Evaluation of the Safety and Efficacy of a Low Fluence, Picopulsed, Alexandrite Laser in a Pico-Toning Technique With a Diffractive Lens Optic for the Treatment of Photodamage and Textural Improvement in “Off the Face” Applications

November 2016 | Volume 15 | Issue 11 | Original Article | 1398 | Copyright © November 2016

Raminder Saluja MD

SALUJA Cosmetic and Laser Center, Huntersville, NC

BACKGROUND: The diffractive optic coupled with a picosecond pulsed alexandrite laser has been shown to effectively minimize pigmen- tation while improving the appearance of textural irregularities and rhytides. We evaluated the safety and ef cacy of the diffractive optic laser treatment for off of the face applications including the hands and décolletage in a pico-toning technique. STUDY: 20 healthy female patients (40-70 years of age) were treated with a picosecond pulsed alexandrite laser with a diffractive lens. 10 of the patients were enrolled in a prospective hand assessment study (20 hands) while the remaining 10 subjects were enrolled in an IRB approved study treating photodamage of the décolletage. Protocol for both groups included 4 treatments to the designated area with a picopulsed alexandrite laser with a diffractive lens on a 6mm handpiece delivering 0.71 j/cm2 with 10 hz repetition at 3 week intervals (+- 7 days) with follow up at 1 month and 3 months post fourth treatment using standardized digital photography. RESULTS: Statistically signi cant improvement in the overall appearance of pigmentation, texture and rhytides were recorded at each sub- sequent visit and at 1 and 3 months post the nal laser treatment. Clinical photographs were evaluated from baseline to the final photo at 3 months post last laser treatment by the treating physician, patient, and an independent evaluator. All hand subjects and chest subjects showed improvement in all 3 areas which were found to be statistically signi cant. No adverse events occurred in either study group. CONCLUSION: These study results show signi cant improvement in not only pigmentation, but in texture and rhytides in all subjects receiving pico-toning laser treatments to off of the face areas. The laser was well tolerated by all patients with no adverse effects. The use of a diffractive lens optic on a 6 mm xed spot size handpiece with a picopulsed alexandrite laser, in a pico-toning technique, provides a safe, low uence, yet effective treatment for not only pigment dyschromia but also textural irregularities and rhytides when treating the hands and décolletage. J Drugs Dermatol. 2016;15(11):1398-1401.


The first picosecond laser was FDA approved in 2012 for the treatment of tattoos and benign pigmentation. Over the next year, adaptations to the laser included the development of a novel diffractive lens array which redistributes light into a multitude of high fluence, focused spots embedded in a low fluence background. These high fluence spots deliver 20 x greater fluence then the low powered background, thus enabling a robust treatment for photorejuvenation while minimizing subsequent adverse effects. This is thought to be partially achieved through the creation of a photoacoustic wave, and the subsequent production of LIOBs (laser induced optical breakdown), which constitutes one of the multiple entities occurring in the skin which research physicians are just beginning to unravel and understand. The link between the presence of the LIOB and the improvement in not only pigmentation, but also dermal collagen, may be a leading factor associated with the benefit of pico-toning in skin revitalization.The concept of laser toning is not new. In the past, the use of Q-switched neodymium-doped yttrium aluminum garnet laser (QS:YAG) has gained popularity for facial rejuvenation, especially in the Asian population.1,2 Laser toning has been primarily focused on the face, due in part to the fact that while off the face applications with low fluence QS:YAG modalities could diminish pigmentation, they could not match the visual improvement of rhytid reduction and textural improvement as seen on facial applications. A recent published article established the safety and efficacy with the use of a picosecond pulsed laser for the décolletage.3 The purpose of our study was to evaluate the efficacy and safety profile for the improvement of pigmentation, skin texture, and rhytid reduction for off of the face applications with a low fluence, pico-toning technique utilizing a diffractive lens optic.


Twenty healthy female patients aged 40-70 (mean age 55.25) with Fitzpatrick skin type II to IV were treated. Ten of the patients