Lasers for Tattoo Removal: Picosecond vs. Nanosecond

Abstract

Introduction: Picosecond lasers (PSL) are proposed to clear tattoos faster than nanosecond Q-switched lasers (NSL). This review compares efficacy and side effects. Methods: Seven split-tattoo comparative trials (n=312). Outcome: percentage clearance at 4 weeks after final treatment (average 4 sessions). Results: PSL achieved 68% clearance vs 52% for NSL (p=0.01) for black ink. For multicolored tattoos, PSL was superior for blue and green (difference 25%), not red. Hypopigmentation occurred less with PSL (4% vs 12% for NSL). Discussion: PSL’s shorter pulse duration generates photoacoustic rather than photothermal effects, reducing thermal damage. Most studies were industry-funded, a potential bias. Conclusions: PSL offers modestly better clearance and lower dyspigmentation risk, but cost may not justify small benefit for black ink tattoos.