Reviews
Vol. 33 No. 2 (2026)
Fractional picosecond laser-induced optical breakdown in dermatology: from controlled microinjury and molecular repair pathways to clinical endpoints and post-procedural care
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 31 August 2026
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Fractional picosecond lasers have expanded the clinical use of ultrashort-pulse devices from tattoo and pigment removal to non-ablative rejuvenation, scar remodeling, enlarged pores, dyschromia and selected photoaging indications. Their distinctive tissue effect is not conventional fractional coagulation or ablation, but focal photomechanical disruption mediated by laser-induced optical breakdown (LIOB) and associated laser-induced cavitation (LIC), with vacuolization in epidermal and dermal tissue planes. This review synthesizes the translational evidence linking fractional optical delivery systems, histologic microinjury patterns, non-invasive imaging correlates, molecular repair pathways, clinical endpoints, safety across skin types and post-procedural care. PubMed-indexed literature was reviewed using search blocks for fractional picosecond lasers, LIOB/LIC, microlens and diffractive optical systems, optical coherence tomography (OCT), reflectance confocal microscopy (RCM), multiphoton and harmonic generation microscopy (HGM), wound healing, barrier repair, photoprotection and post-inflammatory hyperpigmentation (PIH). Current evidence shows that fractional picosecond systems can generate epidermal and dermal vacuoles, shockwave-associated optical signatures, melanin-dependent thresholds and remodeling responses involving matrix metalloproteinases (MMP), collagens, heat shock proteins (HSPs), cytokines, chemokines and barrier-related proteins. Clinical evidence is strongest for atrophic acne scars, photoaging, pores and selected non-acne scars, with increasing data in Asian and darker skin phototypes. However, the extent to which clinical outcomes are directly attributable to LIOB rather than combined photomechanical, photoacoustic and limited photothermal effects remains incompletely defined. Evidence-based aftercare remains underdeveloped. Conservative barrier support, strict photoprotection and avoidance of irritants are currently the most defensible post-procedural principles.
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CRediT authorship contribution
Stefan Bigge: conceptualization, methodology, investigation, formal analysis, writing – original draft; Bianca Bigge: clinical interpretation, critical revision, writing – review & editing. Both authors approved the final manuscript and agree to be accountable for the work.
Data Availability Statement
This review is based on published literature indexed in PubMed and other verifiable bibliographic sources.
How to Cite
Bigge, S., & Bigge, B. (2026). Fractional picosecond laser-induced optical breakdown in dermatology: from controlled microinjury and molecular repair pathways to clinical endpoints and post-procedural care. Laser Therapy, 33(2). https://doi.org/10.4081/ltj.2026.441
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