Dense black tattoo with raised lines - Will Picosure work at complete removal? (photo)

Question

I'm starting Picosure treatments, looking to remove the two visible areas of this tattoo (not the area toward the back of the arm). Some of the areas are very dense black and the artist laid the ink in heavy so some skin is raised (scarring I guess?). I was wondering what I can expect those areas to look like and if anyone could give me an estimate of number of treatments? What's worst case scenario in terms of a remnant? Also any tips to helping the process toward success?

Harold J. Kaplan, MD · Answer

Hi ABS.  What your provider did not tell you is that the Picosure wavelength (755) is not the most ideal type of light for your tattoo.  It may very well take you more treatments with this type of laser than it would with a different type of laser - the q-switched Nd:Yg (1064).  This is the most effective type of light for the dark ink you have.  There are lots of different brands of tattoo removal lasers, but we like the Medlite C6 or the Revlite.  Both are good solid lasers for removing dark ink like you have.  With that shiny type of ink, you may be between 8-12 treatments.  With your light skin, it's very possible to get removal without any residual scarring, but the fewer treatments you have, the higher the risk of scarring.  In other words aggressive treatments increase the chance of scarring while decreasing the number of total visits.  Good luck.

Carmen Doty-Armstrong, DO · Answer

You made the right choice by selecting a provider that uses the PicoSure laser for tattoo removal. Although no one can guarantee you how many sessions it will take to completely clear your tattoo, the PicoSure will likely clear it in half the number of treatments compared to Nano-speed lasers and with better overall results. Best of luck!

Hardik Soni, MD · Answer

Thank you for your question and photograph. Picosure
laser is a good option to have this tattoo removed as it is safe and effective
and there is a low risk of scarring regardless of the tattoo’s size. This
treatment works best on dark inks like black and dark blue which gives you an
effective permanent result. I recommend you see an expert in order to determine
the best treatment plan for you. All the best!

Hratch Karamanoukian, MD, FACS · Answer

Thank you for the picture.It is unfortunate that you have developed scarring from aggressive tattoo ink.Black inks are ideal with nearly all laser tattoo systems, as opposed to blues, greens, red ink and pastels. So, this is fortunate for you.You can choose a picosecond laser such as Picosure or several other nanosecond lasers on the market which should be just as effective. We use the Alex TriVantage for such tattoos in our laser office.

William Kirby, DO, FAOCD · Answer

Black ink responds best to an Nd:YAG (1064nm) and the red/orange will require a 532nm. Green responds well to an Alexandrite (including the PicoSure). Blue responds best to a Ruby laser (694nm). Anyone who tells you differently is incorrect and doesn't understand basic laser principals. Good luck!

Michele S. Green, MD · Answer

A great deal of my patients have tattoos that they regret and wish to have removed.  I have two other lasers that I prefer to the picosure for this type of tattoo removal.  Please be sure to find a dermatologist with a great deal of experience with tattoo removal for the best results.

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