PicoSure Advanced Tattoo Laser Removal Q&A

For years, variations of Q-switched lasers have dominated the tattoo removal industry. PicoSure, a new tattoo removal laser device from Cynosure, arrived on the market with the promise of removing tattoos in fewer treatments with less pain. But does it really work?

TattooHealth.org interviewed Kelly Wala, an experienced aesthetic nurse who utilizes PicoSure at Austin-based Westlake Dermatology, to get her thoughts on PicoSure and how it compares to earlier generations of tattoo removal options.

Can you give us an idea of how long you have been using the PicoSure laser and approximately how many tattoos you’ve removed using the system?

We started using the PicoSure in May 2013. We have had many patients start the series of treatments since that time. Due to the time frame between treatments (typically 4-6 weeks apart), we have totally treated eight tattoos to date.

Can you give us an overview of the laser in general? How does it differ from Q-Switched technology?

The PicoSure laser has an ultra-short pulse duration, which goes beyond photothermal action, creating an intense photomechanical impact and resulting in a greater disruption of the ink for better clearance with fewer treatments. Picosecond pulse width is 100 times shorter than a nanosecond. The Q-switched does treat pigment, but at a much slower rate or pulse width, so it takes more treatments to remove the tattoo. Some patients have had 25-30 Q-switch treatments and still do not have full tattoo clearance.

The PicoSure brochure promises full removal in far less treatments than older lasers. Is this true in your experience? What percentage of tattoos would you say get fully removed in 4-6 treatments?

It really depends on how new the tattoo is and how much ink was used for the tattoo. If the tattoo is older and is just a word (black ink based text), we can usually get that cleared in 3-4 treatments. If the tattoo is large and has a lot of shading and dark color variations, it could take anywhere from 6-10 treatments. If it is a newer tattoo, it could take 6-8 treatments, because the ink has not had time to fade.

PicoSure also promises less pain, both during and post treatment. How painful is the laser? Do you get a lot of patient feedback in terms of pain compared to older lasers?

Undergoing the PicoSure treatment (much like Q-switch treatments) is just as painful as getting a tattoo done. In terms of pain, the difference between PicoSure and Q-switch is that with PicoSure there is no pain after the treatment is complete. With Q-Switched treatments some patients can experience pain and blistering for weeks after treatment.

Also, the PicoSure treatment itself is much faster than Q-switch because of the increased pulsation of the laser. We can treat a 4x4 inch area of a tattoo in about 5-10 minutes, whereas Q-switch treatments could take 30 minutes or longer. So, a shorter procedure time means a shorter time experiencing pain.

Does PicoSure work for all colors/multi-colored tattoos?

Yes, the PicoSure can remove all colors, even the blue and green inks that sometimes pose issues for older technologies.

Can people with darker skin tones be treated using PicoSure?

Unfortunately, PicoSure is only approved for Fitzpatrick skin type’s I-III. The laser cannot be used on people with darker skin tones as there is a chance of hypopigmentation.

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