differ mainly in wavelength and optics, not in principle. PicoSure, made by Cynosure, was built around the 755 nm alexandrite wavelength, with optional 532 and 1064 nm handpieces on its newer version and a lens array for fractional-style delivery. PicoWay, made by Candela, centres on 1064 nm Nd:YAG and its frequency-doubled 532 nm, adds 785 and 730 nm handpieces, and splits the beam into micro-beams for fractional work. Pico Plus, made by Lutronic, and Discovery Pico, made by Quanta System, are likewise picosecond Nd:YAG systems built on 1064 and 532 nm, each with further wavelength handpieces depending on configuration. None of these four is used at this practice; they are described because people compare them.

The DEKA TORO used for Dr Sin Yong's T2 Frax Radiance protocol carries a 785 nm picosecond emission, which its maker describes as engineered with Fitzpatrick III to V phototypes in mind, together with 532 and 1064 nm nanosecond emissions and a longer thermal pulse on the same platform. The Fotona StarWalker PQX, a picosecond Nd:YAG at 1064 and 532 nm, is used here for tattoo removal. The T2 Frax Radiance page lists the specifications in full.

Pulse width is the figure manufacturers compete on, and it is the least useful one for a patient. Every platform above delivers pulses in the hundreds of picoseconds, short enough that pigment is fragmented mainly by a pressure effect before much heat spreads; a difference of a few hundred picoseconds matters less to your skin than whether the wavelength suits the pigment and the fluence suits the skin around it.

Does wavelength matter more than the brand or the pulse width?

Yes, because wavelength decides which pigment absorbs the light and how deep it travels. 532 nm is absorbed strongly by melanin and stays superficial, which suits sun spots and freckles in the epidermis. 1064 nm penetrates further and is absorbed less by epidermal melanin, which makes it the more conservative choice in darker skin and for dermal pigment. 755 and 785 nm sit between them and were adapted largely with mixed-depth pigment and certain ink colours in mind. A platform without the wavelength your pigment needs is the wrong platform for you whatever its name.

Fluence, spot size and the interval between visits sit on the same list, and they are set by the doctor rather than by the machine. Fluence is energy per unit area and the main driver of heat and inflammation; in melanin-rich skin the margin between clearing a spot and inflaming the skin around it is narrower. Laser toning is not run on an open-ended schedule, because pale, mottled spots have been reported after frequent repeated toning of the same area.

What does the doctor choose between, and what decides the fee?

Dr Sin Yong chooses between three things once the pigment has been identified: the wavelength, from 532, 785 or 1064 nm according to depth and skin type; the mode, whether spot treatment of a discrete mark, low-energy toning for diffuse tone or fractional delivery for texture; and the pacing, which includes whether a test spot is advised and how the skin's response is read before the next step. Sun protection is part of the treatment, not an accessory, and begins before the first visit.

Singapore's rules prevent clinics from advertising prices, so no figure appears on this page and none would describe your skin before it has been examined. What moves the fee is the area treated, what the assessment finds the pigment to be, whether one wavelength or several are used, whether fractional mode is added and how the plan is staged. A written, itemised quote follows the consultation, and the how we quote page explains what it contains, including why a lower figure elsewhere may describe a different device, a different plan or a different person performing the treatment.