No Results After Picosure Session?

I've received two tattoo treatments for a black tattoo, one R20 and one Picosure. R20 resulted in significant fading after 1 session. For my next treatment, the technician suggested Picosure. 3 weeks later, I've noticed no fading at all. Is Picosure less effective on black tattoos or on certain people? Is it possible that the setting on the machine was too low? Does it take longer than 3 weeks to see any change? I'm reluctant to continue with Picosure after such a poor result.

Doctor Answers 6

Picosure laser didn't work for black ink tattoo

It is not surprising that the Picosure didn't work for the black ink of your tattoo. It is a 755nm wavelength and 1064 is needed for black inks. I prefer to use the Piqo4 laser for tattoos because it has 4 wavelengths including the 1064 laser and has both nano and picosecond pulse durations. It also has the highest power of all the tattoo lasers. Picosure is great for green inks mainly. 

I actually use a R0 protocol and gets rid of the 20 minute wait. I use something called PFD, which gets rid of the frosting so the laser can be used almost immediately again. Keep in mind that multiple passes of the laser can only occur if the skin can tolerate more treatment and the skin type is light. My experience has shown that 4 passes of the laser doesn't equate to 4 treatments. It is closer to possibly 2 treatments.

Panama City Facial Plastic Surgeon
4.7 out of 5 stars 41 reviews

Results of Picosure

Picosure is a great laser for removing certain colors, but if your tattoo is very colorful you will most likely require a combination of lasers to try to fully remove it. Factors that affect tattoo removal are the amount of ink, depth of placement, tattoo location and the patient’s own ability to clear the ink following treatment. It works best on dark(blue, black, purple, green) ink. There is 95%+ Tattoo Removal Effectiveness.

Hardik Soni, MD
Summit Emergency Medicine Physician
5.0 out of 5 stars 45 reviews

Laser Tattoo Removal Richmond VA PicoSure


Sorry to hear about your disappointing result with PicoSure. I have had excellent results with the Pico on almost all tattoo colors, except red and some oranges. 

I doubt it was the laser that failed you. It was more likely that improper settings were used for the spot size and subsequent energy level. In the PicoSure, the spot size is controlled by the operator and the energy is fixed by the laser's computer. 

If an improper setting was used, you would not have results. At 3 weeks, you certainly should have seen some results. 

My advice would be to find a surgeon or dermatologist with a PicoSure who does their own treatments and has experience with the laser.

Everyone will tell you that their laser or technique is the best. The real truth is that every laser and technique has it advantages and disadvantages. R20 is effective at rapid removal of ink, but has higher risks of pigmentation changes. PicoSure is awesome for most ink colors, but not effective on red and some orange colors. Pico is not safe for very dark skin. Get as much info as possible from experienced physicians and then make your decisions. 

I hope this is helpful and you have successful removal of your tattoo. 


Dr S

Travis L. Shaw, MD
Richmond Facial Plastic Surgeon
4.8 out of 5 stars 22 reviews

R20 tattoo removal faster than Picosure

Your experience illustrated the fact that the R20 method of tattoo removal faster than Picosure and better for removal of red ink when a Q-Switched YAG laser is used.  R20 method produces results up to 4 times faster than traditional methods.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Picosure Results

The R20 method you refer to requires retreating a given area every 20 minutes for up to four passes per session.  While this strategy may improve clearance times with Q-switched lasers it may also increase the possibility of unwanted side effects like scarring or hypopigmentation.  At Hall Plastic Surgery in Austin, TX we often see patients who utilized R20 with Q-switched lasers and had less than desirable outcomes. The PicoSure™ laser goes beyond photothermal technology by utilizing a rapid pulse which creates a pressure wave to more effectively shatter tattoo ink into the smallest of particles.  If your Q-switched laser technician recommended PicoSure™ for you they may feel it is warranted based upon your specific skin type or tattoo.  Spot size and technique may need to be adjusted by your PicoSure™ operator to best suit your situation.

Jeffrey W. Hall, MD
Austin Plastic Surgeon
4.5 out of 5 stars 18 reviews

PicoSure laser results

We have been using the PicoSure for over a year and a half as we performed the original trials that led to FDA clearance. In our studies and subsequent experience with our treating physicians, all patients noticed improvement within a week or two. I wouldnt give up after one session. Perhaps your doctor could modify the technique to provide you a better outcome.

Roy G. Geronemus, MD
New York Dermatologic Surgeon
3.9 out of 5 stars 16 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.