Question 1

What is PicoSure laser?

Accepted Answer

PicoSure is a versatile, FDA-cleared laser that was originally used in dermatology to remove unwanted tattoos. More recently, it has emerged as a popular no-downtime skin rejuvenation treatment, which gently but effectively treats pigmentation concerns, fine lines, and acne scars.

This time-tested laser uses “pigment-seeking technology” to locate hyperpigmentation or ink. The device converts laser light energy into short, controlled pulses of pressure that break down excess melanin and tattoo pigment into more easily absorbed particles, which are then carried away by the body’s lymphatic system.

These bursts of laser energy take just a picosecond (one trillionth of a second), hence its name. Quick bursts reduce the risk of burns, so it’s suitable for all skin types.

Since picosecond lasers don’t generate much heat, they’re commonly used to treat melasma and benign pigmented lesions (like sun-induced brown spots) on heat-sensitive complexions, without worry of post-inflammatory hyperpigmentation.

The latest iteration of the device, the PicoSure Pro, was recently FDA-cleared for the treatment of challenging pigmentary conditions like melasma, nevus of Ota, and Hori's nevus.

When outfitted with a special lens that fractionates the laser beam, the picosecond laser can also stimulate collagen production, making it an effective solution for acne scars as well as fine lines and wrinkles. (It’s FDA-cleared to treat both.)

Question 2

How does PicoSure laser work?

Accepted Answer

On melanin and tattoo ink

The PicoSure laser offers three different wavelengths of light, so it can be used to remove pigment that’s deeply entrenched in the dermis, across a wide range of skin tones.

The 532 nm wavelength is most effective for red, violet, orange, yellow, and brown ink or pigment
The 755 nm wavelength removes green, blue, and black inks
The 1064nm wavelength targets black ink on dark skin

According to Dr. Emil Tanghetti, a dermatologist in Sacramento, California, the “PicoSure is the most popular laser to treat excess pigment in Asian skin. Several monthly treatments are usually recommended for optimal results.”

For wrinkles, acne scars, and skin rejuvenation

With the addition of the PicoSure Focus Lens Array handpiece (which fractionates the laser beam), the wavelength of 755 nm smooths wrinkles and reduces the appearance of scars by stimulating collagen and elastin production.

“The Focus Lens produces a localized area of epidermal injury commonly referred to as an LIOB (laser induced optical breakdown),” Dr. Tanghetti explains. “This injury appears to produce cytokines and chemokines, which induce the dermis to produce new collagen and elastic tissue. The LIOB will remove pigment in the epidermis over a series of treatments. The dermal stimulation will also remodel scars, including acne scars, and improve sun damage.”

Research on PicoSure shows:

It effectively treats signs of aging like fine lines, wrinkles, and pigmentation. In a study from 2017, in which participants were treated every month for four months with PicoSure, nearly 90% of physicians were extremely satisfied or satisfied with their patients’ results six months after treatment. Improvement scores showed that 32% of patients were very much improved, 29% were much improved, and 29% were improved.
It effectively treats acne scars. A 2015 study on treating acne scars with the PicoSure laser reported that, after six treatments, patients were satisfied to extremely satisfied with the improvement in appearance and texture at their final treatment and follow-up visits. According to researchers, the results are similar to those for a series of fractional ablative laser treatments.

Some doctors on RealSelf argue that PicoSure won’t work well on deep-set wrinkles, compared to a more ablative technology like the CO2 laser. However, Dr. Tanghetti says that “many of us combine the PicoSure with the Focus Optic with other modalities, such as RF microneedling, to enhance treatments, producing results that can be comparable to the CO2 laser.”

For Fitzpatrick skin types V and VI, he adds, this is the only device that can be safely used to treat acne scars.

Treatments for acne scars and wrinkles can be scheduled every three to four weeks. Results can sometimes be seen after only two treatments, but a series of three to five is recommended. Expect each session to run about 15 minutes

Question 3

What are the pros and cons of PicoSure?

Accepted Answer

Pros

There’s no recovery time post-treatment. You’ll be slightly flushed for a day or less following a skin revitalization treatment. After tattoo removal, you’ll have a wound with scabbing and dressings that need to be changed for the first week.
Picosecond lasers, like PicoSure, are more tolerable than most other skin rejuvenation devices—even without numbing cream. They may also be the least painful tattoo removal devices, according to a 2019 study.
The Focus Lens allows the laser to target both hyperpigmentation and textural irregularities, like fine lines and acne scars, in a single treatment.
The laser is proven effective at removing difficult tattoo ink colors, like orange, red, blue, green, yellow, and green. “There is no better laser to treat green ink,” says Dr. Tanghetti. “This has often been difficult to treat with any device. With the PicoSure, it's now our easiest ink to treat.”
PicoSure may be better at removing previously treated tattoos (even those treated multiple times) than traditional Q-switched lasers.
The laser can treat larger areas more quickly than other laser technologies. The applicator’s largest spot size is 15.5 millimeters, almost four times bigger than that of other lasers on the market.

Cons

There’s no guarantee that tattoos or unwanted pigment will fully disappear.
PicoSure alone may not be powerful enough to wipe out all signs of sun damage.
Fading a tattoo can be a lengthy process. Like all laser tattoo removal treatments, PicoSure takes multiple sessions to achieve maximum results. The typical tattoo removal treatment plan will include sessions every six to eight weeks. This will allow time for your skin to heal in between. The number of treatments varies widely, but your doctor will give you an estimate after your first session.
Repeat and maintenance treatments can get expensive.

Question 4

How much is PicoSure laser treatment?

Accepted Answer

PicoSure tattoo removal cost can vary depending on area size (larger tattoos will cost more) and if your tattoo has multiple colors.

For skin revitalization, PicoSure treatment costs will vary based on whether you’re targeting a small area or your whole face. Each session is roughly $400 to $600, and most patients need 4-6 treatments for optimal results.

Question 5

PicoSure before and after pictures

Accepted Answer

The PicoSure photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Question 6

Who’s a good candidate for PicoSure?

Accepted Answer

The best candidate is a non-smoker in good health aiming to treat widespread sun damage, remove excess pigmentation, or fade an unwanted tattoo that has already healed (at least six months from the tattoo date). Your tattoo can be any color and size.

PicoSure laser treatment isn’t recommended for some people. Discuss other options with your dermatologist if you:

Have an autoimmune disorder, including lupus or type 1 diabetes (type 2 may be acceptable, if it’s well controlled)
Have melanoma, an active infection (such as herpes), psoriasis, or eczema in the area being treated
Are pregnant or breastfeeding; there’s no research to suggest laser tattoo removal may affect your or your baby’s health, but it’s wise to not risk it
Have a tan; most practitioners recommend avoiding the sun or tanning (even using self-tanning creams) on the area for about four weeks prior to treatment
Have a history of keloid scarring

Additional precautions that may not exclude you from treatment but will be taken into consideration include taking blood thinners (anticoagulants can interfere with healing) and having a pacemaker or defibrillator.

If the tattoo you want to remove is right over or within six inches of a medical device, it can’t be treated with a laser.

Question 7

How do you prepare for PicoSure treatment?

Accepted Answer

Before giving you the go-ahead for treatment, your doctor will need to know about all existing conditions, any prescription medications or supplements you’re taking, and allergies you may have.

If you smoke, you’ll need to stop smoking at least two weeks before treatment.

You’ll also have to stop tanning a month prior to PicoSure. Having a tan can make it difficult for the laser to distinguish between the pigment you want to remove and the increased pigment in your skin from tanning.

Question 8

What happens during a PicoSure laser treatment?

Accepted Answer

A typical treatment lasts 10 to 30 minutes, depending on the size of the area you’re treating (discrete spots vs. full face); the size and colors of your tattoo; and the intensity of the ink or pigment.

For tattoo removal, the area can be anesthetized with injected lidocaine or a topical numbing cream. When treating sun damage or isolated age spots, numbing cream isn’t usually needed, but you can ask for it if you’re sensitive and you can spare the time. “Topical numbing cream has to sit on the skin for at least 30–45 minutes, to be of any use,” notes Grand Junction, Colorado, dermatologist Dr. Amy Paul.

Once you’re numb, you’ll be given protective eyewear.

Your provider will place the applicator unit against your skin and then move it across the treatment area, as it delivers quick bursts of laser energy.

After zapping a tattoo, your provider will likely apply antibiotic ointment, to prevent infection, and a nonstick dressing.

No topical is needed following PicoSure skin rejuvenation, but your provider may apply a soothing or antioxidant serum, plus sunscreen, before you head out.

Question 9

Does PicoSure hurt?

Accepted Answer

That depends on what you’re treating. Zapping sun damage and brown spots tends to be far more tolerable than treating unwanted tattoos.

Most patients compare the sensation of PicoSure to that of small rubber bands flicking the skin—but the discomfort can be greater for tattoo removal because of the larger area of ink pigment. Some patients say it’s even more painful than being tattooed, but your doctor can apply numbing cream before more aggressive PicoSure tattoo removal sessions, to help lessen the discomfort.

“Pain can limit people’s ability to tolerate aggressive treatment, and having to turn down the laser energy makes the treatment less effective and take longer,” says Dr. Paul.

Question 10

Can PicoSure completely remove tattoos?

Accepted Answer

PicoSure is more effective than previous tattoo removal technology, but it’s still recommended that patients expect only significant fading and not full removal.

Picosecond lasers like PicoSure are a big improvement over the Q-switched lasers that were invented years ago, according to Dr. Ronald Shelton, a dermatological surgeon in New York City.

However, he also notes that while they can be very effective at lightening tattoos in fewer treatments than older lasers, it can still take multiple sessions to significantly fade a stubborn tattoo with a pico laser.

Question 11

How long does PicoSure recovery take?

Accepted Answer

After skin rejuvenation or acne scar treatment

You won’t need true downtime after skin revitalization treatments, but you can expect some changes in your skin.

You’ll experience up to a few hours of minor swelling and redness, as well as a warm sensation.
You may feel like you have a mild sunburn, and some people notice a slight bronzing of the skin for up to 10 days.
Age spots treated with a PicoSure laser immediately turn pinkish-white, then darken and flake off after about a week (to prevent scarring, don’t pick at them).
Cleanse the treated area with mild soap, pat dry, and moisturize to promote healing.

RealSelf Tip: The longevity of your results will depend on how well you protect your skin from sun exposure as well as your aging process. Some pigment conditions can recur, and new ones can appear due to new sun damage or hormonal changes (for instance, melasma can be triggered by pregnancy, menopause, and birth control). For these, a PicoSure treatment can be spaced out every six months.

After tattoo removal

You won’t need to take recovery time after tattoo removal, but your provider will provide aftercare instructions to help ensure a smooth healing process. Here’s what you can expect:

The treated skin will be tender for a few days.
Keep the area clean, and apply a nonstick bandage until it’s healed. Dr. Tanghetti recommends using a gentle cleanser up to three times a day, followed by Vaseline or Aquaphor, and applying the nonstick dressing if the wound looks “weepy.”
Wait at least 24 hours before showering or soaking your treated skin, and avoid swimming pools and hot tubs until your skin is totally healed.
“After three to five days of ointment and dressings, patients are free to leave the treated area open to the air but absolutely must apply sunscreen to the area or risk damage and scarring,” advises Dr. Paul. The skin is still trying to heal at this point and is very sensitive.
You may also see blisters and scabs developing on the treated area. Make sure not to pick at the irritated skin, and keep it clean. It will dry up and flake off within two weeks of treatment. After each tattoo removal session, there will be less scabbing.

Question 12

Is PicoSure safe?

Accepted Answer

PicoSure is generally regarded as safe, but laser procedures can have side effects.

When used for skin rejuvenation, the safety profile of the PicoSure compares to that of most other nonablative lasers (which don’t remove the top layer of skin); the risks are largely related to the person performing the treatment. For the best outcome, see a board-certified dermatologist or plastic surgeon who has experience treating a range of skin types, tones, and conditions with PicoSure.

Even though the laser is considered suitable for all skin tones, there’s still a risk of hyperpigmentation or even burns on olive, brown, or deep skin tones, since “the melanin can sometimes absorb the laser light,” says Dr. Tanghetti. “Using air cooling can help minimize this risk to some extent.”

With tattoo removal, “there can be swelling, heat, pinpoint bleeding, and even some small blisters after treatment, so treating the area like a wound is safest,” says Dr. Paul. These are temporary, lasting only a few days at most.

An article in the Journal of the American Academy of Dermatology on reducing the risk of pigmentation changes on dark skin during tattoo removal also recommends applying “a refrigerator-cooled, nonstick, clear hydrogel dressing … over the tattoo immediately before treatment and lasing … through [the] hydrogel dressing.” This helps reduce scarring or pigmentation issues by absorbing heat, and it can also make the procedure more comfortable.

Question 13

What are the alternatives to PicoSure?

Accepted Answer

For tattoo removal

PicoWay: The PicoWay laser is FDA-cleared to remove tattoos and treat benign pigmented lesions, along with acne scars and wrinkles. It offers three wavelengths and a number of unique handpieces.

The laser uses photoacoustic energy to achieve its effects without thermal damage. Like PicoSure, PicoWay is a nonablative device that requires a series of treatments—four to five monthly sessions—to see optimal results.

Some doctors on RealSelf say that the PicoWay, with its shorter pulse duration, treats tattoos faster, more efficiently, and with less discomfort than the PicoSure.

Q-switched lasers: Commonly used in dermatology practices, “these are safe, effective, reliable tattoo removal lasers that patients have been happy with for years and years,” says Dr. Paul.

Traditional Q-switched lasers like the ruby, alexandrite, and Nd:YAG remove discoloration and sunspots by releasing laser energy in short, nanosecond bursts. Hyperpigmentation clusters in the dermis absorb the heat, which breaks up the discoloration. The lasers vary in effectiveness and safety for dark skin tones.

For skin rejuvenation

Clear + Brilliant: Dubbed “baby Fraxel,” the Clear + Brilliant is a light fractional resurfacing laser that can ramp up collagen production while brightening the skin and subtly improving its overall texture. It’s best for those with only mild sun damage and a series of treatments is usually needed for best results.

Though the Clear + Brilliant generates more heat than picosecond lasers, some doctors find it gentle enough to treat melasma. The PicoSure has more data supporting its efficacy for the treatment of acne scars, which experts say speaks to its collagen-boosting powers.

Downtime after Clear + Brilliant is similar to that with picosecond lasers—generally a day or less of pinkness followed by a gritty skin feel that lasts a couple days.

Fraxel Dual: One of the most popular skin revitalization devices in dermatology, the Fraxel Dual is a nonablative resurfacing laser that, by definition, treats only a fraction of the skin, leaving behind untouched columns of tissue that help aid in healing.

By combining two wavelengths, the laser works both superficially (to clear the epidermis of sun damage) and deeper, to stimulate collagen production in the dermis.

Downtime with the Dual is more extensive than with picosecond lasers—usually a week of redness, swelling, darkening, and peeling—and single-treatment results are more dramatic.

The Fraxel Dual is not generally recommended for those with brown or deep skin tones (Fitzpatrick skin types V and VI).

Question 14

Sources & studies

Accepted Answer

Alabdulrazzaq, Hamad, et al. “Clearance of Yellow Tattoo Ink with a Novel 532-Nm Picosecond Laser.” Lasers in Surgery and Medicine, vol. 47, no. 4, 2015.

Bäumler, W, and K T Weiß. “Laser Assisted Tattoo Removal - State of the Art and New Developments.” Photochemical & Photobiological Sciences : Official Journal of the European Photochemistry Association and the European Society for Photobiology, U.S. National Library of Medicine, 13 Feb. 2019.

Brauer, Jeremy A., et al. “Successful and Rapid Treatment of Blue and Green Tattoo Pigment With a Novel Picosecond Laser.” Archives of Dermatology, vol. 148, no. 7, 2012.

Brauer, Jeremy A, et al. “Use of a Picosecond Pulse Duration Laser with Specialized Optic for Treatment of Facial Acne Scarring.” JAMA Dermatology, U.S. National Library of Medicine, Mar. 2015.

Feng, Hao, et al. “Application of Cooled Hydrogel Dressing to Minimize Dyspigmentation from Laser Tattoo Removal.” Journal of the American Academy of Dermatology, vol. 81, no. 3, 2019.

Saedi, Nazanin, et al. “Treatment of Tattoos with a Picosecond Alexandrite Laser: a Prospective Trial.” Archives of Dermatology, U.S. National Library of Medicine, Dec. 2012.

Shah, Swapnild, et al. “A Prospective Open-Labeled Study of Tattoo Removal with Q-Switched Nd:YAG Laser Utilizing the R0 Technique and Correlation with Kirby–Desai Scale.” Journal of Cutaneous and Aesthetic Surgery, vol. 12, no. 2, 2019.

Weiss, Robert A, et al. “Safety and Efficacy of a Novel Diffractive Lens Array Using a Picosecond 755 Nm Alexandrite Laser for Treatment of Wrinkles.” Lasers in Surgery and Medicine, John Wiley and Sons Inc., Jan. 2017.

PICOSURE

Emil A. Tanghetti, MD

Jolene Edgar

Emil A. Tanghetti, MD

Jolene Edgar

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	PicoSure nonsurgical	PicoWay nonsurgical	YAG Laser nonsurgical	Clear + Brilliant nonsurgical	Fraxel Laser nonsurgical
Worth It Rating	92%	100%	43%	57%	71%
Average Cost	$1068	Not yet available	Not yet available	$1150	$1433
Downtime	No downtime	Minimal downtime	3 to 7 days of social downtime	No downtime	Up to 1 week of downtime
Anesthesia	Topical or local anesthesia	No anesthesia	Local anesthesia	Topical anesthesia (if needed)	Topical anesthesia

Emil A. Tanghetti, MD

Jolene Edgar

Emil A. Tanghetti, MD

Jolene Edgar

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