How to proceed after two unsuccessful PicoSure treatments: back to Q-switched or stick with PicoSure? Black tattoo (photo)

Question

I've started to remove my tattoo approximately 1,5 year ago - had 2 or 3 Q-switched treatments and then stopped for a year as I didn't have access to lasers at the time. Two months ago I continued with PicoSure and now after 2 treatments I don't see the results at all. It's been 4 weeks between 1st and 2nd and 7 weeks after the 2nd treatment now. My doctor told me the settings: 755 nm x 2,5. What do I do now - go back to Q switched or stick with PicoSure and hope it starts working?

Jason Emer, MD · Answer

It takes a series of treatments with laser tattoo removal and the amount of sessions needed can be variable. Tattoos should be removed with q switched or pico lasers. The Eclipse MicropenTR is an alternative. I recommend getting a formal evaluation with a tattoo removal expert. Best, Dr. Emer

Vicki J. Levine, MD · Answer

the Ruby laser which is 694nm is very good for black tattoos.However, if alot of pigment was put in and deeply it will be hard to rid of. Even 10 treatments may not work.Wait 2 months between treatments. I cannot tell if it is an arm or leg.Leg tattoos are harder to improve.

Brian Citro, MD · Answer

All tattoos are different and so are the lasers used to remove them. Black ink is best removed with a 1064 nm laser. The Picosure works best for greens/blues/reds, not black. I recommend a pico laser if there is one available near you. Cutera Enlighten, Piqo4, Picoway are all good choices. If you want the tattoo removed more quickly, consider the Describe Patch as well.

Jessica H. Kim, MD, FAAD · Answer

You need the 1064nm wavelength in either nanosecond (Q-switched) or picosecond (newest technology) pulse duration.  Picosure wavelength is 755nm and typically most effective for green ink.  Consult with a board-certified and experienced cosmetic physician.

Richard Ort, MD · Answer

I would treat with a YAG laser (1064 nm wavelength), either Q-switched or picosecond, rather than alexandrite.  Picosure is alexandrite (755 nm).  Also consider using the Describe patch which allows multiple passes with the laser in rapid succession.Regards,Dr. Ort

Steven F. Weiner, MD · Answer

This isn't entirely unexpected. The black tattoos respond best to a 1064 wavelength. Picosure is 755. I would find a specialist that offers the 1064 QS and/or Picosecond laser. I have the Piqo4 which is the most powerful tattoo laser and has both nano (QS) and picosecond pulse durations.

Lisa Vuich, MD · Answer

The lighting is different in the pictures, but it does look like you have had SOME clearing of ink. Your provider may need to make further adjustments to joules or to the spot size. Does your provider have 1064 picosecond capability on the PicoSure?
You could also consider having a treatment with a different device such as the Cutera Enlighten which has both picosecond and nanosecond capabilities, and 3 different wavelengths.
Best,
Lisa Vuich, MD

How to proceed after two unsuccessful PicoSure treatments: back to Q-switched or stick with PicoSure? Black tattoo (photo)

Answers (7)

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