Written and medically reviewed by Dr. Farah Izzati. Last reviewed 2026-08-28. 13 min
By Dr. Farah Izzati · Cosmetic Dermatology and Longevity, AOKLINIK
Drive along almost any road in Penang and you will pass three or four buntings promising Pico. Electric blue, soft-focus model, an exclamation mark or two. Somewhere between the traffic lights you start to wonder whether you are missing out on something.
Then patients arrive in my room and ask the most sensible question of all: is Pico actually better, or is it just this year's word?
I love that question, partly because the real answer is more interesting than yes or no, and partly because nobody should feel silly for not knowing. The information genuinely is not made available to you. You are asked to choose between machines using only a colour scheme and a price.
So instead of telling you which one to pick, let me hand you the two ideas that explain every laser you will ever see advertised. They take about five minutes to understand, and once you have them, you can work the rest out yourself. That seems like a much better thing to give you.
Idea one: how fast the light arrives
This is the important one, and it is almost never on the poster.
A laser does not just deliver energy. It delivers energy over a certain stretch of time, and that timing completely changes what happens inside your skin. It is the difference between leaving a pot to simmer and giving something a sharp tap.
Here is the scale.
Older lasers work in milliseconds, thousandths of a second.
Q-switched lasers work in nanoseconds, billionths of a second.
Picosecond lasers work in trillionths of a second.
That last one is difficult to picture, so here is my favourite way to hold it in your head. A picosecond compared to one second is roughly like one second compared to thirty-one thousand years.
That is not sales talk. It is the actual gap, and at that speed the physics genuinely changes rather than just getting stronger.
Think of a stubborn rock in the garden
Say you have a small rock you would like to get rid of.
The slow way is to warm it with a heat lamp. The rock heats up, but so does everything around it. Sometimes that is exactly what you want, which is why slower lasers are the right tool for hair follicles, blood vessels and collagen. You are supposed to be warming the neighbourhood.
The Q-switched way is to hit it with a hammer. The energy lands fast, the rock breaks into gravel, and a fair bit of heat spreads out around it. This works. It has worked for decades.
The picosecond way swings the hammer so quickly that the rock shatters before it has a chance to warm up. Instead of gravel, you get something closer to sand.
Two nice things follow from that.
Finer fragments are easier for your body to clear away, so you may need fewer visits.
And less spare heat means less irritation left behind. That second point matters a great deal in our skin. The most common way pigment treatment goes wrong in Malaysia is not a burn. It is the brown mark that appears afterwards, because inflammation in our skin type tends to leave a souvenir. Anything that breaks pigment while making less heat is worth having.
A small piece of trivia: the Q in Q-switched has nothing to do with medicine. It is borrowed from engineering, where Q describes the quality of the laser cavity. Q-switching means holding the energy back and then letting it go all at once, like drawing a bow and releasing.
And something the marketing tends to leave out: most picosecond machines actually deliver pulses of roughly 300 to 750 picoseconds, not one. The name describes the neighbourhood, not the house number.
Idea two: what colour the light is
If speed decides how the energy lands, colour decides what it lands on.
Your skin contains different substances that each prefer a different colour of light. Melanin, the pigment. Haemoglobin, in your blood vessels. And plain water, which is everywhere. Choosing a laser really means asking which of those three you are aiming at.
Here is the tour, kept short.
Green light, 532 nm. Melanin loves it, which makes it excellent for surface brown spots and certain tattoo inks. That same enthusiasm means it needs careful hands in darker skin.
Dual yellow, 511 and 578 nm. Two colours at once from a copper bromide laser, one leaning towards pigment and one towards blood vessels. It is popular across Asia for a very practical reason: redness and pigment so often turn up together, especially in rosacea and in melasma with a flushed component.
755 nm. Good for the stubborn blues and greens in tattoos, and widely used for hair.
1064 nm. The quiet workhorse in our part of the world. It travels deepest and bypasses surface melanin far better than shorter wavelengths, making it the safer, gentler choice for deeper pigment and skin types prone to post-inflammatory hyperpigmentation. You will meet it for dermal pigment, black tattoo ink, and laser toning.
1550 and 1927 nm. These go after water rather than pigment, and are the fractional resurfacing family. The 1927 is particularly good for surface pigment and overall tone.
2940 nm, Er:YAG. This one has a lovely bit of physics behind it. It is absorbed by water ten to sixteen times more eagerly than CO2, which means it removes tissue in clean thin layers and leaves very little heat behind. Some people call it the cold ablative laser. Faster healing, though less of the tightening that heat provides.
10,600 nm, CO2. Also removes tissue, but leaves more warmth behind. That gives more tightening and more collagen, in exchange for longer downtime and, in our skin types, a higher chance of pigment afterwards.
A bit of naming trivia: Nd:YAG stands for neodymium-doped yttrium aluminium garnet. Garnet, as in the gemstone. The light is made inside a small synthetic crystal.
And the one that genuinely surprises people: IPL is not a laser. It is a bright filtered flashlamp producing a spread of colours rather than one pure colour. It has real and legitimate uses and I am not dismissing it at all. But if a signboard says laser and the machine is an IPL, that is worth a polite question.
So, does Pico really matter?
Sometimes yes, sometimes hardly at all, and never as a cure.
Where it genuinely shines is tattoo removal, especially awkward colours, where the evidence for fewer sessions is strongest. Some deeper pigment too. And that reduced heat is a real benefit in darker skin.
Where it is oversold is melasma. I want to be gentle but clear here, because melasma is one of the most emotionally wearing skin conditions I treat and people are often exhausted by the time they reach me.
No laser cures melasma. Nothing does. It is a chronic, long-term condition with complex hormonal, vascular and light-related drivers, and laser is at most one part of managing it. Clinical success depends far more on using low-fluence, gentle parameters, strict daily photoprotection and topical pigment inhibitors than on whether you choose a nanosecond or a picosecond device.
In fact, aggressive laser treatment, or gentle laser toning done too often, can make things worse, triggering either a rebound of darkening or small pale spots that do not come back. You deserve to hear that before you start, not after.
Where it makes little practical difference is general brightening and mild sun damage, which respond to lots of approaches.
Here is the honest summary. The settings chosen for your skin, the spacing between visits, and the experience of the person holding the handpiece will shape your result far more than the name of the machine. A well-run older device in careful hands will beat a brand new one used too enthusiastically, every single time.
Why two Picos are not the same Pico
This is where things get genuinely confusing, and it is not your fault.
Picosecond is a category, like saying SUV. It tells you the general shape, not what is under the bonnet. Within that category, machines differ in ways that really do affect your result.
How fast the pulse actually is. Some are around 450 picoseconds, some 750, and some machines sold as picosecond sit closer to the older nanosecond range.
Which colours it can produce. Some platforms offer one wavelength, others several. A machine with one colour simply cannot address as many problems as one with three, no matter how it is marketed.
How hard it hits. Peak power, which is energy divided by time. This is the number that describes the actual punch, and it rarely appears anywhere in the advertising.
Whether it is the machine it appears to be. As with several device categories, there are copies built to resemble well-known systems. In a treatment room they look identical. What differs is whether the energy arriving in your skin matches what the protocol assumes it will be.
Reading a bunting like a pro
Now the entertaining part. Next time you are stuck at a red light, try these.
Does it name the manufacturer and model, or only a treatment name? Something like "Pico Glow Signature Radiance" is a name invented for a price list. Lovely as it sounds, it tells you nothing about the machine.
Does it say FDA approved? This is my favourite tell. Nearly all aesthetic lasers reach the American market through something called 510(k) clearance, which means the maker showed their device is broadly similar to one already on sale. That is clearance. Approval is a different and much more demanding route used for higher-risk devices. Most lasers are cleared rather than approved, so if a poster says approved, it is worth asking what they meant.
Is the claim on the poster the same as the claim on the paperwork? A device cleared for brown spots is not automatically cleared for melasma. That leap gets made quite often.
Does one machine promise everything? Pigment, redness, scars, wrinkles, hair, tattoos and lifting, all on one bunting. Different targets need different colours of light. When the list covers everything, the list is aspirational.
Is there any technical detail at all? Wavelength and pulse speed are not secrets. Their total absence across an entire industry is itself quite telling.
What to bring to your appointment
Please do bring questions. Nobody is going to think you are being difficult, and honestly, a patient who asks good questions makes my job easier rather than harder.
Is this a registered medical device, and what is its MDA registration number? In Malaysia, medical devices must be registered before they can be placed on the market. You can check for yourself on the Malaysia Medical Device Register at mmdr.mda.gov.my. Do look at the status and expiry date rather than just seeing a name appear.
What is the make, model and manufacturer, and where did it come from? A machine from a licensed local distributor comes with servicing, calibration and genuine parts behind it.
Which wavelength and what pulse speed will be used on me, and why that one for my particular problem? This is the question I would most like patients to ask. It shifts the conversation from what the clinic owns to what you actually need.
Who will be operating it? In Malaysia, a doctor performing aesthetic procedures holds a Letter of Credentialing and Privileging from the Ministry of Health, and it covers specific procedures rather than everything. It is perfectly reasonable to ask.
What is my skin type, and how does that change the settings? If nobody has looked properly at your skin before giving you a price, that is worth pausing on.
And what happens if it does not work? Every good plan has a point where we stop and think again. Ask where yours is.
The part nobody puts on a poster
A laser removes or reshapes something. It does not change why that something appeared.
For pigment, this means sunscreen is not the boring accessory to your laser treatment. It is a large part of the treatment. We live near the equator and the light here does not take days off. Visible light, not only UV, drives melasma in our skin tones, which is why a tinted sunscreen containing iron oxides genuinely outperforms a clear one for this particular problem. That single swap is one of the highest-value changes most of my melasma patients make.
It also means looking at what is feeding the problem. Hormonal factors. Active acne, if the marks are left over from breakouts. Topical treatment, sometimes tablets, alongside. Settling an irritated skin barrier before doing anything more assertive.
For scars and texture, collagen rebuilds on its own schedule of roughly three months a cycle, which is why sensible spacing matters more than a big number of sessions.
A laser plan without a skincare plan attached is only half a plan.
Let us talk about the twenty-session package
This is the question everyone actually wants answered, so let me be straightforward and also kind about it, because plenty of lovely people have already signed up for one and there is no point in feeling bad about that.
More than one session really is necessary. Broken-up pigment has to be carried away by your body, which takes weeks. Pigment cells recover and repopulate. Collagen rebuilds slowly. And in our skin types we deliberately use gentler settings each time to reduce the risk of marks afterwards, which naturally means more visits rather than fewer strong ones. So a course of treatment is normal and correct.
But more is not automatically better. Too much energy, or visits too close together, can produce exactly the pigmentation you came in to fix. Repeated gentle toning can occasionally leave small pale spots that do not recover. This is a real thing and it is worth knowing about.
So why does twenty make me pause? Not because twenty is always wrong. Because a number that large is usually decided before anyone has seen how your skin responds to the first one.
The sensible order is to assess, treat once, review at the right interval, and then decide the next step based on what actually happened. A large package quietly reverses that. It settles the plan before the evidence exists.
If you are offered one, these five questions will tell you a lot. How many sessions before we review. What the spacing is and why. What happens to unused sessions if we stop early, and whether they can be refunded or transferred. What is included besides the laser itself. And what would make you recommend stopping.
What a reasonable offer looks like is a small block, often three to six, with a proper review built in. Or simply paying as you go. For a long-term condition like melasma, upkeep is more of an ongoing relationship than a package, and a good clinic will tell you that at the beginning rather than at session eighteen.
If the reason for twenty turns out to be the discount, that is a pricing answer to a medical question. Perfectly fine to notice, and perfectly fine to ask for something smaller.
One last thought
You do not need to become an expert in laser physics to get a good result. You only need to know that speed and colour are the two things that matter, that the machine matters less than the person using it, and that a good clinic will happily answer every question in this article without making you feel awkward for asking.
If a conversation leaves you feeling rushed or slightly embarrassed for wanting details, that is information too. Trust it.
Come and have a chat
The best first step is not choosing a machine. It is finding out what is actually causing the pigment, redness or texture that is bothering you, and whether a laser is even the right tool for it. Sometimes it is. Sometimes the answer is far simpler and much less expensive.
Book a consultation with Dr. Farah Izzati at AOKLINIK Penang for a proper skin assessment, a realistic plan and a clear idea of when we stop.
References
- Malaysia Medical Device Register, public device search: https://mmdr.mda.gov.my/
- Medical Device Authority Malaysia, Medical Device Registration under Act 737: https://mda.gov.my/index.php/component/content/category/162-medical-device-registration
- Aesthetic Medical Certification Malaysia, LCP guidelines: https://www.aestheticmedicalcertification.org.my/lcp-guidelines/
Frequently asked questions
For tattoos and some deeper pigment, generally yes. For everyday brightening, the gap is much smaller than the advertising suggests, and settings and spacing matter more.
No, and I am sorry, because I know that is not what anyone wants to hear. It can be managed well, often very well, but it is managed rather than cured, and sunscreen does more of the work than the laser does.
There is no single winner, though 1064 nm is absorbed less by superficial melanin and tends to feature heavily in our skin tones. Safety comes far more from settings, spacing and a proper assessment than from the wavelength alone.
No, it is filtered broadband light. It has genuine uses, but it is a different technology and should be described as what it is.
That the device was shown to be broadly similar to one already on the market. It is a route to market rather than proof that it does the specific thing printed on a poster.
Ask for the make, model and MDA registration number, then look it up at mmdr.mda.gov.my. Check the status and expiry, not just that something appears.
Genuinely unknowable before the first one. Which is rather the point of everything above. ---