PicoSure Laser Pigmentation Treatment

PicoSure 755 nm picosecond laser (Cynosure) for pigmentation removal including age spots, café-au-lait macules, melasma, nevus of Ota, and birthmarks. Ultra-short picosecond pulses generate photoacoustic pressure waves that shatter melanin granules with less thermal damage than nanosecond devices. Also effective for acne scar remodelling via the FOCUS diffractive lens. Minimal downtime — one to two days of redness.

PicoSure, manufactured by Cynosure, is a 755 nm picosecond laser platform available at the Laser & Skin Surgery Center of New York for the treatment of a wide spectrum of pigmentation disorders. Unlike Q-switched lasers that operate in the nanosecond range, PicoSure emits energy in pulse widths measured in picoseconds — trillionths of a second, approximately one hundred times shorter than nanosecond pulses. At these ultrashort pulse durations, the dominant mechanism shifts from photothermal (heat-based) to photoacoustic (pressure-wave-based): the absorbed laser energy creates an intense pressure wave within the melanin granule that causes explosive mechanical shattering of the pigment particle into sub-micron fragments without generating the heat that damages surrounding tissue. This photoacoustic mechanism means that PicoSure treatment is associated with lower risk of post-inflammatory hyperpigmentation (PIH) compared to nanosecond devices, a particularly important consideration for darker Fitzpatrick skin types common among New York City's diverse patient population. The 755 nm wavelength has high melanin absorption, making it effective for targeting a broad range of pigmented lesions: solar lentigines (age spots), café-au-lait macules, ephelides (freckles), melasma (in combination with topical treatment), nevus of Ota, Becker's nevus, and complex birthmarks. The PicoSure FOCUS lens array, a diffractive optical element, redirects the beam to create thousands of micro-photoacoustic zones when placed over the skin, triggering collagen remodelling without the need for melanin absorption — this expands the device's clinical utility to acne scar remodelling and overall skin texture improvement in patients without significant pigmentation. Sessions run approximately twenty to forty minutes depending on the area and indication. Post-treatment findings include temporary darkening of treated pigmented lesions (expected treatment response as melanin fragments undergo phagocytosis) and mild redness lasting one to two days. Session count varies by indication: a single isolated lentigo may clear in one to two sessions; melasma and deeper dermal pigmentation may require four to six sessions with integrated topical protocols.