Q-Switch vs Pico on initial stages of tattoo removal?

Question

I recently did an upper and tattoo in black ink and tribal style. The next day I realized that I want to have it removed. I know I need to wait at least 6 weeks but I heard at a few places that it is best to start with QSwitch and then use Pico. Does this make sense or will I get better results if I start with Pico right away?

James Shire, MD · Answer

I have used both Q-switch and Picosecond lasers, and the Pico definitely requires fewer treatment sessions. In addition, with the Pico I seem to get better clearance (less ghosting), it's more effective on different colors of ink, there is no scarring and the sessions are quicker.  I would recommend finding an experienced doctor with a Pico laser. Also you will need to wait around 4 months after getting the tattoo to begin the treatments.

Mark A. Blair, MD · Answer

Hello, thank  you for your question.  Sorry to hear that you already regret your new tattoo.  Pico-second technology is the latest technology in laser tattoo removal.  The PicoWay Laser (Candela/Syneron) uses photoacoustic
impact/pressure waves rather than photothermal/heat.  This process has less heat, therefore it is
more comfortable and the chances of hyperpigmentation are less.  The Pico-second pulse shatters the ink into
even smaller particles, allowing the body to more easily absorb the ink.  This type of device can usually remove unwanted ink in about half as many treatments as the traditional Q-switch device.  There would be no reason to start treatments with a Q-switch device, as opposed to starting with the latest and best technology.  You can click on the weblink below and put in your zip code to "find a provider" in your area.
Good Luck!

Laura Riehm, MD · Answer

Thanks for your question.  Tattoo regret is very common.  Almost every tattoo can be completely removed with enough time and treatments.  The most important factor in laser tattoo removal is patience.  You have to give your body time to absorb the ink.  For laser tattoo removal you have two routes.  We are constantly asked to repair the damage caused by q-switch lasers.  Some damage is permanent.  Make sure you know all of the facts before you start.The older nanosecond or Q-Switch lasers that came out about 20 years ago.  The majority of former Q-Switch patients we see have significant hypopigmentation (ghosting) around and under their tattoo.  The Q-Switch lasers have trouble differentiating between the melanin in your skin and ink.  The technology uses heat to burn the pigment out of your skin.  In addition, we have seen patients with raised scars as if they have been branded.  Both of these condition are typically irreversible.  Picosecond laser came out about 4 years ago.  Every laser manufacturer has a different marketing hook to make you choose their laser.  At the end of the day, it's about the technology and experience of the clinician.  All PicoSecond lasers (like the Enlighten, PicoWay & PicoSure) fire 1000 times faster per second, using a pressure wave rather than heat to shear the ink molecules apart.  The hype of extra wavelengths does not make that much of a difference.  The 755 nm will get rid of most of the ink colors.  For red and pink ink, you would need to make sure they have 532 nm.  After using the PicoSure for 3 and half years, we have only seen pinpoint hypopigmentation in a very small number of patients usually of darker skin tones.  We cannot say it is impossible to get burned with a Picosecond laser, but it is highly unlikely.  We tell every PicoSure tattoo patient to expect at least 6 treatments, but don’t be surprised if it takes 10 to 12.  Patience is the key for our patients.  We typically see our tattoo removal patients every 8 to 12 weeks initially.  We eventually encourage them to wait up to 6 months as the tattoos seem to continue to fade while they wait.Treatment prices vary by market. The cost for picosecond treatments will be higher, but you should need less than half the treatments compared to a nanosecond laser.  The patch is only used with the older nanosecond lasers.  Best of luck

Richard Rosol, MD · Answer

I know no rationale for approaching laser tattoo removal this way. Since pretreatment with Q-switched lasers can complicate layer attempts with a picosecond laser, I’d say the opposite of the advice you heard is true.
You are probably best off with picosecond technology all the way. Find an experienced provider with medical training and who will properly numb you. Numbing is a good indication that your provider sees this as a medical procedure and that their patients should not have to endure unnecessary pain. 
Best of luck to you!
PS. I agree with Dr. Shire. Wait a good few months before starting treatments.

Glenn Messina, MD · Answer

Actually I use the Q switched constantly and do not use pico at all. Despite the hype there is no decrease in the number of sessions using pico and in fact in the initial sessions it is recommended that a Q be used. If the physician you are going to has both then go ahead start with the Q and transfer later on if not the Q has been the gold standard since 1962.

Q-Switch vs Pico on initial stages of tattoo removal?

Answers (5)

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