The primary benefit of combining a 5 Hz irradiation frequency with a sliding technique is the prevention of localized thermal damage. This approach allows the operator to maintain a constant-speed motion, ensuring that laser energy is distributed evenly across the treatment area rather than accumulating in a single spot.
Core Takeaway: Melasma-affected skin is notoriously sensitive to heat accumulation. By utilizing a high repetition rate (5 Hz) and a continuous sliding motion, you effectively eliminate the risks associated with "pulse stacking," delivering therapeutic energy diffusely without triggering the thermal injury that often worsens pigmentation.
The Mechanics of Safe Energy Delivery
The Role of High Repetition Rate
Using a 5 Hz frequency means the laser fires five times per second.
This high speed is essential because it allows the operator to move the handpiece continuously. It transforms the treatment from a slow, "stamp-like" process into a fluid, painting motion covering the entire area.
Achieving Diffuse Distribution
The sliding technique, often paired with a 4 mm spot size, typically delivers between 1,000 and 2,000 shots per session.
Because the handpiece is constantly moving, these shots are spread out. This ensures the thermal energy is applied diffusely, rather than concentrating intensely in specific zones.
Why This Matters for Melasma
Preventing "Stacking" Injuries
In traditional stationary laser techniques, overlapping pulses—known as stacking—can be dangerous.
Stacking causes heat to build up rapidly in one location. For melasma patients, this excess heat can damage the epidermis and trigger rebound hyperpigmentation, effectively worsening the condition you are trying to treat.
Managing Heat Sensitivity
Melasma is highly sensitive to heat accumulation.
The sliding technique effectively mitigates this sensitivity. By keeping the energy source in motion, the skin is exposed to the laser for the shortest possible duration necessary for effect, preventing the deep thermal spikes that lead to inflammation.
Enhancing Safety with Beam Profile
Note: While frequency controls the timing of energy, the shape of the beam controls its spatial uniformity.
The Advantage of Flat-Top Beams
To maximize the safety of the sliding technique, it is often paired with a flat-top beam profile.
Unlike traditional beams that have high-energy peaks in the center, a flat-top profile ensures energy is uniform across the entire spot. This eliminates "hot spots" within the beam itself, further reducing the risk of localized burns during the multiple passes required by the sliding technique.
Critical Operational Considerations
The Importance of Constant Speed
The safety of this technique relies entirely on the consistency of the operator’s motion.
If the sliding motion slows down while the laser continues to fire at 5 Hz, the energy will inadvertently stack. The operator must maintain a steady rhythm to ensure the "diffuse" benefit is realized.
Balancing Coverage and Overlap
While intentional stacking is avoided, the sliding technique requires careful management of the treatment area.
Operators must ensure full coverage without excessive overlapping of the sliding paths. The goal is a uniform blanket of energy, not a patchwork of untreated and over-treated skin.
Making the Right Choice for Your Goal
To apply this technique effectively, consider your specific treatment objectives:
- If your primary focus is Safety: Prioritize a consistent, moderate sliding speed to ensure no single area receives consecutive pulses, minimizing thermal shock to the melanocytes.
- If your primary focus is Efficacy: Utilize the high shot count (1,000–2,000 shots) allowed by this method to ensure sufficient cumulative energy is delivered to the target pigment without breaching the thermal threshold.
Ultimately, the 5 Hz sliding technique converts a high-risk laser procedure into a controlled, cumulative treatment that respects the fragile nature of melasma-affected skin.
Summary Table:
| Feature | 5 Hz Sliding Technique | Traditional Stationary Technique |
|---|---|---|
| Energy Delivery | Diffuse & Uniform | Concentrated & Localized |
| Risk of Stacking | Minimal (constant motion) | High (overlapping pulses) |
| Thermal Effect | Controlled, gradual heating | Rapid heat accumulation |
| Shot Count | High (1,000 - 2,000 shots) | Lower, site-specific |
| Safety Profile | High for heat-sensitive skin | Risk of rebound hyperpigmentation |
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References
- Motoko Nakata. Treatment of Melasma with Low Fluence Q-switched Alexandrite Laser. DOI: 10.2530/jslsm.jslsm-39_0015
This article is also based on technical information from Belislaser Knowledge Base .
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