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Q Switch ND YAG for melasma

Updated: Jan 5

from laser of Cutaneous and Aesthetic Surgery June 2012 Volume 5 Issue 2

article link 

Q Switch ND YAG for melasma

The most widely use for Melasma treatment

Low Dose Q Switch ND YAG for melasma treatment by these mechanism

  1. induce sub-lethal injury causing fragmentation and rupture of melanin granule to cytoplasm

  2. subcellular damage to the upper dermal vascular plexus which is one of the pathogenetic factors in melasma

  3. subthreshold injury to the surrounding dermis stimulates the formation of collagen resulting in brighter and tighter skin

“laser toning” Technique

  1.  large spot size (6-8 mm)

  2. low fluence (1.6-3.5 J/cm 2 )

  3. multiple passed QS 1064 nm Nd:YAG laser

  4. performed every 1-2 weeks for several weeks.

click for the table of  laser toning study 

laser toning complication reported

While few studies document good efficacy with this Technique,  several others have found hypopigmentation and depigmentation after a series of laser toning.

other reported complication

  1. rebound hyperpigmentation

  2. physical urticaria, acneiform eruption

  3. petechiae

  4. and herpes simplex reactivation

cause of hypopigentation for laser toning technique

  1. high fluences causing direct phototoxicity and cellular destruction of melanocyte

  2. subthreshold additive effect of multiple doses

  3. intrinsic unevenness of skin pigmentation

  4. non-uniform laser energy output.

suggestion to avoid serious side effect

should be avoid

  1.  too many (>6-10)

  2.  too frequent (every week) laser sessions

  3.  Hypopigmentation should be looked for after every session and further treatments should be stopped.

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