What are my options if picosure does not work? (photo)

Question

It's almost been a year since I began picosure laser tattoo removal on the back side of my arm. My tattoo from day 1 was only an outline in black ink. I just had my 6th session and my doctor says I will need about 2 more. It has faded very slowly, and I can still see the entire tattoo clearly. I'm so worried that it will be very noticeable, because my doctor didn't sound very confident.. what do you think

John L. Burns Jr., MD · Answer

This unfortunately can take numerous treatments.  Given the amount of pigment left I would say you will likely need more than the recommend/suggested 2 more treatments.  Many patients require upwards of 20 treatments.

Daniel J. Ritacca, MD · Answer

From my professional experience I prefer the PiQo4 laser for black pigment. This laser uses picosecond technology and has 4 wavelengths including the 1064 wavelength which is ideal for black pigment. I have been practicing tattoo removal for 20 years and have 5 different Pico wavelengths. Dr. Daniel Ritacca

Richard Ort, MD · Answer

Picosure is a picosecond alexandrite laser with wavelength of 755 nm.  My preferred laser for black ink is Nd:YAG laser at 1064 nm wavelength.  You could try treatment with Nd:YAG laser, either traditional Q-switched Nd:YAG or Picoway which is a picosecond Nd:YAG laser.  1064 nm laser penetrates deeper than a 755 nm laser.  Regards,Dr. Ort

Sejal Shah, MD · Answer

My suggestion is to try the Enlighten laser, or even try the Revlite-we use both of these in my office and have seen great success with black inks.  The wavelength of the Picosure, 755nm, does not specifically target black and you will likely benefit more from trying a laser that is 1064nm.Good Luck!Dr. Shah

H.L. Greenberg, MD · Answer

We use the RevLite SI to treat unwanted tattoo ink- it is a 1064nm Q switched Nd:Yag laser that fires in the nanosecond range.  I love our machine, but it will take a number of treatments for the ink to go away, whether it's a Picosure, Picoway, Nanosecond laser or other therapy.  A lot of factors come in to play, including the location of the tattoo, the amount of ink present and the color of the ink.  I have some patients who have had 2 years of treatments.  If the tattoo does not go away, options include a CO2 laser, dermapen and other microneedling techniques.  Have patience, your tattoo looks to me to be healing perfectly.

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