Distinguishing Pigmentation with a Subtle Difference [Laser Toning]

Key Features of Our Clinic's Laser Toning

• 1. We prioritize applying over 2,000 shots of energy and avoid overly fast procedures. At our clinic, we delicately apply over 2,000 shots of energy to the skin, striving to achieve the expected improvements while minimizing skin irritation.
• 2. Customized intensity adjustment by medical staff based on pigment depth and type. Various pigmentary conditions like melasma, ABNOM (Acquired Bilateral Nevus of Ota-like Macules), and freckles have different depths and characteristics. We approach melasma gently, use a more focused method for ABNOM, and for complex cases, we adjust the intensity and settings to match the condition of each area.
• 3. We meticulously observe skin reactions during the procedure and adjust parameters in real-time. Laser irradiation is not the end; during the procedure, our medical staff directly monitors the skin's reaction with a mirror and can change the spot size, intensity, and even the handpiece as needed. This is a precisely planned, individually customized treatment that focuses on actual skin improvement, going beyond just the name 'toning.'
• 4. We use a Mark-Vu diagnostic device to accurately identify the location and depth of pigments. We don't rely on guesswork; instead, we use the Mark-Vu diagnostic device to meticulously check the type, distribution, and depth of pigments, then use this information to create an individualized treatment plan.
• 5. We attempt a multi-layered approach to complex pigment issues. In cases where melasma and ABNOM coexist, treating only one aggressively can risk worsening the condition. We first stably soothe melasma, then apply a controlled, intensive approach to ABNOM in the dermal layer.

What makes our clinic's laser toning special?

Laser toning is a commonly used method for managing pigmentary conditions. However, the treatment results can vary significantly depending on the equipment used, the number of shots applied, and the intensity of the procedure.

Various pigmentary conditions like melasma, freckles, and ABNOM (Acquired Bilateral Nevus of Ota-like Macules) are located at different depths within the skin and exhibit diverse tissue reactions. Therefore, careful planning that considers individual characteristics before treatment is crucial.

1. Application of over 2,000 shots of energy

Many studies report that when performing low-power laser toning, stable and effective results can be achieved with 1500 to 2500 shots.

At our clinic, we typically apply over 2,000 shots of energy, planning the treatment to ensure sufficient improvement while minimizing skin irritation.

Simply operating the device alone is not enough to bring about skin changes.

The treatment must be conducted by individually adjusting the number of shots, output, irradiation speed, and spot size, considering the depth of the pigment, its distribution range, and the skin's sensitivity.

2. Customized toning by medical staff, considering disease characteristics

1) Melasma

Melasma is one of the common pigmentary disorders that primarily appears on both sides of the face and tends to spread widely.

Since it involves hyperactivation of melanocytes that produce melanin pigment, unnecessary stimulation can potentially worsen melasma.

We use the Mark-Vu precise skin diagnostic device to meticulously assess the extent and depth of melasma. Based on this, we cautiously attempt improvement using a toning laser with a short pulse width of 5 nanoseconds (ns).

Our clinic's toning method, which selectively targets only melanosomes within cells without directly stimulating melanocytes, helps reduce the possibility of side effects.

Even during the procedure, our medical staff directly checks the skin's reaction with the patient using a mirror. We adjust areas requiring more intensity and focus, and to ensure no spot is neglected, we may replace the handpiece or delicately fine-tune parameter settings as needed.

We perform the procedure by checking the skin condition with the patient in the mirror before, during, and after the treatment.

2) ABNOM (Acquired Bilateral Nevus of Ota-like Macules)

ABNOM is a condition where pigment is located in the dermal layer, similar to melasma, but may require higher energy adjustments than melasma.

When melasma and ABNOM appear together, it requires conflicting strategies simultaneously: a gentle approach for melasma and an appropriately strong approach for ABNOM. At this point, the skilled experience and meticulous judgment of the medical staff are crucial.

If strong treatment is performed without first considering melasma, there is a risk of exacerbating melasma.

At our clinic, we undergo a thorough differential diagnosis process before treatment to establish an individualized treatment plan. This helps reduce the possibility of side effects and allows us to set an individual intensity for each patient to improve ABNOM simultaneously.

For ABNOM treatment, after an accurate differential diagnosis through Mark-Vu, the medical staff proceeds with parameter settings tailored to each individual patient. Spot size, repetition rate, and output are meticulously adjusted and applied according to the skin type.

3) Other Pigmentary Disorders

Pigments that respond relatively quickly, such as lentigines, freckles, and general spots, are likely to improve with the appropriate wavelength. However, if they appear along with melasma or ABNOM, the treatment approach can become more complex.

In such complex cases, accurate differential diagnosis is crucial, and a delicate, individualized strategy involving output adjustment and laser handpiece changes, confirmed with a mirror during each treatment, is required. At our clinic, you can understand our approach not as a standardized laser toning method, but rather as melanin pigment management through the precise judgment and adjustments of our medical staff.

Comparison of Pico Toning and Laser Toning

Pico toning theoretically offers the advantage of breaking down pigments into smaller units using very short laser pulses in picosecond units.

In contrast, laser toning uses nanosecond units, delivering energy for a relatively longer duration compared to pico toning.

Both toning methods can selectively break down melanin pigment to help improve skin tone and can be used for pigmentary conditions such as melasma, freckles, and ABNOM (Acquired Bilateral Nevus of Ota-like Macules).

Due to the difference in laser irradiation time, you might feel that pico toning has a faster response speed in the initial 2-3 treatment sessions. However, after 10 or more consistent sessions, both methods can be expected to provide similar skin tone improvement effects.

Laser toning is a treatment method whose efficacy has been verified for nearly 20 years. It can be a relatively stable approach, especially for individuals with sensitive skin or conditions like melasma that are highly sensitive to irritation.

Due to pico toning's characteristic of delivering concentrated energy in a short moment, some may temporarily experience redness or stinging after the procedure, depending on the case.

Clinical studies, when comparing based on a 1064nm wavelength, have also reported numerous results indicating no significant difference between pico toning and laser toning in terms of skin tone improvement, reduction in melasma indicators, and decrease in melanin index.

So, can sufficient improvement be expected with laser toning alone?

It is important to consistently receive treatments 10 or more times. Improvement can be expected through the cumulative effects of the treatment.

The treatment is performed by observing the skin's reaction and adjusting the appropriate energy intensity within the range of 1.0 to 2.0 J/cm².

For sufficient effect, at least 2000 shots or more may be required.

It is recommended to perform treatments maintaining a 1-2 week interval. This is because if the interval becomes too long, the cumulative effects of the treatment may decrease.

It is recommended to receive treatment from a professional medical team who can adjust treatment settings in real-time according to individual skin type and reaction.

When these conditions are met, some research suggests that similar effects can be expected when compared to Pico Toning.

All content mentioned above has been written with reference to relevant research papers.

This includes papers such as Medicina (Kaunas), 2022, Lasers in Medical Science, 2021, and Journal of Cosmetic and Laser Therapy, 2021.

What is Laser Toning?

Laser toning is a treatment method that gradually breaks down pigmentation and evens out overall skin tone by repeatedly delivering low-power laser energy deep into the skin.

This treatment differs from conventional methods that directly burn pigments with strong energy. Instead, it continuously provides gentle stimulation to softly break down melanin and can help promote skin regeneration.

It is a treatment that can be applied to various pigmentary disorders such as melasma, freckles, and ABNOM (Acquired Bilateral Nevus of Ota-like Macules) while minimizing skin irritation. It is also one of the most widely used methods among various pigment treatments today.

1. Type of Laser Used: Q-switched Nd:YAG

Q-switched Nd:YAG laser devices are primarily used for laser toning treatments.

The 1064nm wavelength of this laser can deeply penetrate the upper dermis, where melanin pigment is primarily located. This is advantageous for selectively destroying only the desired pigment while minimizing damage to the skin's surface.

Thanks to these characteristics, it can help protect the skin barrier while focusing on pigmentation issues. Therefore, it can be considered for sensitive or thin skin types.

2. Low Power, High Repetition 'Tone-up' Stimulation

While typical pigment treatments remove pigment at once with high energy, laser toning differs by repeatedly delivering low-energy laser thousands of times.

This approach focuses on gradually and finely breaking down melanin particles while minimizing damage to skin tissue. The broken-down pigment is then absorbed by macrophages, our body's immune system, and naturally expelled.

Through this process, you can expect a gradual change towards a more even and brighter skin tone.

3. Dendrite Sheath Destruction + Melanin Removal within Melanocytes

Laser toning not only breaks down pigments but also participates in inhibiting the process of melanin production.

A crucial part of this action involves damaging the dendrites, or sheaths, of melanocytes.

Mature melanosomes (melanin carriers) produced in melanocytes move to the epidermis, the outer layer of the skin, via dendrites (sheaths).

When the laser damages these sheaths, melanosomes cannot be delivered to the epidermis. As a result, this can help inhibit the occurrence of new pigmentation on the skin surface.

Furthermore, it directly breaks down the melanin pigment accumulated inside melanocytes, which is useful for improving existing pigmentation.

This specific action is primarily observed in lasers with short pulse durations, measured in 'nanoseconds' or 'picoseconds'.

This can be considered one of the important mechanisms observed in treatments like laser toning or pico toning.

3 Key Points of Laser Toning

Three Main Treatment Principles of Laser Toning

Laser toning is a treatment method aimed at controlling the overall process from melanin production to its transport, beyond simply removing pigment.

1. Removal of Existing Pigment Particles

For pigmentary disorders other than melasma, such as freckles or ABNOM (Acquired Bilateral Nevus of Ota-like Macules), improvement can be expected by breaking down melanin with relatively strong treatment settings.

However, melasma can react sensitively to stimulation, so very careful energy control is required. Special attention must be paid to ensure that unnecessary stimulation does not inadvertently activate melanocytes.

2. Inhibition of Melanosome Transport through Dendrite (Sheath) Destruction

This prevents melanosomes produced in pigment cells from being transported to the epidermal layer of the skin, thereby inhibiting the formation of new pigmentation.

3. Direct Melanin Destruction within Melanocytes

The laser directly breaks down the melanin pigment accumulated within melanocytes, reducing melanin concentration. Through this, an overall improvement in skin tone can be expected.

Effects of Laser Toning

• 1. Skin Tone Improvement: Melanin pigment is gently broken down through subtle laser stimulation. This can help dull skin become generally clearer and brighter.
• By selectively targeting melanosomes without stimulating melanocytes, this treatment can help improve sensitive melasma and hyperpigmentation.
• With customized intensity that can reach ABNOM (Acquired Bilateral Nevus of Ota-like Macules) located deeper than melasma, you can expect improvement in dermal pigmentation.
• By destroying the dendritic sheaths, which are the main migratory pathways for pigment, this treatment helps inhibit melanin from reaching the epidermis and reduces pigment production.
• The stimulation from the laser promotes skin regeneration, which can refine skin texture and soften fine lines, offering additional cosmetic benefits.
• By using low energy for multiple passes, we reduce skin burden, allowing us to comfortably apply this treatment to sensitive skin types to help improve pigmentation.

Recommended for Laser Toning

• 1. Those with generally dull and uneven skin tone
• 2. Those with recurring or worsening pigmentary lesions such as melasma, blemishes, and freckles
• 3. Those with deep dermal pigmentation such as ABNOM (Acquired Bilateral Nevus of Ota-like Macules)
• 4. Those with thin or sensitive skin who are cautious about pigmentation treatment
• 5. Those who want both fine line reduction and skin texture improvement simultaneously
• 6. Those who want to achieve steady skin changes with minimal skin irritation

Laser Toning Procedure

• STEP 1. Precise skin diagnosis using Mark-Vu identifies the depth and distribution of pigmentation not visible to the naked eye.
• STEP 2. A 1:1 consultation with the director establishes a treatment plan tailored to your individual skin condition.
• STEP 3. Laser toning is performed with personalized parameters (final confirmation with the director looking in a mirror before the procedure).
• STEP 4. During the procedure, progress is checked in a mirror, and areas requiring focused attention are re-examined thoroughly.
• STEP 5. After the procedure, your skin condition is checked in a mirror, and detailed guidance on post-procedure care is provided.

A Message from the Director

Many patients often experience long-term discomfort due to pigmentation issues like melasma or ABNOM.

I believe the concerns and anxieties of 'Will it really get better?' or 'Will it get worse?' are also significant.

Understanding these feelings, we prioritize an approach to pigmentation treatment that goes beyond mere mechanical procedures.

Our principle is to personally check each patient's skin condition and perform delicate and precise treatments only as much as necessary for each individual.

The approach to pigmentary lesions must vary depending on skin depth and sensitivity.

Laser toning is a procedure that cannot be taken lightly, and we approach it cautiously and diligently to ensure patients experience satisfactory improvement.

Post-Treatment Precautions

• · Cleansing and makeup are possible from the day of the procedure, and it is important to apply sunscreen diligently.
• · It is advisable to provide sufficient soothing and moisturizing care for temporarily sensitive skin.
• · Swelling or redness may appear immediately after the procedure, but these usually subside naturally over time. If symptoms persist for several days, it is recommended to contact the clinic for guidance.