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Pico laser at Dr. Nüchel Aesthetik in Mönchengladbach

Laser treatments

Pico laser

The Pico laser works with ultra-short picosecond pulses and breaks down excess pigment particularly finely – for the gentle treatment of pigment spots, sun damage and freckles, as well as for refining the skin's appearance.

Treatable areas

  • Age spots (face)
  • Sun damage (hands)
  • Pigment spots (décolleté)
  • Freckles
  • Pore refinement
  • Fine lines
  • Acne scars

The Pico laser – in our practice the PicoStar by Asclepion – works with ultra-short light pulses in the picosecond range. Because of this extremely short pulse duration it acts predominantly photoacoustically, via a mechanical pressure wave rather than heat: excessively deposited melanin is broken down into the finest particles, which the body clears away via its own removal system – the surrounding tissue is subjected to comparatively little thermal strain.

Its main field of application is the treatment of benign pigment changes: age and sun spots (lentigines) on the face, hands and décolleté, blotchy pigmentation as a result of sun damage, and bothersome freckles. The Pico laser is also suitable for gently refining the skin's appearance in the case of coarsened pores, an uneven complexion and fine crepey lines – and it is a central building block of our combined laser tattoo removal, which we describe on a dedicated treatment page.

All information is provided for general guidance and does not replace personal medical advice. Treatment results can vary from one individual to another.

Indications

Who it is suitable for

Whether a treatment makes medical sense in your case is something we determine together in a personal consultation. Typical concerns include:

  • Pigment spots such as age spots and sun spots (lentigines) on the face, hands and décolleté
  • Blotchy, irregular pigmentation due to sun damage following dermatological clarification
  • Freckles that are perceived as bothersome – following an individual medical assessment
  • Benign superficial pigment changes, e.g. individual café-au-lait spots, following a medical examination on a case-by-case basis
  • An uneven, irregular skin appearance and coarsened pores
  • Fine crepey lines and incipient light-induced skin ageing for gentle refinement of the skin's appearance
  • Mild superficial acne scars to support a smoother skin appearance

Step by step

How the treatment works

This is how the treatment usually proceeds with us – from the first consultation through to aftercare.

  1. Medical consultation and dermatological assessment

    We examine your skin and assess the pigment changes dermatologically – only clearly benign findings are eligible for a laser treatment, while unclear pigmented lesions are clarified beforehand. You receive detailed information about the procedure, realistic expectations and risks.

  2. Preparation of the skin

    The area should not be intensively exposed to the sun for a few weeks before the session, as tanned skin increases the risk of pigment shifts. On the day of treatment, the skin is cleansed and disinfected.

  3. Laser treatment

    The Pico laser delivers ultra-short light pulses specifically onto individual pigment spots or across the treatment area; depending on the extent, this takes a few minutes to about half an hour. Your eyes are protected throughout by special protective goggles.

  4. Cooling and care

    Immediately after the treatment, the skin is cooled and, if needed, treated with a soothing wound care; you receive specific advice from us on care over the following days.

  5. Check-up and follow-up sessions

    Many age and sun spots can already be visibly lightened in one to three sessions; for refinement of the skin's appearance, a series of three to five sessions at intervals of about four weeks is usually sensible – a binding commitment to the number of sessions is not possible. We monitor the progress and adjust the parameters to your skin's reaction.

Patient information

Safety & patient information

Responsible treatment includes open information about possible risks and side effects – even when they occur only rarely.

  • Redness, swelling and a feeling of warmth

    Immediately after the treatment, redness, slight swelling and a sensation of warmth or burning in the treatment area are the norm. These reactions are harmless and usually subside by themselves within a few hours to days.

  • Darkening and flaking of the treated spots

    Treated pigment spots typically darken in the first few days and form fine crusts or flakes before they lighten. This is part of the normal healing course and no cause for concern; the crusts should fall off by themselves and not be scratched off.

  • Crust and blister formation

    In the treated area, small crusts or blisters may form, which are normal for healing. They should not be scratched open or opened, as this increases the risk of infections and scars. The crusts fall off by themselves after a few days.

  • Pigment shifts

    The treated skin may temporarily appear lighter (hypopigmentation) or darker (post-inflammatory hyperpigmentation) than the surrounding skin. Such shifts usually resolve over weeks to months, but occur more frequently in darker skin types and with pre-existing sun tan. Consistent UV protection before and after the treatment lowers this risk.

  • Incomplete lightening and recurrence

    Not every pigment change responds equally well. Individual spots can remain visible despite several sessions or – especially upon renewed UV exposure – re-pigment over time. A complete and permanent removal can therefore not be assured.

  • Worsening in the case of melasma

    In the case of melasma, a laser treatment can paradoxically intensify the pigmentation or favour a rapid recurrence. For this reason this diagnosis is medically distinguished before every treatment, and a laser treatment is considered here only with great restraint and embedded in an overall concept.

  • Infections

    As the skin barrier can be briefly disrupted, there is a low risk of infection. Careful wound care, cleanliness and refraining from swimming pool and sauna in the first few days significantly lower this risk. Signs of an infection are, for example, increasing redness, swelling, pain or pus formation.

  • Texture changes and scarring

    In rare cases, permanent changes to the skin surface may occur, for example depressions, raised areas or scars. With a corresponding predisposition, excessive scarring (keloid) is also possible. The predominantly photoacoustic mode of action of the Pico laser is considered comparatively tissue-sparing; a residual risk nevertheless remains.

  • Temporary sensory disturbances

    In the treated area, a feeling of tension, an increased sensitivity to touch or a slight numbness may occur briefly. Such complaints are as a rule temporary.

  • Allergic reactions

    Care products used or anaesthetic creams can in rare cases trigger allergic reactions. Please therefore inform us of known allergies and intolerances before the treatment.

  • Eye damage in the absence of protection

    Laser light can seriously damage the eye. Throughout the entire treatment, both the person being treated and the practice team therefore wear suitable eye protection. This risk is practically excluded through consistent protective measures.

When we do not treat

In certain situations we do not carry out a treatment, or only at a later time – for your safety.

  • Pregnancy and breastfeeding – here, as a precaution, elective aesthetic laser treatments are refrained from.
  • Active skin infections, open wounds or inflammatory skin conditions (e.g. an active cold sore) in or on the treatment area.
  • Freshly tanned or strongly sun-exposed skin as well as recent tanning bed visits, as this increases the risk of pigment shifts.
  • Pigment changes whose benign nature is not established beyond doubt – these must be clarified dermatologically before every laser treatment.
  • Melasma or partly hormonally caused pigment disorders – a laser treatment is an option here only after a particularly cautious medical consideration, as the pigmentation can worsen.
  • A known tendency to excessive scarring (keloids) or to pronounced pigment disorders.
  • Use of light-sensitising medications or certain active substances that increase the skin's light sensitivity (medical consultation required).
  • Certain skin conditions that are prone to abnormal skin reactions at sites of irritation (e.g. psoriasis or vitiligo in the area) – treatment only after an individual medical consideration.
  • Acute irradiation of the area or recent chemical peels or other superficial skin treatments in the same region.
  • Impaired wound healing, for example with inadequately controlled diabetes mellitus or under immunosuppressive therapy – only after careful medical consideration.

This information does not replace a personal medical consultation. Before every treatment we inform you individually about the procedure, risks and alternatives.

In depth

Medical details & background

How it works & the evidence

The Pico laser belongs to the Q-switched laser systems; its pulses last only picoseconds – trillionths of a second. Decisive for the effect is the principle of selective photothermolysis: light energy of a particular wavelength is preferentially absorbed by the target pigment (chromophore) – in pigment treatment the excessively deposited melanin – while the surrounding tissue remains largely spared.

Whereas classic pigment lasers in the nanosecond range primarily heat the pigment, a photoacoustic effect comes to the fore with the Pico laser: the abrupt absorption of energy generates a tiny pressure wave that mechanically shatters the pigment; this tends to produce smaller fragments – with comparatively low thermal strain on the surrounding tissue. Scavenger cells of the immune system (macrophages) clear the particles away, and part of the pigment is shed with the natural renewal of the epidermis; treated spots therefore initially darken, flake and then appear lighter.

In the refinement of the skin's appearance, laser-induced optical breakdown (LIOB) is sometimes used: microscopically small, controlled stimulus points in deeper skin layers can stimulate the body's own repair and remodelling processes without removing the surface across the board. Whether this results in a visible effect varies from person to person and should not be overrated; the benefit here is to be assessed more cautiously than for actual pigment removal.

Picosecond lasers have been established in aesthetic dermatology for several years. For benign pigment changes – in particular lentigines and freckles – studies and case series show that treated spots can often be markedly lightened in a few sessions; individual comparative investigations suggest a lower risk of inflammation-related re-pigmentation in certain skin types, but the data on this are not consistent. For refinement of the skin's appearance, the data situation is more heterogeneous: devices, settings and assessment standards vary considerably, so that positive reports – for example on coarsened pores, fine lines and superficial acne scars – cannot be generalised to an effect equally achievable for everyone.

Many studies comprise small case numbers and different protocols; results can therefore not be transferred one to one to the individual finding. The depth and density of the pigment deposit, skin type, location, UV behaviour and individual healing significantly influence the result, which is why the treatment course and final result cannot be guaranteed in advance. The Pico laser is a high-performance, well-studied procedure, but no promise of a particular result; we are guided by the current state of scientific knowledge and the recommendations of the dermatological specialist societies.

Preparing for your treatment

A few simple measures before your appointment help you contribute to the best possible result with as few complications as possible.

  • Avoid intensive sun exposure and tanning beds for about four weeks before the treatment; the area should, if possible, not be tanned at the appointment.
  • Refrain from self-tanner in the treatment area in the weeks before the appointment, as it can affect the assessment of the pigment spots and the laser effect.
  • Inform us about all medications and food supplements, in particular anticoagulant agents – please pause these only after medical consultation, never on your own initiative.
  • Tell us about pre-existing conditions, allergies, a tendency to cold sores or to conspicuous scarring, as well as previous treatments of the area.
  • The treatment area should be clean and free of make-up, creams and perfume at the appointment.
  • Refrain from irritating care products (e.g. fruit acids or retinol-containing products) in the area immediately before the treatment.
  • Plan for some rest after the session and avoid, for the first few days, activities involving heavy sweating or mechanical irritation of the treated site.
Aftercare

The right care after treatment supports healing and the result. You will receive individual recommendations from us – as a rule:

  • Cool the area carefully if needed, for example with a clean cooling element wrapped in a cloth, in order to relieve redness and a feeling of warmth.
  • Keep the treated site clean and dry and apply only the wound or care cream recommended by us.
  • Do not scratch or rub off crusts and flakes, and let them fall off by themselves, in order to prevent pigment disorders, infections and scars.
  • Protect the area consistently from UV radiation and, after healing, use a high sun protection factor (SPF 50+) over several weeks.
  • Refrain from sauna, steam bath, swimming pool, intensive sport and heavy sweating for a few days.
  • Avoid irritating cosmetics, self-tanner and peels in the treated area for the first few days.
  • Keep agreed progress check-ups; the result on treated pigment spots can usually only be reliably assessed after complete flaking, after about two to four weeks.
  • Contact our practice immediately at signs of an infection (increasing redness, swelling, pain, fever) or in the event of unusual reactions.

FAQ

Frequently asked questions

Answers to questions we are asked particularly often about “Pico laser”.

The laser pulses are usually felt as a brief pinch or the snap of a rubber band; the sensation varies from person to person and depends on the region of the body. On request, we apply an anaesthetic cream beforehand, and in addition the skin is cooled. Most patients experience the treatment as well tolerable.

The Q-switched ruby laser is a classic, highly selective pigment laser whose wavelength of 694 nanometres is absorbed particularly well by melanin – tried and tested for decades on age and sun spots. The Pico laser works with markedly shorter pulses and acts more strongly photoacoustically, so the thermal strain on the surrounding tissue tends to be lower. Both systems have their justification for benign pigment changes.

Yes. The Pico laser is a central building block of our practice's combined laser tattoo removal, in which, depending on the colour spectrum, a Q-switch Nd:YAG laser is additionally used. You will find all the details on the number of sessions, treatable colours and the procedure on our dedicated treatment page on laser tattoo removal.

Behind a seemingly harmless age spot, a skin change requiring treatment can in rare cases be concealed, for example an early form of black skin cancer (lentigo maligna). If it is lasered, the necessary diagnostics can be obscured and an illness allowed to progress. For this reason we assess every pigment change dermatologically beforehand – in case of doubt with the dermatoscope – and treat exclusively clearly benign findings.

The treatment is carried out exclusively by licensed physicians – in our practice with a dermatological background. The assessment of pigment changes, the selection of the laser parameters and the information on benefits and risks belong in medical hands and are not delegated to non-medical staff.

Sources & guidelines

  • Guidelines and recommendations of the German Dermatological Society (DDG) as well as the AWMF guideline register (www.awmf.org) on laser therapy of the skin.
  • Information from the Federal Institute for Occupational Safety and Health as well as applicable provisions on protection from non-ionising radiation when using lasers on the skin.
  • Manufacturer specifications and prescribing information on the laser system used as well as on the care and anaesthetic products employed.
  • Current review articles in the dermatological specialist literature on laser-based treatment of benign pigment changes (general state of research, without transferability to the individual case).

Personal consultation

Arrange a personal consultation

In a confidential conversation on our practice floor at the Albertus Zentrum in Mönchengladbach, we take time for your questions and assess whether the treatment may be suitable for you.

Book a consultation

More treatments

You might also be interested in

Depending on the findings, another procedure may be more suitable: the Q-switched ruby laser for many age and sun spots, the Erbium:YAG laser for layer-by-layer ablation of raised benign changes such as age warts (seborrhoeic keratoses), or vascular-acting systems (dye or Nd:YAG laser) for dilated small veins and redness. If your concern is wrinkles or volume loss, botulinum toxin or hyaluronic acid fillers are the more suitable procedures; for tattoo removal, please see our dedicated treatment page.

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