PicoSure: Your Essential Questions Answered Here

By ETanghetti

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Laser tattoo removal was introduced in 1990, but hasn't changed drastically over the last two decades. The PicoSure laser, FDA-approved in 2012, purports to change all of this -- asserting the ability to erase your indelible (and regrettable) decisions in less time than other laser removal methods.

So, if you happen to be lamenting your ex's initials on the nape of your neck, you may want to read on. We've got the skinny on the most-asked PicoSure questions from dermatologist and PicoSure clinical researcher, Dr. Emil Tanghetti

What's the difference between PicoSure and older methods of laser tattoo removal?

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Certain colors of tattoo ink absorb laser light. With PicoSure -- the light gets absorbed, heats the tattoo ink and fractures the ink into little particles.

The difference is, that older laser devices just basically heated the ink. PicoSure both heats and fractures the ink so it works much more efficiently. PicoSure puts a laser pulse into the ink 8-9 times quicker than the older devices did.  

If you get something from the freezer and it’s glass and you stick it into a hot oven – it will blow it apart. That’s because you heat it up quickly.  And on the other hand, if you put that same frozen glass jar from the freezer and you slowly heat it up – it will dissolve.  

So, one device basically heats it up quickly and fractures the ink – and the other device goes more slowly and heats. They both work -- but one works much more effectively because it does both.

See also: PicoSure Tattoo Removal Treatment: A Real Story [VIDEO]

Tattoo removal can be painful -- do you think PicoSure is less so?

It is less painful -- it's because the Nd:YAG, a commonly used type of Q-switched laser, goes much deeper and affects nerve fibers which cause pain.

How many treatments can one expect?

Professional tattoos, maybe three or four. And amateur tattoos, a little less. It goes much more quickly, often twice as quick as the old device. But that’s a ballpark, it depends on the patient.  

What colors does PicoSure easily erase?

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If they have red tattoo ink, PicoSure won’t work. Yellow is difficult as well. That’s when you need a 532 device to treat the tattoo. You see the most dramatic improvement in green, blue and purple inks that were previously very difficult to treat. Now, you often get rid of them in one to two treatments. It’s incredible. A lot of my patients have been treated for years with older types of lasers and all of a sudden, with one treatment, everything is gone.

Are there other reasons why PicoSure wouldn't be your first choice?

If the patient's skin color is very dark – they may need a Nd:YAG laser. Patients that are deeply tanned may wait for the tan to fade, then would be appropriate candidates for the PicoSure laser.

What will my skin look like after a PicoSure session?

It depends. You can get a little light bruising or blistering if you’re trying to push fluence (or increase the amount of laser energy needed to remove the tattoo). You don’t want to have large areas of blistering, but if you have a deep tan or have very dark skin, there is more potential.

Why is a person more at risk for blistering with very dark skin?

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The PicoSure laser recognizes melanin (a naturally-occurring pigment responsible for skin tone) and melanin can absorb the laser light. If someone has very dark skin – there is more melanin and tattoo removal can be more challenging.

See also: 7 Ways to Avoid Tattoo Regret

What about lower extremity tattoos? Aren't they harder to remove with older laser methods? Does PicoSure make tattoos on the hands, legs and feet easier to remove?

I think any tattoo removal you do with any tattoo device is more challenging on the lower extremities -- you're dealing with circulation that isn't as robust as it is on the face or upper extremities. So, for example, you've got to understand that after you get tattoo removal on your leg, you probably want to keep your leg elevated when you are resting or not active.

Is treatment with the PicoSure laser less or more expensive than older laser removal methods?

It depends on what the physician's office wants to charge. My own PicoSure machine is a $300,000 unit, so obviously, the physician will have to cover some of the cost. The safety and efficacy of the PicoSure laser were the major reasons why I brought this machine into my practice.

Will the PicoSure laser scar my skin?

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I think scarring is based on a number of things. Scarring depends on the amount of ink, how deeply it's applied and what you do to care for it afterwards. All of those are equally important. 

Scarring is also prevented by using the appropriate fluence (or amount of laser power used to remove the tattoo). This is where a physician has to be careful. Scarring is unusual with tattoo removal -- but can occur if you overdo the fluence (or if the patient does not appropriately care for the tattoo removal site after treatment).

Since PicoSure technology is so new, I'm finding I have to do some research to locate it. Any suggestions on how to easily locate a PicoSure provider in my area?

Cynosure, the company that manufactures the laser, has names of physicians that provide the service on their website.

Have more questions about PicoSure? Ask a doctor in our Q & A section here!

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Comments (1)

I just read an article today that the picosure now also has FDA approval for acne scarring. Do you have any experience with treating with the focus lens?
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