Table 3.
Combination therapy of fractional picosecond lasers
| Disease | Laser | Therapy parameters | Fitzpatrick scale | Number of cases | Clinical outcome | Adverse events | Reference |
|---|---|---|---|---|---|---|---|
| Facial rejuvenation | 755-nm picosecond laser with DLA and botulinum toxin | Botulinum toxin: mean total units per treatment was 39.5 units |
I–V I (n = 75); II (n = 76); III (n = 45); IV (n = 11); V (n = 1) |
208 | Combined therapy improved efficacy and introduce synergistic effects | No adverse events recorded | [40] |
| 755 nm picosecond laser with DLA and 1060 nm laser lipolysis | 755-nm picosecond laser with DLA: fluence of 0.71 J/cm2, 6 mm spot size for 3 Laser treatments and 2 lipolysis treatments at 2- to 8-week intervals | II–VI | 11 | Neck laxity improved in all subjects from baseline | Transient pain, nodule formation, dyspigmentation, tenderness, edema, roughness, and blister formation | [41] | |
| Facial fillers and 755-nm picosecond laser with DLA | Soft tissue fillers; picosecond 755-nm alexandrite laser with DLA: the mean was 3,730.2 pulses |
I–IV I (n = 71), II (n = 64), III (n = 38),IV (n = 10) |
183 | Single-session facial fillers and 755-nm picosecond laser with DLA was safe | No adverse events recorded | [42] | |
| Melasma | Fractional picosecond 1064-nm laser and 4% hydroquinone | Fractional picosecond 1064-nm laser: fluence of 1.3–1.5 mJ per microbeam, pulse duration 450 ps, 4 Hz; daily application of 4% hydroquinone |
III–IV III (n = 5), IV (n = 25) |
30 | The intervention side considerably reduced the melasma area severity index scores than 4% hydroquinone cream alone | Mild erythema,skin desquamation and burning sensation | [43] |
| Tattoo | Fractionated 1064-nm picosecond lasers and unfractional 1064-nm picosecond lase | The 1064-nm picosecond laser: fluence of 1.5–7.24 J/cm2; spot size: 3–4.5 mm, 2- 5 Hz; fractionated 1064-nm picosecond lasers: fluence of 0.8 J/cm2; spot size: 8 mm, 2–5 Hz |
III–V III–IV (n = 8) V (n = 3) |
11 | The combination side showed greater clearance scores and fewer adverse events than the side of unfractional 1064-nm picosecond laser alone | Temporary crusting, purpura, edema, erythema, burning, sensation, and petechiae | [44] |
| Acne scars | 1064-nm MLA‐type picosecond lasers and HAF | Each scar was filled with 0.01–0.1 ml of HAF and MLA handpiece: 6 mm spot, fluence of 1.4 J/cm2, 5 Hz frequency; 450 ps pulse duration for two treatments at 4‐week intervals | III–IV | 36 | Acne scars improved significantly | Temporary pain, instant erythema, and flushing | [45] |
| FxPico and IPL |
FxPico: 6 mm spot size, energy of 1.5–2.5 mJ/microbeam, 3–4 passes IPL: 560- or 590-nm filter, pulse width of 3.5–4.0 ms, fluence of 15–19 J/cm2, 1 pass One half of the face treated by FxPico + IPL, and the other by IPL alone for five sessions of treatment |
III–IV III (n = 13); IV (n = 2) |
17 (15 patients completed) |
More pore count reduction and scar improvement were observed on the FxPico + IPL side | Mild‐to‐moderate pain, erythema, edema, petechiae, crusting, pruritus, and acneiform eruptions, | [46] | |
| Full-thickness laceration scar | 1064-nm Nd:YAG laser with MLA and polynucleotide gel | 1064-nm Nd:YAG laser with MLA at fluence of 0.7 J/cm2, and then 20 mg/mL polynucleotide gel was injected | Not mentioned | 1 | Significant clinical improvement | pruritus | [47] |