I do not use the 755 but would likely use same energy settings but shorten the pulse width. Of course, do spot treatment before full face.

Sometimes when I treat hyperpigmentation (whether melasma or solar lentigoes), I use a 755 laser, 5mm spot, 16 J, pulse width 0.5, and I double-pulse. I often get great results. Other times I use 25 J and single-pulse, of course adjusting for skin type. I usually get pretty good results with that, too. My question is, if all of the discoloration is not gone after one treatment, when they are back for a second treatment, how should I adjust the treatment parameters? In other words, if a lesion is lighter in color, should I use more energy or change the pulse width? (The patient may or may not be on hydroquinone; if we're doing laser hyperpigmentation treatments, I usually wait until I'm done with the treatments before starting HQ)

That is the problem with the 560. You have to do a lot of treatments to get OK benefits. We have mainly fitz 1-3 and use the 560 at its upper limits and still have to do up to 5 treatments. Patients do not want to keep coming back that much especially if you are doing a full face.

I do not use my 560 any longer now and only use my BBL. I can accomplish the same with 1 treatment as I could with 3 to 5 with the 560.

Tony:
Great question. Knowing that melasma for example can be both superficial and deeper in nature I would surmise:
1) If you need to go deeper to get the rest of the spots then you increase fluency
2) If you just need to get more effective elimination of the spots knowing that they are primarily of the same depth, then decrease the pulse duration.

We are using the Cutera LP560 and generally getting good to great results in 3-5 treatments on patchy hyperpigmentation by starting as 18J for FST 1-3, 16J for FST4. I actually treated a FST5 who had lots of hyperpigmentation under her neck from electrolysis and she was pretty happy with it. I started at 10J for a test spot on her and had relatively brief hypopigmentation which was easily covered with bare-minerals until she pigmented back in. We spot test almost everyone when they come in for the consult so we know in advance how they will react. We have not gotten into the habit of starting the HQ along with the treatments as we are doing well enough on its own. True melasma is a long process with mild to moderate results involving multiple low fluence treatments to avoid the inflammatory reaction that caused it to start with. We have been using Tri-luma to pre-treat these folks about a month before starting laser therapy and have been generally satisfied with the results. The tough part is getting the patient to realize they won't be 100% and it may come back even if they are meticulous in avoiding the sun.

I think as long as they are still in the reproductive age, they will be at risk of recurrences, unfortunately

Thanks for your replies. Another question though; isn't pulse width (PW) also related to depth of penetration? If I think a spot is deeper, I know I can increase the energy, but don't I also want to increase my PW? Likewise, if I decrease the PW for a lighter lesion, aren't I also targeting a more superficial layer?

Also, the settings I gave as my example in the original post are such that I cannot decrease the pulse width with that particular spot size to less than 0.5. Would it be a good idea to increase the spot size from 5mm to 7 or 10 and use a low pulse width setting to achieve enhanced reduction of the lighter pigmentation?

At the same PW, e.g. 0.5ms and same fluency, you get a deeper and more uniform (less light scattering) when you go from a smaller to bigger bigger spot size (this explanation might not make sense to you but it is true) With the same spot size and and same fluency, when you change the PW, e.g. from 3ms to 0.5ms, you get more intense thermal heating at the same depth and when it is less than the tissue thermal relaxation time, it can "burn off" the target. This IS how you can achieve the so called "permanent hair removal" goal, for example.

...which, I suppose, is also why it's safer in type IV to keep the PW a bit higher in general than in type III...

That brings up a question if you can't get hair reduction even with dark hair using 695 filter IPL. What can you tweak? I was told to decrease the filter to a 590 for finer or lighter hair, but that doesn't seem right.

SLL,

You can move up your fluence, lower your pulse width or move to a filter that has a higher melanin absorption characteristic. We use our 640 nm filter for hair removal and get really good results, especially if the hair is thick and dark. We use 18-20 joules and 20-25 milleseconds. Which IPL do you have, what are your settings? Maybe we can help.

does anyone use the gentlelase for treatment of brow spots and hyperpimentation? what's the best setting and how are the results? The setting listed in the manual is similar to the hair removal treatment, How is this treatment different from laser hair removal?

To pmdoc,
In your post back in December you mentioned using the gentleyag to do the LASER PEEL. Can you tell me what setting you use, and if that treatment is effective on treating brown spots.

I have Both the GentleYag and Gentlelase, and want to use either one for photo facial. Which has better results?

Thank You in dvance,
Sara