What is a picosecond laser?

A picosecond laser is a laser device that uses ultra-short pulse durations to precisely target endogenous pigmentation and exogenous ink particles, such as tattoos. The laser medium varies according to the wavelength used, typically employing a neodymium-doped yttrium aluminium garnet (Nd:YAG) crystal at 532 nm or 1064 nm, or an Alexandrite crystal at 755 nm.

What are the indications for a picosecond laser?

The primary indication for picosecond laser treatment is tattoo removal. Depending on the wavelength, picosecond lasers are particularly effective at clearing blue and green pigments, which are often difficult to remove with other laser systems. They are also beneficial for tattoos that are resistant to treatment with traditional Q-switched lasers.

Picosecond lasers have also been reported to be effective in the treatment of various pigmentary disorders, including melasma, naevus of Ota, naevus of Ito, minocycline-induced pigmentation, and solar lentigines.

In addition, some picosecond laser systems are equipped with fractionated handpieces that promote tissue remodeling. These are commonly used in the treatment of acne scarring, photoageing, and rhytides (wrinkles).

What are the contraindications to picosecond lasers?

As with other laser devices, picosecond lasers are relatively contraindicated in patients with darker skin tones (ie, Fitzpatrick skin types 4–6), as these individuals are more susceptible to laser-related adverse effects.

Picosecond lasers operate with pulse durations of less than 1 nanosecond, producing predominantly photoacoustic effects—light pulses that generate measurable pressure changes (ie, sound waves)—rather than photothermal destruction of pigment or ink particles, which is associated with heat generation. This mechanism allows for effective clearance of abnormal pigmentation while minimizing photothermal damage to surrounding tissues.

Why choose a picosecond laser?

A picosecond laser selectively targets and destroys pigment while preserving healthy surrounding tissue. This enables rapid clearance of abnormal pigmentation with minimal collateral damage.

When used for tattoo removal, picosecond lasers typically require fewer treatment sessions, produce fewer adverse effects, and result in shorter post-procedure downtime compared with nanosecond Q-switched lasers. They are also capable of clearing certain tattoos that are resistant to other laser therapies, with a lower risk of scarring and hypopigmentation.

However, the higher cost and limited availability of picosecond lasers relative to Q-switched systems currently restrict their widespread adoption.

What are the side effects and risks of picosecond lasers?

Picosecond laser treatment is generally well tolerated. Potential side effects include pain, erythema, oedema, pinpoint bleeding, crusting, blistering, scarring, post-inflammatory hyperpigmentation, and post-inflammatory hypopigmentation. The severity of these effects may increase if excessive fluence levels are used during treatment.