Which is better Q-switched or Q-switched ND YAG laser for best safest results for a black orange red tattoo for rework? (photo)

This is an excellent question.  Our office specializes in laser tattoo removal. We use the Alex Trivantage laser which is an excellent option for your black, orange and red tattoo.  The black ink can be removed precisely with the Q Switched 755nm or Q Switched 1064nm laser. The Alex Trivantage laser also converts the 1064 nm wavelength to a 532 nm wavelength via a process known as harmonic doubling with a potassium titanium phosphate (KTP) crystal.  This wavelength is designed to precisely target orange and red tattoo and we get excellent results with this laser.
If you would like to learn more about the procedure I recommend an in person consultation with a board certified dermatologist with cosmetic training.

Black inks are targeted by almost most laser tattoo systems as black ink absorbs all wavelengths.You can choose a picosecond laser like Picosure for black ink tattoos or others like RevLite or the Alex TriVantage.Red inks are difficult to treat and require a 532 nm laser (Q switched) or a picosecond laser like PicoWay - note that PicoWay is different than Picosure.Picosure targets blue and green inks and used high speed, high intensity laser that uses high pressure to disintegrate tattoo ink into very small particles that are cleared by the skin sooner. Pastels colors are more stubborn to treat with tattoo lasers and more than one laser system may be needed. Alex TriVantage has 3 wavelengths - 755 nm, 532 nm and 1064 nm, each with different advantages and so on. The 1064 nm laser is great for black ink tattoos as it spares the melanocytes in dark skin individuals and high Fitzpatric scales.

The Yag laser can be q-switched or long pulsed.   Only a q-switched laser would be used for tattoo removal, any experienced physician can help you with this question.  Your tattoo has dense pigment.  The black and red can be taken care of by the more routine q-switched nd-yag laser, sometimes the orange may be more stubborn.  In your case I think it is fortuitous that you are going for lightening, not removal, which would require many more treatments and many years.   Also, the laser can create a scar so in tattoos such as yours, the physician will start off with lower settings to ensure blistering and possible scarring do not occur.  Now we tend to space treatments two months apart, no sooner. The laser process takes time.   If you eventually cover it with another tattoo and ever with to treat it again with the laser, the physician will have to reduce the settings significantly as it has, due to the layering, much more pigment and is prone to blistering if too much energy is used.The pico-sure laser is a step forward it seems in tattoo removal, flashing faster than the normal q switched lasers, and theoretically with less tissue injury and clearing tattoos faster (twice as fast is their claim).  These lasers are expensive and thus treatments cost more.    Orange is a traditionally stubborn color to remove and the picosure claims better results.  The red will have to be treated with the traditional nd-yag q switched or similar laser.  Any physician with a picosure should have another laser to treat your red section.I advise my patients with such tattoos that it will take time to achieve lighteining.  To avoid scarring a conservative start to laser settings is important.

Thank you for your question and photo. I
recommend learning more about the Picosure laser in regards to permanently
removing your tattoo. This revolutionary new laser will not harm the
surrounding tissue while removing the laser. Good luck!