Safety and efficacy of standard PICO second laser alone and in combining with fractional picosecond laser in the treatment of tattoo removal - a prospective split study.

Tattooing is an ever-increasing phenomenon and has become an accepted form of beautification, self-expression, and art. As commonly as people get themselves tattooed, many of them seek its removal at some point in time. Lasers have superseded other older modalities of tattoo removal such as dermabrasion, salabrasion, chemical cauterization/ peel, cryotherapy, and surgical excision.

Laser therapy is the gold standard method to remove unwanted tattoos.1 It is available and widely accessible. In the 1980s, the vaporizing CO 2 and erbium:YAG lasers, and argon lasers, were used to remove tattoo pigment but again resulted in scarring.

Anderson and Parrish’s principle of selective photothermolysis revolutionized the treatment of tattoos.2 whereby an extremely short pulse width was delivered less than the thermal relaxation time (TRT) of a target.

The Q-switched laser has pulse duration in nanosecond (10-9 of a second). If the pulse duration is narrowed further, the peak energy of the laser beam becomes very high. The picosecond lasers have a pulse duration of (10-12 of a second).3 A variety of holographic or diffractive lens arrays can be used to produce fractional picosecond laser energy. These arrays allow the energy to be concentrated within laser microbeams, while neighboring tissue between the microspots is unharmed.4

Commercially available fractional optical delivery technologies include, diffractive lens arrays (DLA), micro-lens arrays (MLA), and holographic optical arrays.5 Nanosecond laser treatment relies mainly on photothermolysis rather than photomechanical effects; however, picosecond lasers rely mainly on photoacoustic destruction.6 This approach can enhance the energy transmitted to target cells within the lesion, and avoid thermal damage to surrounding tissues. 7

This results in more rapid heating of the tattoos and finer fragmentation. The lymphatic elimination of these finer particles is easier resulting in faster clearing of the tattoos.3 In 2012, the FDA approved the first picosecond laser for skin applications (Picosure, Cynosure, Westford, Massachusetts).8 The picosecond lasers with pulse durations in the range of 450–750 ps were introduced commercially in early 2013. At present, there are three or more systems with a wavelength of 755 nm and 1,064 nm and a pulse duration of 450–750 ps.8