The Discovery PICO Plus laser by Quanta System (Milan, Italy) combines powerful Nd:YAG and Ruby wavelengths to treat tattoos, scars and more. With pulses ranging from microseconds to picoseconds, plus multiple handpieces and spot shapes, this innovative device also delivers flexibility.
Having the Discovery PICO laser’s maximum 1.8 Gw (at 1064 nm) allows for spot sizes up to 7.5 mm, with the right fluence for treating deep pigment, such as a tattoo on a man’s back, quickly. “I’m surprised by the amount of energy you can deliver with a very large spot size,” said Matteo Tretti Clementoni, M.D., a plastic surgeon in Milan, Italy. “The bigger the spot size, the deeper the penetration.”
With the 532 nm, 1064 nm and Q-switched 694 nm wavelengths, Dr. Tretti Clementoni can treat most classic tattoo colors (black, red, green and purple). During successive treatments spaced two months apart, he reduces the spot size because it takes higher energy to pulverize ever-smaller ink particles with picosecond pulses. Compared to Q-switched lasers, with the PICO Plus, “We can reduce the total number of sessions by at least 20%, and I don’t have ‘tattoo ghosting’ as in some cases with Q-switched modalities,” he reported.
Dr. Tretti Clementoni considers the device’s square-spot handpiece critical for early tattoo removal treatments. “With the square spot you can place one spot exactly next to the other, without a very high frequency, resulting in precise procedures,” he explained.
Conversely, the round-spot handpiece is useful for treating rounded lesions such as solar lentigines. “You cannot put a round spot exactly next to the other,” Dr. Tretti Clementoni pointed out. “So, to cover an area you have to overlap, or leave some untreated areas to allow feathering of the final result.”
With the PICO Plus fractional handpiece, “I love what we can do for scars. Now we are sure to achieve collagen remodeling
due to the laser-induced optical breakdown (LIOB) we are creating in the superficial dermis,” Dr. Tretti Clementoni expressed. “This technology focuses enormous amounts of energy on very small spot sizes to break up tissue. “The LIOB produced via the 1064 nm wavelength is like an explosion in the superficial dermis.”
Damaging the dermis drives collagen remodeling and collagen production, Dr. Tretti Clementoni continued. “That is why we see such good results on atrophic acne scars, as well as on most traumatic and surgical scars.”
To treat acne scars, Dr. Tretti Clementoni delivers medium doses (with topical anesthetic and a Zimmer cooler), using a lower range for darker skin. “I’m doing five to seven passes on the area, with a frequency of 10 Hz. Instead of a stamping technique, I’m using a very high frequency so I’m able to use a painting technique on the skin,” he noted.
Post-procedural pinpoint bleeding gives way to inflammation and erythema, which reportedly disappear after two to five days.
“Patients can see results after the second session, but with my protocol, I’m doing four sessions spaced three to four weeks apart,” Dr. Tretti Clementoni advised. “Because we have collagen production, I see maximal improvement six months after the last procedure. In a nutshell, I love the Discovery PICO Plus. It is one of three devices in my office that I run for 12 hours a day – from the moment we open to the moment we close.”
