PicoSure Lasers

There are two qualities that make the new PicoSure laser different from the currently used nanosecond (q-switched) tattoo removal lasers. The first is that the light from a PicoSure laser has a wavelength of 755nm. This just means that it is a red light. That wavelength (755nm) has historically been used to treat green and bright blue ink, though it can treat black ink as well. I have had a 755nm laser for 8 years. Several years ago, I tried to use it on black ink, and, although it did remove the ink, I was very unhappy with the final results. That laser took a lot of the natural skin color out of my patient’s skin, and left them with a “white” tattoo of what they used to have inked. Contrary to what the PicoSure representative told me, I know from personal experience that that whiteness does not resolve quickly. I have not used my 755nm laser to treat black ink for the past 6 years because of this unacceptable side effect. We use other lasers with other colors of light that are much safer and still very effective.

The other difference in the PicoSure laser is that it turns on and off faster than the currently used lasers; the theory is that this is supposed to remove more ink. The PicoSure laser turns on and off in 750 picoseconds which is equal to three-fourths of a nanosecond. Previous experience with the currently used lasers showed that if the laser turned on and off in 20 nanoseconds or 2 nanoseconds, the tattoos didn’t come out any better. Given that fact, I am reluctant to believe that a laser that turns on and off in three-fourths of a nanosecond will do much better. So far the only examples of tattoo removal using the PicoSure laser have been provided by the company that makes the machine. I look forward to seeing the results of independent studies to see if there really is a difference in removal. I especially want to see if the final results are acceptable. My patients would rather come in for a couple more treatments and have a completely removed tattoo with normal skin, then come in a couple less times, but have to live with a “white” patch of skin that everyone recognizes as an old tattoo. One last concern I have with the new technology is that the pictures shown to the public look fantastic, but the pictures shown to us physicians at conferences are much less impressive. Here is one such picture shown at a medical conference held at Rutger’s University in 2013.

Over the past several years, there have been many failed attempts to improve tattoo removal. Thus far, with one exception, all of the new techniques and technologies that initially looked promising, in the end, failed to improve the removal process. It would be great if this new laser really works. I will watch for the future studies to come out. The way all medical studies work is that the first one or two will look very promising, then the next few will be the most reliable studies to prove if something really works or not. It’s going to take 2-3 years before we know for sure. I personally believe, based on my past personal experience, that as it stands now, the risks associated with this new laser outweigh the potential benefits, so I will not be getting a PicoSure laser in the near future. I will continue to use what I know is safe and effective.

Statement composed by Mike Towey, MD Fellow of American Society for Laser Medicine and Surgery