"BRIGHTONE Multi-Pulse: 7 Years to an Answer"

A melasma protocol built on low fluence and stepwise escalation
"If you want multi-pulse, verify the sub-pulse waveform first"
532nm multi-pulse and sapphire cooling tip — what to expect from BRIGHTONE M

In the field of aesthetic medicine, high usage volume of a particular product or device is more than a mere number. It represents the accumulated know-how forged through countless procedures — and evidence that satisfied patients keep coming back. High usage means a corresponding track record of results, and that is simply impossible without patient satisfaction and trust behind it. Admittedly, large-scale clinics can inflate usage numbers through sheer physician headcount alone. What the Top Rankers series focuses on, however, is not the power of scale but the physicians who have built outstanding usage records in their own practices. We delve into their clinical philosophies, techniques, and even how they communicate with patients.

BRIGHTONE — Dr. Sangsoo Lee, Mirabel Clinic

The featured practitioner for the BRIGHTONE edition is Dr. Sangsoo Lee of Mirabel Clinic. He has been using LTRA GLOBAL's Q-switched Nd:YAG laser, the BRIGHTONE, as his primary device for seven years since 2019. The platform's core technology — Active Q-switching Multi-pulse, LTRA GLOBAL's patented method that distributes energy across up to six uniform sub-pulses at 25μs intervals — serves as the central pillar of his melasma treatment approach.

What makes his story particularly compelling is that his protocol has reversed course entirely over those seven years. In the early days, he pushed sub-pulse energy higher for more aggressive delivery; today, he has completely shifted to utilizing 6-Pulse mode in the low-fluence range. Despite having served as a clinical advisor for picosecond lasers and currently operating two pico platforms in parallel, he still maintains multi-pulse as his primary modality for melasma. We asked him why — and explored the clinical rationale behind his assertion that "many devices claim multi-pulse capability, but actually delivering uniform sub-pulses is an entirely different level of engineering."

Q. You have been named BRIGHTONE's Top Ranker. How do you feel about the recognition?

A. I think it is largely because I have been using the device since its earliest days, so I am grateful for the recognition. Over the years, LTRA GLOBAL and I have maintained an ongoing dialogue — continuously exchanging feedback, and even collaborating on experimental approaches that have not been commercially released. I believe this close working relationship is what ultimately led to the Top Ranker designation.

 

Q. What was the decisive factor behind adopting BRIGHTONE — then known as MIIN Laser — over other devices?

A. At the time, existing devices were limited to single-pulse or PTP (Pulse-Train-Pulse) modes at best. The core concept was to deliver sufficient energy without exceeding the tissue damage threshold, but even with PTP mode, sensitive or compromised melasma patients could develop rebound hyperpigmentation or mottled hypopigmentation. To lower the threshold further while still delivering adequate energy, you need to split the pulse into more fractions — and the MIIN Laser was the device that achieved that. Back then, it was the only option available, which naturally drew my attention.

 

Q. Your treatment protocol must have evolved considerably since those early days.

A. It has changed dramatically. In the beginning, I frequently tried pushing sub-pulse energy higher for more aggressive delivery. Now, I have completely shifted to working in the low-fluence range with 6-Pulse mode. For example, in situations where you would typically use a fluence of 0.7–1 J/cm², I set it at 2 J/cm² and distribute that across six pulses — the result is a much smoother, more stable treatment. Even with refractory melasma cases where there is concern about darkening, I can approach them without hesitation, and the need to agonize over endpoints has been substantially reduced.

 

Q. Compared to competing Q-switched Nd:YAG platforms, what objective advantages does BRIGHTONE offer in terms of beam quality and output stability?

A. I have been approached by several companies regarding their multi-pulse devices. Each time, I asked them to show me the data — to prove that their multi-pulse was real. Not a single company other than BRIGHTONE was able to demonstrate that all six sub-pulses are delivered at uniform peak power. Generating multi-pulse output itself is not that difficult — you just adjust the Q-switch timing. But delivering each sub-pulse at uniform peak power is an entirely different technical challenge. Many other devices max out at around 280 mJ per pulse and then split that into a Gaussian distribution pattern. BRIGHTONE achieves a uniform 350 mJ output, and I consider that to be its most significant differentiator.

 

Q. How do you utilize the 6-Pulse mode in clinical practice, and which lesions do you prioritize it for?

A. Melasma. In melasma treatment, even a slight excess of energy can paradoxically stimulate melanin synthesis, which is precisely why melasma remains the most challenging area in pigment treatment. I believe multi-pulse is the best available means of implementing the laser toning concept — suppressing melanin synthesis while minimizing tissue damage. The multi-pulse principle is not limited to lasers, either; it is being applied in needle RF and other modalities as well. In a published study conducted using ShenB's Virtue RF, for instance, it was confirmed that applying multi-pulse with the same total energy enables stable delivery of non-coagulative heat.

 

Q. When treating patients with sensitive skin or compromised barriers, how do you adjust your parameters and mode selection?

A. In patients with significant basement membrane disruption, the risk of adjacent tissue damage from shockwaves and cavitation during Q-switched irradiation increases, so lowering the fluence is critical. At the same time, you still need to deliver sufficient energy — and that is exactly where multi-pulse proves its value.

I always start melasma patients with multi-pulse first. If solar lentigines or other pigmented lesions are also present, I selectively increase the fluence for those areas. Finally, I use the Quasi-Long mode with a Genesis technique to deliver heat to the papillary dermis and promote basement membrane restoration — all within the same treatment session.

 

Q. For practitioners who are new to the device, what clinical endpoint would you recommend to minimize the risk of over-irradiation?

A. The clinical endpoint for Q-switched treatment is DPE — Delayed Perilesional Erythema. The skin should redden gradually over time; if immediate erythema appears, the energy is excessive. Even at the same fluence setting, individual responses vary significantly. Patients who have recently developed PIH (post-inflammatory hyperpigmentation), in particular, can flare up dramatically even at low energy levels.

The principle is clear: start with 6-Pulse at the least aggressive setting, observe the response, and then escalate stepwise through PTP and finally single-pulse modes. There is absolutely no need to start aggressively.

 

Q. When treating melasma, what are the non-negotiable principles you follow to prevent PIH or hypopigmentation?

A. Melasma is one of the pigmentary conditions with the highest melanin burden. Provoke it, and you get hyperpigmentation. Hit it too hard, and you get mottled hypopigmentation. Once hypopigmentation develops, laser toning must be stopped immediately. Aggressive treatment simply does not work for melasma. Since we cannot predict each patient's individual threshold in advance, the most important rule is to always start low, observe the response, and titrate the fluence upward accordingly.

 

Q. How do you view the clinical significance and limitations of using MLA and DOE handpieces for rejuvenation?

A. Think of MLA (Micro Lens Array) and DOE (Diffractive Optical Element) handpieces as fractional handpieces. The mechanism involves energy absorption by melanin and chromophores, followed by optical breakdown that generates plasma. Due to the nature of this process, penetration depth is inherently limited — primarily reaching from the epidermis to the upper papillary dermis, but not the deeper reticular dermis. So they can be helpful for fine periorbital wrinkles, but for deep wrinkles or scars, combination therapy with other modalities is essential. One important caveat is that erythema following MLA treatment can persist for approximately one week.

Q. Having also served as a clinical advisor for picosecond lasers, how do you combine pico platforms with BRIGHTONE's multi-pulse in practice?

A. I currently use two picosecond platforms alongside BRIGHTONE — Sudo Group's PICOLITE and Wontech's PicoAlex. Pico has a clear advantage when you need strong photomechanical fragmentation — as in tattoo removal. But for melasma, there are still uncertainties. Sometimes pico works well, but in other cases, hyperpigmentation flares up unexpectedly because the energy delivery is simply too intense.

So for sensitive patients whose pigmentation is fluctuating and darkening, I default to multi-pulse as the safest approach. When more aggressive fragmentation is needed, I alternate with pico Nd:YAG. In melasma treatment, a degree of photothermal effect is also necessary, but pico provides virtually none of that. Multi-pulse can harness the thermal component as well, which helps induce cytokine and growth factor secretion. Incidentally, I once suggested to a pico manufacturer that they develop a multi-pulse pico, but it seems to be technically extremely challenging.

 

Q. Are you actively utilizing the 532nm wavelength in clinical practice?

A. I used it extensively in the past, but since adopting pico, my use of 532nm has decreased considerably. Pico-generated cavitation is far smaller than what occurs at nanosecond pulse durations, resulting in less peripheral tissue injury and a lower risk of subcutaneous hemorrhage. That said, for practitioners who only have a Q-switched platform, 532nm multi-pulse could be a highly valuable addition — offering a stable treatment option for solar lentigines, café-au-lait macules, and similar lesions.

The implementation of 532nm multi-pulse was something that Dr. Haksoo Kim of Doctor Basic Clinic — a Key Doctor for the MIIN Laser — and I jointly requested from the company. We wanted to apply the concept of the Repeat Pulse Method proposed by Dr. Jaedong Lee of Misodam Clinic — a technique involving repeated low-fluence irradiation of the same area approximately four times — to the 532nm wavelength. I have been told that the upcoming next-generation model will feature 532nm multi-pulse capability.

 

Q. Could you share your combination protocol with skin boosters?

A. I recommend skin boosters at three-month intervals alongside laser sessions every two to three weeks. Personally, I believe any skin booster capable of improving the dermal environment contributes to pigment treatment outcomes. I recently started using Elravie Re2O, an hADM (human acellular dermal matrix)-based skin booster, and a 2026 study by Yonsei University researchers has reported that acellular dermal matrix contributes to melanogenesis suppression. Rejuran has similar supporting data. My expectation is that improving the dermal environment may help suppress melanogenesis. In practice, patients who receive concurrent skin booster treatments consistently show improvement in overall skin tone.

The most common combination I use is Rejuran HB Plus 3cc. For patients with budget constraints, I apply HA- and PN-based products, or cosmeceutical skin boosters such as CELEXO and K-Booster REJUVE Plus, delivered via MTS or similar methods.

 

Q. After more than seven years of continuous use, how would you assess BRIGHTONE's durability and after-sales support?

A. One of the inherent advantages of Q-switched platforms is that they rarely require servicing, and BRIGHTONE has not experienced a single malfunction since I began using it in January 2019. Gradual output decline is a natural phenomenon with any laser, but whenever the treatment response seemed inconsistent, a simple call brought the service team in promptly for recalibration. They also proactively notify me when a component is approaching its replacement cycle, so there has been no operational inconvenience whatsoever. The ability to operate at up to 15–20 Hz is another advantage, enabling rapid treatment delivery at low fluence settings.

 

Q. What is the most fundamental reason you have kept BRIGHTONE as your primary device for this long?

A. Durability and multi-pulse technology are the baseline, but what really made the difference was the company's open-minded approach. Whenever I wanted to try something new, they would discuss it with me, actually fabricate a handpiece prototype, bring it in for testing, and explore how it might be brought to market. Even attempting lentigo treatment with an unreleased Ruby handpiece was part of that collaborative process.

 

Q. What can you tell us about the upcoming next-generation model, BRIGHTONE M?

A. To the extent of what I know, a sapphire glass cooling tip will be integrated into the handpiece for epidermal cooling, and multi-pulse control will be expanded beyond 6-Pulse to include 2, 4, 6, and 8-pulse configurations. The feature I am most looking forward to is 532nm multi-pulse implementation. I have also heard that the Quasi-Long mode will offer a wider pulse duration adjustment range. As I mentioned earlier, the 532nm multi-pulse was something Dr. Haksoo Kim of Doctor Basic Clinic and I specifically requested from the company.

 

Q. With the range of options in pigment treatment expanding rapidly, how do you see the future of Q-switched Nd:YAG lasers?

A. Multi-pulse is definitively a valuable tool for refractory melasma. Picosecond lasers have limitations in melasma treatment — identifying the endpoint is difficult and the learning curve is steep. If erythema appears during pico treatment, the energy is already excessive. Q-switched multi-pulse, by contrast, can appropriately leverage the photothermal effect and offers a clear, readable endpoint, enabling safer treatment delivery.

In melasma management, the laser should remain the mainstay, with adjunctive modalities — RF, ultrasound, low-intensity shockwave therapy, skin boosters — serving as the plus-alpha that accelerates outcomes or mitigates side effects. Even the needle RF protocols that have been generating recent publications are, at their core, aimed at improving the papillary dermal environment to restore the basement membrane — which places them in the same conceptual family as the Genesis technique.

 

Q. As a Top Ranker, what practical advice would you offer to colleagues considering a Q-switched Nd:YAG purchase?

A. If you want multi-pulse, the single most important thing is to verify with your own eyes that the sub-pulses are delivered at uniform peak power. There are multiple devices on the market claiming multi-pulse capability, but when I requested sub-pulse waveform data from various manufacturers, the cases where truly uniform output was demonstrated were exceedingly rare. Before committing to a purchase, I strongly recommend requesting sub-pulse waveform data from the company and confirming through a hands-on demo that the 6-Pulse mode is properly implemented.