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Skin Resurfacing with the PicoSure® Focus Laser Columbus OH

One of the most common signs of aging is unwanted pigmented spots on sun-exposed areas of the body such as the face, hands and chest. Contrary to popular belief, the development of these lesions has nothing to do with liver disease.

Age Spots

There are a variety of lesions that are grouped into the category of 'age spots.' Included in the catch phrase of conditions are solar lentigos, seborrheic keratosis, ephelides (freckles) and other benign spots of hyperpigmentation. Unfortunately, these lesions tend to get darker with age and sun exposure and the predilection to their development is hereditary. Thinner spots are amenable to elimination with in-office treatments such as chemical peels and lasers.

Fraxel® Laser

For many years, the Erbium Fraxel® Laser has been our mainstay for facial, neck, chest and hand skin resurfacing treating pigment spots, lines, wrinkles, sun damage and more. Fractional treatment revolutionized skin resurfacing in the early 2000's to allow for in-office treatments without a lot of downtime and less pain. There is, however, a certain amount of pain with Fraxel® Laser treatments requiring at least topical anesthesia if not local injections as well. In addition, there is a few days of pinkness and swelling, which is a lot better than with the old ablative laser treatments, but still some recovery time was necessary.

PicoSure® Focus Laser

We were the second office in Ohio and the first in the Columbus area to have the PicoSure® Laser for tattoo removal and it is still the proverbial 'latest and greatest' laser for treating tattoos. It is a Q-switched laser with the advanced proprietary technology of mode-locking, which allows the PicoSure® Laser to fire in trillionths of a second rather than billionths of a second. Recently, Cynosure, the parent company for the PicoSure® Laser, came out with a new hand piece for skin resurfacing, which allows for true minimal downtime. The Focus hand piece scatters the Alexandrite laser beam into tiny fragments, much like the Fraxel® Laser does with its Erbium beam.

Minimal Pain

Most unwanted pigmented lesions are quite thin and superficial, therefore, high laser energy is not required for deep penetration of the beam, which translates into less pain during the treatment. Although some patients may choose to use a topical anesthetic prior to their PicoSure® Laser session, the vast majority require no anesthesia at all. After Fraxel® Laser treatment, most patients have a sunburned like feel while following a PicoSure® Laser session, there is only a slight warmth or no sensation at all.


Our experience with the PicoSure® Focus Laser from a recovery standpoint has been a very pleasant surprise. Most patients will only be slightly pink when they leave our office and this is almost always gone in less than two hours. Others will have no evidence at all that they had a treatment.


Melasma is a patchy brownish pigmentation commonly found on the face most commonly in women during their reproductive years. It is more common among women with darker skin and can get significantly worse during pregnancy. The PicoSure® Focus Laser can dramatically improve the appearance of melasma when combined with the use of 4% Hydroquinone cream twice a day.

Frequently Asked Questions About the PicoSure® Focus Laser

  1. What does the PicoSure® Focus laser treat?

    Although you can find reports and brochures indicating that the PicoSure® Focus laser is effective at treating fine lines, wrinkles and acne scars, it is primarily effective at treating various forms of hyperpigmentation including freckles, melasma, age spots and sun spots. It will have little effect on nevi (moles) and seborrheic keratoses. Flat forms of hyperpigmentation have a much better chance of lightening with PicoSure® Focus Laser treatments than thick, raised lesions.

  2. What are the advantages of the PicoSure® Focus laser?

    The PicoSure® Focus laser has two significant advantages over most laser treatments for hyperpigmentation: minimal downtime and relatively little discomfort. Immediately following a session with the PicoSure® Focus laser, the skin on most patients is pink but there is no swelling, bruising, scabbing or crusting. Often this resolves over the next few hours, and they look completely normal the next day. Others may still have some mild pink discoloration the next morning.

    Small areas are treated without the use of any local or topical anesthetic. Some patients who are having a full-face treatment choose to come in early and have a topical anesthetic applied (Benzocaine®, Lidocaine® and Tetracaine® or BLT) for 30-40 minutes. Treating the neck, chest and hands generally does not require any pretreatment with BLT.

  3. What is the PicoSure® Focus laser?

    The PicoSure® Laser is an advanced light-based piece of equipment built and designed by Cynosure, a leader in laser technology. It was primarily built to remove tattoos. What is unique about the PicoSure® Laser is that it was the first laser developed for tattoo removal that fired in picoseconds (trillionths of a second). Virtually all previous lasers fired in nanoseconds. By firing at a faster speed, the PicoSure® laser tends to break up ink particles into finer fragments that area easier to remove by your immune system.

    The specialized Focus handpiece takes the coherent laser beam and breaks it up into thousands of tiny beams which target human pigment and so are absorbed by dark spots on the skins surface.

  4. Is the PicoSure® Focus laser dangerous?

    The PicoSure® Focus laser is an extremely safe laser, especially when used by an expert such as Dr. McMahan who has performed laser treatments in Columbus, Ohio for over 30 years.

    Eye injury is a risk with any laser, so everyone in the room must be protected by goggles that are specific to the wavelength of light being used. We prefer to double-protect our patients with both adhesive eye shields directly over the eyelids as well as metallic eye shields.

  5. Will the PicoSure® Focus laser remove cosmetic tattoos?

    Cosmetic facial tattoos have become commonplace. Eyeliner is not generally at risk as the laser is not used that close to the eyes. Lip and eyebrow tattoos are another matter. As the laser is designed to remove tattoos and treatments generally extend into the eyebrows and onto the lips, these tattoos are at risk for permanent alteration in color or removal with the PicoSure® Focus laser. If you have cosmetic facial tattoos, please let us know so that they can be avoided during your laser sessions.

  6. When will I see fading of my hyperpigmentation following a laser session?

    One thing that we warn patients about prior to their first PicoSure® Focus laser session is that it is common for their hyperpigmentation to get worse 4-7 days after the treatment and start to lighten a few days later. It normally takes 10-14 days to see lightening. Different spots respond differently, and some may not change much at all while others may improve significantly.

  7. What should I do prior to my PicoSure® Focus laser sessions?

    Whenever we are trying to lighten or eliminate hyperpigmentation, it is imperative to use 4% hydroquinone cream on the area twice a day for at least one month. Hyperpigmentation can get worse, rather than better after laser treatments, therefore, the cream is an attempt to make it more difficult for your skin to produce pigment after a laser treatment.

  8. How many PicoSure® Focus laser sessions will I need?

    This is the hardest question to answer as the PicoSure® Focus laser is still relatively new technology. Lighter forms of hyperpigmentation in patients with lighter skin are easier to treat and require fewer sessions than darker spots in patients with darker skin. Some will get significant improvement in just two or three sessions.

  9. Are the results from PicoSure® Focus laser treatments permanent?

    There is no such thing as permanent removal of hyperpigmentation. If your skin has a tendency to form excess pigment, it always will, and laser sessions will not change that. To make your results last as long as possible, avoid sun exposure, wear a protective hat when going outside, apply an SPF 23-30 sunscreen before going outdoors and continue to apply your hydroquinone cream twice per day.

  10. Can I have more than one area treated at the same time?

    Yes. The limiting factor with respect to how many areas can be treated is the number of areas to be pre-treated with BLT. We can use this “numbing” cream on only two areas per session. Otherwise, there is not a limit as to the number of areas that can be done in a single session.

  11. What other treatments are available to treat hyperpigmentation?

    At Advanced Aesthetic & Laser Surgery, we have a variety of lasers to treat hyperpigmentation. In addition to the PicoSure® Focus laser, we also have two Nd:YAG (Neodymium-doped Yttrium Aluminum Garnet) lasers and the Fraxel® laser. Our Medlite C6 Nd:YAG laser is mostly used to treat tattoos but can also be used to treat individual pigment spots as opposed to large areas that are better done with the PicoSure® Focus laser or Fraxel® laser. The PicoSure® laser without the Focus handpiece can also be used for individual spots.

    Our Fraxel® laser can be set to target pigment and is commonly used for larger areas such as the face, neck, chest and hands. It is effective for treating hyperpigmentation but has more downtime than the PicoSure® Focus laser but has the advantage in that it effectively treats lines, wrinkles, sun damage and acne scars.

The answers to the above questions are my personal opinions based on years of legitimate general surgery and plastic surgery training and extensive experience in plastic surgery private practice. They are intended to give you, the patient, as much knowledge as possible in making your decision about plastic surgery and who performs that surgery. They are not intended to be derogatory or demeaning towards any individual physician or group of physicians. I firmly believe that physicians should only practice within their field of training and expertise, except in life-saving, emergency situations. – James D. McMahan, M.D., F.A.C.S.

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4845 Knightsbridge Blvd, Ste 230, Columbus, OH 43214

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