The short answer
Pico laser has a narrow, useful job. It fragments discrete pigment with picosecond pulses, and in fractional mode it remodels surface texture. Problems arise when one laser is expected to solve every skin concern.
This guide sets out where it stops, and what each problem may need instead. The first step is always to identify the problem. Pigment must be diagnosed, and a changing or irregular mark is examined before any laser.
What pico laser does do
The pulse is very brief, so little heat spreads, which is why it is often used for pigment in darker skin. It may suit discrete pigment such as freckles and sun spots, some dermal pigment and tattoos, and surface texture in fractional mode. Sun spots and freckles are usually treated at 532 nm. Here, the protocol is T2 Frax Radiance on the DEKA TORO, chosen once the pigment has been identified. In fractional mode, a diffractive optic makes small zones of tissue breakdown with intact skin between them. See the pico laser page for the full picture.
What pico laser cannot do, problem by problem
| Problem | Why pico falls short | What may be considered |
|---|---|---|
| Melasma | Heat can darken it, and treating it like a sun spot tends to cause rebound | A managed plan with a stopping point |
| Tethered rolling scars | It cannot release a tether | Subcision |
| Deep boxcar and ice-pick scars | It does not reach the base | Fractional CO2, TCA CROSS |
| Pores | It does not shrink them | A 675 nm laser may be discussed |
| Loose skin | It does not tighten or lift | HIFU, VF Lift, Time Freeze Laser LCLR® |
| Wrinkles | Movement lines belong to muscle, and etched lines to the dermis | Anti-wrinkle injections for movement lines |
| Red marks | A pico pulse does not close a vessel | A vessel-directed approach |
Why melasma is the main caution
Melasma is managed rather than removed. Heat can act as a trigger, and the rebound can be darker than the original patch. So any laser here is a conservative, low-fluence add-on within a plan that has a stopping point. It is never a fixed course on its own. The same logic applies more widely. Pico laser breaks up pigment that is present, but continued sun exposure keeps making more, so protection has to continue.
Why scars need more than pico
Fractional pico reaches shallower than fractional CO2. The S3 Resurfacing Lift reaches deeper and remodels scars that pico cannot, though it brings crusting and a recovery that needs care. Scars are often pulled down from below, and no surface laser releases that pull. Most faces carry more than one scar type, so a plan may use several tools in order. Heavy skin excess is a separate matter again, and is referred to a plastic surgery specialist.
Who should think again about pico
Pico should not be used as a spot treatment. A diagnosis and a topical plan come first.
It is likely a vessel, so a pico pulse is the wrong tool.
An irregular or changing mark is examined before any laser.
Laxity needs a different approach, and heavy skin excess needs a surgical opinion.
Risks, sessions and fees
The risks that matter here are melasma rebound, which can be darker, and ongoing pigment formation with sun exposure. Pico laser can also cause marks of its own, as the pico laser for dark marks page explains. No session count is given here, as it depends on the problem. Fees are set in writing after consultation, along with the fee factors and the option of no treatment. Results vary.