What is the most effective picosecond laser protocol for tattoo removal? A comparative study by histopathologic review

Abstract

Background Picosecond lasers have become widely adapted as the mainstay of tattoo removal due to their faster heating of target chromophores and consequently more effective tattoo removal. Different protocols for tattoo removal using the picosecond laser are actively being studied. Our investigation focuses on the R20 method: repeated exposure to laser light at 20-minute intervals in a single session. Several preliminary studies have shown that R20 technique could be effective in reducing treatment time while maintaining efficacy.

Objective This study aims to compare different picosecond laser techniques in clearing tattoos.

Methods and materials Three patients with tattoos (1 on foot, 2 on arms) underwent skin biopsy followed by laser tattoo removal. The target site was divided into 4 areas, each of which received different protocols: picosecond laser alone, R20 method, picosecond MLA followed by picosecond toning, and picosecond laser after gel application. The protocols were all performed five times at 1-month intervals. After treatment completion, 1 patient underwent biopsy of all four treatment sites while the other 2 underwent biopsy only at the R20 treatment area.

Results Histopathologic evaluation showed that the R20 treatment site had the least remaining intradermal pigmentation. Picosecond MLA followed by picosecond toning laser was shown to have the following best outcome.

Conclusion Our report compares skin biopsy findings before and after laser treatment and clinical results for tattoo removal. Although the number of cases is small, our preliminary findings suggest that the Pico R20 is favorable for tattoo removal.