Medical beauty review | Picosecond laser: the "gold standard" in tattoo removal

2025.06.04

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In the field of tattoo removal, picosecond laser is known as the gold standard for tattoo treatment due to its excellent performance. However, in actual clinical applications, the tattoos we face vary greatly in size and color. So, for these tattoos of different colors, are there differences in the treatment effect of picosecond laser? Is there a better treatment method? Next, let us explore it in depth.


PRINCIPLE AND MECHANISM

Principle and mechanism of tattoo removal by picosecond laser


Picosecond laser is a laser with an output pulse width at the picosecond level. Common working wavelengths are 755nm, 532nm and 1064nm. Thanks to its extremely short pulse width, picosecond laser can release extremely high peak power in an instant. This feature enables it to produce photoacoustic effect (or photomechanical effect) when acting on tattoo dye particles or melanin particles, crushing these particles into smaller particles. After such treatment, the crushed particles are easier to be cleared by chromophilic cells such as macrophages, and the inflammatory response during the treatment is relatively mild.


Compared with traditional Q-switched lasers, picosecond lasers have shown better efficacy in the treatment of tattoos and most pigmented diseases, and the incidence of adverse reactions is also lower. According to the "Expert Consensus on the Clinical Application of Picosecond Lasers", the evidence level for the treatment of tattoos with picosecond lasers has reached level 1a , which is the highest level among all its indications, fully demonstrating its authoritative status and gold standard status in the field of tattoo removal. In addition, the "Guidelines for the Diagnosis and Treatment of Common Diseases Related to Laser Cosmetology (2024 Edition)" also clearly pointed out that picosecond lasers are the first-line solution for tattoo treatment. Although Q-switched laser is also one of the main means of tattoo removal, it usually requires more treatments than picosecond laser.


In clinical work, common tattoo colors mainly include dark blue or black, red and yellow, green and colored tattoos.


EFFECT INVESTIGATION

Effect of Picosecond Laser Treatment of Tattoos of Different Colors


A study of 77 tattoos in 59 patients provided us with valuable reference data. Among these tattoos, there were 21 blue-black tattoos, 17 black tattoos, 21 red tattoos, and 18 green tattoos. In the study, blue-black, black and green tattoos were treated with a 755nm picosecond alexandrite laser, while red tattoos were treated with a 532nm picosecond Nd:YAG laser. It is worth noting that if the dye turns red or yellow during the treatment of blue-black, black and green tattoos, a 532nm picosecond Nd:YAG laser will be used instead. Only one instrument was used for each treatment.

The instruments and parameters used for treatment are as follows: picosecond alexandrite laser (PicoSure, wavelength 755nm) and picosecond Nd:YAG dual-wavelength laser (PicoWay, 532nm band). The specific treatment parameters for 77 tattoos will be determined by comprehensively considering factors such as the patient's age, tattoo color, skin type, and the actual endpoint response during the treatment process. The treatment interval is set at 2-3 months, and the patient will be followed up for 3 months after the treatment.


From the table data obtained from the above research, we can clearly observe that the cure rate of the blue-black tattoo group is 76.2%, the cure rate of the black tattoo group is 70.6%, and the cure rate of the red tattoo group is as high as The cure rate of the green tattoo group was 88.9%, and the cure rate of the green tattoo group was 85.7%, among which the green tattoo group performed best in terms of efficacy score. The results of this study strongly indicate that it is crucial to choose the corresponding laser wavelength when treating tattoos of different colors. Usually, the 755nm wavelength laser is mainly used for dark tattoos such as black, blue and green, while the 532nm wavelength laser is mainly suitable for red and yellow tattoos. However, in actual clinical operations, for patients with dye color changes, the treatment plan should also be flexibly adjusted to suit different situations.


OPTIMAL TREATMENT MODE

How to choose the best treatment method according to the tattoo color


Dark blue or black tattoos: These tattoos are generally more sensitive to laser treatment. For patients with light skin, Q-switched and picosecond 755nm alexandrite lasers, Q-switched 694nm ruby lasers, and Q-switched and picosecond 1064nm Nd:YAG lasers are effective in removing tattoos. However, for patients with darker skin, longer wavelength lasers, such as picosecond 755nm and 1064nm Nd:YAG lasers, are safer and more reliable.


Red and yellow tattoos : For patients with darker skin, the use of 532nm wavelength requires extra caution. Because at shorter wavelengths, melanin in the epidermis will absorb more laser light, increasing the risk of postoperative pigment changes. However, there are a few studies that show that picosecond frequency-doubled 532nm Nd:YAG lasers may be safe and effective for red and yellow tattoos under selected treatment parameters.


Green Tattoos: The Q-switched 694nm ruby laser is widely considered the wavelength of choice for treating green tattoos. However, this wavelength should be used with caution for those with darker skin types. In addition, Q-switched and picosecond 755nm Alexandrite lasers have also shown good results in removing green tattoos.


Colored Tattoos: When faced with colored tattoos that include multiple colors, multiple lasers are often required to achieve the best removal results. Generally, the black outline of the tattoo can be treated with a Q-switched or picosecond 1064nm Nd:YAG laser. After the black pigment is removed, the remaining red or yellow ink in the tattoo can be treated with a Q-switched or picosecond 532nm frequency-doubled Nd:YAG laser. If the tattoo ink is green, it can be treated with a Q-switched 694nm ruby laser or a Q-switched/picosecond 755nm alexandrite laser. In addition, a 650nm Q-switched Nd:YAG laser with a dye-containing handpiece can also be used. During the treatment process, if the tattoo ink shows a noticeable frosty reaction immediately after treatment, it usually means that the selected laser wavelength can effectively lighten this color.


In short, picosecond lasers play a vital role in the field of tattoo removal, but for tattoos of different colors, the reasonable selection of laser wavelengths and the development of personalized treatment plans are extremely important for improving treatment effects and reducing the risk of adverse reactions.


References:

1. Observation on the efficacy and safety of 755 nm and 532 nm picosecond lasers in removing tattoos of 4 different colors

2. Expert consensus on the clinical application of picosecond lasers

3. Diagnosis and treatment guidelines for common diseases related to laser beauty (2024 edition)


Foremed Legend


The core founding team of Suzhou Foremed Legend Medical Technology Co., Ltd. comes from well-known universities at home and abroad such as Peking University. Foremed Legend focuses on the design, development and application of high-end medical beauty optoelectronic equipment based on compliance and product strength, and is committed to becoming a leading company in the field of high-end medical beauty optoelectronic equipment, a provider of integrated intelligent solutions for diagnosis and treatment, and a pioneer of medical beauty data integration platform.

Through the development of a series of underlying key technologies, Foremed Legend has independently developed a number of high-end medical devices, including picosecond laser therapy devices, long pulse laser therapy devices, intense pulsed light therapy devices, photoacoustic imaging skin detection devices, and cold air therapy devices, and continues to deepen the research and development of core product technologies, using better technical solutions to benefit the vast number of beauty seekers.

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