Removal of resistant tattoo ink
A Q switch laser with 1064 and 532 nm wavelengths is usually sufficient to remove blacks and reds, but if you are not seeing further clearing after additional treatments it may be that you have resistant ink and/or ink that is deeper than the reach and power of the system you are being treated with. Lasers do vary in their peak power and their ability to treat resistant inks, and picosecond lasers are no exception. In fact, they sacrifice some power for the speed of impulse which is sometimes a problem. A ruby laser such as the Astanza Eternity is excellent in treating resistant black ink. The hypopigmentation is of course a separate issue. If it is going to bounce back in my experience it does so within a few months. You might want to consider having the area treated with medical microneedling with PRP (platelet rich plasma) to see if you can encourage repigmentation.
Lisa Vuich, MD