Objectives: In this presentation, two members of the Philippine Dermatological Society will share their experiences in laser treatments on Filipino skin.

Introduction: Filipinos are products of the long process of evolution and movement of people. Filipino culture is a mix of Malay, Chinese, Hindu, Arab, Polynesian, Spanish, English and Japanese and it shows in our genes. In the Philippines, our skin falls under a wide range of skin types, and thus experience a variety of skin conditions.
More common are (1) pigmentation problems, such as melasma, lentigines and post-inflammatory pigment alterations, (2) scars both atrophic and hypertrophic and (3) fine lines and wrinkles.

Conclusion: Fortunately, advancements in technology allow us to address these concerns and provide non-surgical and non-invasive treatments with minimal downtime and satisfactory results.

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Objectives: Evaluation of the safety and efficacy of a new picosecond – domain laser using Q-Switched 1064nm fractional energy with depth control capabilities for the treatment of acne scars in skin types IV and V Filipino (Philippine) patients.

Introduction: Acne vulgaris affects 80% of 15-30 year-olds causing atrophic acne scars.The gold standard of ablative laser resurfacing gives good results after one treatment but comes with pain, downtime, adverse events(AE) like post inflammatory hyperpigmentation(PIH) in darker skin.Ablative fractional lasers were introduced minimizing AEs while maintaining efficacy, but multiple sessions are needed and PIH still occurs in darker skin.Non-ablative picosecond fractional lasers were evaluated for treatment of acne scars. These deliver shorter pulses and lower fluences, proving safer for treating darker skin.

Materials / method: Eight patients with mixed atrophic scarring (rolling, boxcar, icepick) were treated using a picosecond Q-Switched Nd:YAG 1064nm fractional laser with depth control capabilities. Treatment parameter included 3 different depths, 4 passes at 0.7mJ/Pixel (49 pixels) per depth. Patients received four treatments at 4-6 weeks interval and follow-up visits at one and three months after their final treatment. Pre-and post-treatment assessment were done using standardized GAIS scoring by 2 independent blinded evaluators. Subject discomfort scores and adverse events were recorded after each treatment.

Results: All patients completed full treatment protocol. Treatment response was recorded in all patients: three patients had good to excellent improvement, two had moderate improvement and three had mild improvement. Patients who responded well with excellent, good or moderate GIAS score had over 50% rolling type acne scars. A minimum of three treatments were required for visible improvement. Safety parameters included post treatment responses: erythema and mild edema, which resolved within the first 24-48 hours following treatment. No other treatment related adverse events were recorded.

Conclusion: The picosecond Q-Switched Nd:YAG 1064nm fractional laser with depth control capabilities was found to be safe and effective for the treatment of acne scars in patients with skin types IV and V. Rolling atrophic scars were found to respond better than boxcar and icepick scar types. The treatment protocol was well tolerated and patients experienced minimal to no downtime. Picosecond Q-Switched Laser can provide a non-ablative treatment alternative for acne scars in dark skin patients.

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Objectives: Melasma is a pigmentary disorder which has no promising solution at present. . The methods of treatment include melanin biogenesis pathway blockers, depigmenting agents, chemical peels, dermabrasion and laser treatments. The topical agents including hydroquinone and tretinoin are the most well- known treatment for melasma, but the treatments have not been very effective for Asian skin types. We evaluated Picoway (Ultrashort picosecond laser) for recalcitrant melasma treatment

Introduction: The picosecond laser is a groundbreaking innovation that can be applied not only for the removal of tattoos and the treatment of various pigmentary conditions, it can also improve skin texture and quality for a unique rejuvenation effect characterized by improved skin clarity, reduced fine lines and wrinkles, and reduced pore size. Instead of using the longstanding photothermal approach to treatment via selective photothermolysis, the picosecond laser is designed to cause a photomechanical effect beneath the skin.

Materials / method: We studied retrospectively back on 100 melasma patients with Picoway toning. We selected the melasma patients who have not response to tranxaminic acid (either oral or intralesionl administration) or other laser toning for picoway treatment. Patients received 450ps alone or 450 ps plus 350ps or 450ps plus 300ps laser.

Results: We found most patients have a good satisfaction rates with 450ps plus 350 or 300ps laser. Certain parameters are required for better results. Mostly are the parameters with low fluences and higher >10 repetition rates. Adding shorter picosecond pulse duration gives long-term improvement >1year.

Conclusion: In summary, Ultrashort picosecond laser give a promising results for the treatment of refractory melasma. The application various ultrashort pulse durations is recommended to get rid of various type and size of melanosomes.

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Objectives: Various devices are available on the markets for local fat reduction. Cryolipolysis and laserlipolysis are two of popular procedures in our field. What is difference between both devices?
And how to use the devices depending on the condition of patients?

Introduction: The devices for fat reduction are not as effective as liposuction, yet does not have a limit on daily activities due to its non-invasive, non-surgical procedures. Also, many of the devices have less pain and fewer possibilities of complications. Therefore, we should understand the mechanism of these devices for getting good results.

Materials / method: For body sculpting (reduce excess fat tissue and make ideal body figure), the treatment by using two kinds of devices were performed; crtolipolysis and laserlipolysis.

Results: Compare with both, the mechanism is different.
About cryolipolysis, fat cells don’t like the cold and at a certain temperature they freeze. About laserlipolysis, infra-red light (1060 nm) penetrate to subcutaneous fat tissue and heat around 45 ˚C. Fat tissue is damaged by heating. It seems almost same. However, damaged subcutaneous layer is different each other and heat diffusion after laser irradiation (not photothermal effect) stimulate dermis.

Conclusion: Obviously, both cryolipolysis and laserlipolysis are effective for local fat reduction. However, result is different. Therefore, we should take a slightly different approach, and should know how to choose and how to combine both devices to get high satisfaction rate of patients.

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