What is the most effective picosecond laser protocol for tattoo removal?: a series of 9 cases.

Laser-based procedures for tattoo removals are popular due to their high efficacy. However, multiple sessions are required to remove the tattoo satisfactorily. Various methods have been proposed to remove tattoos quickly. The objective of this study was to report nine patients who underwent tattoo removal using four different ways with a picosecond laser. The target site was divided into four areas, each of which received different tattoo removal protocols: picosecond laser alone, a modified R20 method, picosecond laser with MLA (microlens array) handpiece followed by picosecond laser, and picosecond laser after gel application. Clinical evaluations were conducted for all nine patients, focusing on clinical improvements such as tattoo fading and skin texture. The R20 method picosecond laser showed the most significant improvement in clinical evaluation. Histopathologic examination showed that the picosecond R20 treatment site had the least intradermal pigmentation. These case series provide further evidence to support the effectiveness of the R20 method of picosecond laser in histopathological examination and clinical improvement.