Pico-Laser

In short: Pico-laser, laser that operates with an ultra-short pulse duration of picoseconds (10⁻¹² seconds); The 1/1000 shorter pulse interval of the Q-switched nanosecond laser maximizes mechanical fragmentation while minimizing thermal damage. It provides safe, effective treatment with minimal downtime for all skin types for melanin, tatu pigment, benign lesions and acne scars.

Description

Pico-laser (picosecond laser, picosecond laser) is a high-power laser system based on photomechanical fragmentation technology that has revolutionized medical aesthetics and dermatology. While conventional Q-switched lasers operate with a pulse duration of nanoseconds (10⁻⁹ seconds), the pico-laser produces ultra-short pulses of 1/1000 of a nanosecond, 10⁻¹² seconds (picoseconds). This minuscule time difference creates a radical change in laser physics:

Thermal vs. Photomechanical Mechanism: Q-switched lasers break down tatu pigment or melanin with “heat” — the pigment absorbs, heats up, breaks down. However, some of this thermal energy also passes to the surrounding healthy cells, creating the risk of scar, erythema and postinflammatory hyperpigmentation (PIH). Pico-laser, on the other hand, provides pulses in a shorter time interval than the thermal relaxation time required for the heating of the pigment, thanks to its ultra-short pulse. Result: the pigment "explodes" with a sudden, mechanical force, "fragments" (disintegrates), and cell damage is minimal.

Laser-Induced Optical Breakdown (LIOB): Another mechanism of pico-laser used in acne scars and skin rejuvenation is dermal plasma formation called laser-induced optical breakdown. The ultra-high energy pico-pulse creates a momentarily plasma in the dermis layer — this "micro-explosion" triggers a controlled collagen remodeling and neocollagenesis (production of new collagen). Result: the depth of the scar decreases, skin texture improves, pores tighten.

The pico-laser system was first brought to market with FDA approval by Cynosure in 2012 (PicoSure brand — 755 nm Alexandrite wavelength). In the following years, contemporary devices such as Candela (PicoWay - multi-wavelength), Cutera (Enlighten) and Quanta (Discovery Pico) followed and the indications (areas of use) were gradually expanded.

Pico-Laser Physical Principle and Photomechanical Fragmentation

Pulse Duration and Thermal Relaxation Time: The "thermal relaxation time" of a melanocyte (melanin-producing cell) or tatu pigment particle of the skin is between 250-1000 nanoseconds (10⁻⁹ seconds). If laser energy is concentrated on the target pigment during this time period, the pigment heats up, expands, explodes and fragments (thermomechanical fragmentation). However, the same heat also leaks into the surrounding collagen, cell membranes and blood vessels, causing cell death and scarring.

The Q-switched laser provides pulses of 10⁻⁹ seconds, while the pico-laser provides pulses of 10⁻¹² seconds. 1000× shorter pulse = NO enough time for pigment heating. Instead, instantaneous photoelectric and photomagnetic forces act on the pigment particles—the pigment explodes, breaking apart, creating a "photoacoustic wave" and mechanical fragmentation. Heat leakage into the environment is minimal — "minimal collateral thermal damage" (environmental thermal damage is minimized).

Dermal Plasma and LIOB Mechanism: The powerful pulses of the pico-laser can momentarily create an electromagnetic breakdown in the dermis layer — if the internal electric field of the tissue reaches a critical level, an ionized gas is formed inside the tissue: plasma. This plasma creates a micro-explosion (micro-cavitation), creates controlled dermal trauma, triggers fibroblast activation, collagen remodeling and neocollagenesis. Fractional pico-laser creates this LIOB at multiple points in a raster (grid) pattern, providing skin rejuvenation with "fractional photomechanical injury".

Pico-Laser Devices and Wavelength Options

1. Cynosure PicoSure (755 nm Alexandrite)

The first pico-laser device to receive FDA approval in 2012, it is still the dominant system on the market. It uses a 755 nm wavelength Alexandrite laser. Wavelength profile: in the red-to-infrared spectrum (red-ultraviolet infrared), melanin absorption optimal, dermal penetration 1-2 mm. Application: tatu removal (all colors), pigmentary lesions (lentigo, freckle), melasma toning. PicoSure Focus Lens Array, for fractional mode — for acne scar, texture improvement. PicoSure starting price ~$80,000 USD; Cabinet cost per device is high, clinical profitability is low.

2. Candela PicoWay (1064/532/785 nm Multi-Wavelength)

Multi-wavelength system FDA approved in 2014. Three separate laser modules: 1064 nm (Nd:YAG, deep dermal penetration), 532 nm (frequency-doubled, superficial-medium), 785 nm (diode, melanin selective). Advantage: targeting all pigment colors in one device (melanin absorption spectrum wide 400-1000 nm), adaptation to all skin types. PicoWay Focus (fractional), acne scar and texture treatment. Price: ~$60,000-90,000 USD, more modular design.

3. Cutera Enlighten (1064/532 nm Dual-Wavelength)

FDA 2014. Enlighten, two wavelengths: 1064 nm Nd:YAG + 532 nm frequency-doubled harmonic. Feature: Cutera's proprietary "R20 Rapid Handpiece" — fast repeat pulses (20-hertz rapid-fire), speed advantage in tattoo removal. Tatu, pigment lesion, melasma. Enlighten Plus (2016) add-on: gen-2 technology for dermal rejuvenation.

4. Quanta System Discovery Pico (1064/532 nm)

Italian manufacturer, 1064+532 nm wavelength pico-laser. Compact design for regional distribution. Tatu, pigment, melasma indications.

Wavelength Selection Criteria: Optimum wavelength according to pigment color (melanin absorption peak): melanin peak ~700-800 nm (755 nm optimal), hemoglobin (red) ~420-545 nm (532 nm optimal), tatu pigments: black/dark gray (1064 nm), red (532 nm), blue/green (1064/755 nm), yellow (532 nm). The choice of pico-laser device is determined by which pigment colors you will treat.

How to Apply

1. Consultation and Tatu Analysis: In case of tatu: what are the colors, how old (old pigment more resistant), depth (dermis vs. epidermis), tattoo quality (professional vs. amateur, amateur pigment has larger particles). Patient's expectations: complete erasure etc. palliation. Fitzpatrick skin type classification: I-III (light skin) etc. IV-VI (dark skin) — is there a risk of PIH in dark skin? Disease history: keloid history (risky), active infection, isotretinoin (contraindication before 6 months).

2. Preparation and Anesthesia: The skin is cleaned with an antiseptic (chlorhexidine or povidone-iodine). Topo anesthetic cream (lidocaine 5%) or local block injection (1% lidocaine + epinephrine). Pico-laser is painful (may be more painful than Q-switched — photomechanical "snap" sensation acoustic wave), anesthesia is mandatory. Protective glasses, device and doctor glasses; infrared-absorbent goggles (suitable for laser wavelength).

3. Test Pulse and Fluence Setting: A test pulse is applied to the hidden area (masked area), and target pigment disintegration is observed. The energy level in Fluence (joules/cm²) is set sequentially — target fragmented pigment, peripheral erythema minimal. Tatu hide red/green colors are more resistant, the fluence may be higher (typically 8-15 J/cm² for all colours). Acne scar / fractional mode: 2-4 J/cm² lower energy, fractional grid (50-70% coverage).

4. Laser Application Technique:

• Non-Fractional (Tatu Deletion): The handpiece is held perpendicularly (upright) on the skin. Fast, overlapping passes — each pass overlaps 10-20% of the previous one. Pulse rate: at the rate allowed by the system (10-20 Hz typical). Laser stamp technique, raster (grid) pattern, or linear sweeping—according to physician preference. Result: gray-white "frost" appears in the pigment area — a sign of dermal plasma formation.
• Fractional Pico (Scar + Rejuvenation): Fractional handpiece (holographic lens array, similar to PicoSure Focus) creates multiple micro-spots — 50-70% skin coverage in a grid pattern, interspersed untreated areas to aid dermal healing. Number of passes: 2-4 passes, depending on physician patient tolerance and end-point. Dermal plasma, LIOB via micro-cavitation, fibroblast response ← neocollagenesis → skin quality improves.

5. Post-Application Maintenance: The area is immediately cooled with ice (ice pack) — swelling, pain reduction. Lightly moisturize (fragrant-free), SPF 50+ sunscreen absolute. First 24 hours: no heavy make-up, vigorous washing. Weekly öff-label steroid cream (betamethasone 0.1%) if there is a risk of PIH (in dark skin). Average 3-8 sessions for tatu removal, depending on tatu color/age (old = fewer sessions, new = more). Between sessions: minimum 6-8 weeks (pigment elimination + skin recovery).

Indications

Tatu Deletion (Tattoo Removal): The main indication of pico-laser. Superiority: More effective disintegration against Q-switched, resistant colors (brown, green, blue, metallic). While Q-switched 40-50 sessions may be required, pico-laser 3-8 sessions are sufficient. Minimum of 6-8 weeks between sessions (let the immune system eliminate the pigment). Tatu type: professional vs. amateur (amateur larger pigment particles, more resistant), colors and depth. Complete deletion etc. Mitigation: stated in consultation.

Benign Pigmentary Lesions:

• Lentigo (age spot): Solar lentigo (epidermal melanosis). Pico-laser non-fractional mode, epidermal melanin targeting (532 nm or 1064 nm), fluence moderate (4-8 J/cm²), 1-2 sessions. Result: the stain lightens or disappears completely.
• Freckles (ephelid): Benign melanotic macule, epidermal. Similar treatment, 1-2 sessions.
• Melasma (Chloasma): Dermal/epidermal melanosis, hormonal. Pico-laser “laser toning” — low fluence (2-4 J/cm²), multiple sessions (6-10), weekly or biweekly interval. Mechanism: melanin fragmentation + fibroblast stimulation (collagen remodeling) reduces melasma brownness. Caution: risk of postinflammatory hyperpigmentation (PIH) in Fitzpatrick IV-VI — careful patient selection.

Acne Scars (Atrophic Scars): Fractional pico-laser (Pico Focus, holographic lens), dermal collagen remodeling with LIOB mechanism. Clinic: sunken acne scars, boxcar, rolling and icepick types. Fractional Pico 2-4 sessions, 4-6 weeks. Result: scar depth can be reduced by 30-50%. Combination: fractional pico + microneedling (after 2 weeks) + filler (temporary volumization) provides a synergist effect.

Skin Rejuvenation and Texture Improvement: Fractional pico-laser for general facial collagen remodeling. Indications: large pores, fine lines, dull skin, post-inflammatory erythema. 3-4 sessions, monthly interval. By-product: all pigmentary lesions can also heal.

Stretch Marks (Stretch Marks): Dermal collagen disruption. Pico-laser (especially fractional mode) reduces the color and depth of the stretch mark by collagen remodeling. New (erythematous, red) etc. old (white/atrophic) — red striea is more responsive to laser. 3-6 sessions.

Pore Tightening and Antiwrinkle (SMAS Tightening Effect): The dermal thermal effect of fractional pico (there is even a minimal thermal effect) triggers collagen contraction. The result: pores appear tighter, fine lines fade. T-zone, perinasal areas are ideal.

Contraindications

• Pregnancy and Breastfeeding: Insufficient safety data; not applicable
• Active Infection: Presence of open wound, herpes labialis, bacterial folliculitis at the application site — spread of infection + treatment failure
• Isotretinoin (Accutane) Usage: Not applicable, should be discontinued at least 6 months before — acute photosensitivity, atypical wound healing risks
• History of Keloid/Hypertrophic Scar: Laser injury may trigger keloids; Relative contraindication or applied with extreme caution
• Photosensitive Drugs (Doxycycline, Tetracyclines, NSAIDs high dose): Relative contraindication; physician decision
• Severe Immunosuppression: Slow healing, risk of infection
• Metallic Implant Area: Permanent metal implant in the application area (e.g., gold threads, permanent eyeliner, tattooed eyebrow) — risk of metal absorption of laser energy, thermal injury. Also pay attention to temporary gold-based dermal fillers.
• Recent Sunburn or Tan: Increased epidermal melanin, risk of PIH — wait 2-3 weeks

Duration of Effect and Recovery

Tatu Deletion Timing:

Pico-Laser Tatu Removal Session Progression

session	Tatu View	Pigment Fragmentation (%)	Waiting Between Sessions	Immune Elimination Duration
baseline	Full color, solid tatu	0%	—	—
1. After Session	Graying, fragmented appearance	30-50%	6-8 weeks (minimum)	4-8 weeks (immune clearance)
2. After Session	Significant fading, light pigment residues	60-75%	6-8 weeks	6-10 weeks
3. After Session	Very faint, barely visible	80-90%	6-8 weeks	8-12 weeks
4-8. sessions	Complete deletion or minimal remains	95%+	Between 6-8 weeks	12+ weeks

Stage-by-Step Healing Process:

Day 0 (Practice): After pico-laser, the skin is red, hot. Edema begins upon gray-white "frost" appearance. Patient "shock reaction" — sign of normal, laser-induced plasma/acoustic wave.

Days 1-3 (Early Phase): Erythema may peak. There may be slight "crusting" in areas of pigment fragmentation — but less crust with pico-laser than with Q-switched because thermal damage is minimal. Mild swelling, pain. Ibuprofen + topical moisturizer (fragrance-free).

Week 1-2 (Beginning of Pigment Clearance): Erythema decreases. The pigment fragment is absorbed by the lymphatic system (immune clearance begins). Macroscopically: tatu "dusty" (powder-like), greyish, faded appearance. The skin is almost normal.

Weeks 2-6 (Active Immune Elimination): The immune system (macrophages, lymphocytes) "eats" the dermal pigment fragment. Tatu gradually becomes lighter. After weeks 4-6, visible fading appeared. The patient's "next session" is scheduled after 6-8 weeks.

6-8 Weeks (Internal Session): Pigment clearance is 80% complete. In the new session, the remaining pigment disintegrates. Cycle is repeated.

Acne Scar/Rejuvenation Healing:

Day 0-1: After application of fractional pico, redness in the microgrid, minimal edema. The thermal sensation is mild.

Week 1-2: Erythema gradually decreases. Collagen remodeling START — fibroblast activation at the microscopic level. The skin may feel slightly "rougher" (normal, new collagen deposition).

Week 3-4: The erythema has mostly resolved. Neocollagenesis maximal. The depth of the scar may appear to have diminished. The patient is told that "the result will be optimal after 6-8 weeks."

Week 4-12: Collagen remodeling continues. After 3-4 sessions, scar improvement is clearly seen at 30-50%. Some scars may need repeat sessions or combination therapy (microneedling, fillers).

Risks and Side Effects

Common (Mild, Transient):

• Virtue and Pay (Redness, Swelling): 24-72 hours, no problem. Less cust, cleaner recovery than Q-switched.
• Pigmentation Waffle (Raster Marks): After fractional pico, the grid pattern may be slightly visible — it usually fades within 1-2 weeks. Minimal/cosmetic problem.
• Transient Hyperpigmentation: In certain patients (Fitzpatrick III-IV), mild temporary darkening in the first weeks. Normalizes in 2-4 weeks.
• Pain/Discomfort: Pico-laser is painful; Anesthesia is mandatory. Post-operative pain is minimal (ibuprofen is sufficient).

Moderate-Serious (Rare, less than 1% with Experienced Physicians):

• Postinflammatory Hyperpigmentation (PIH): The most serious risk is in Fitzpatrick IV-VI. Laser injury → dermal inflammation → melanin production overactivity → skin darkening (for weeks or months after treatment). Prevention: low fluence on dark skin, patient topical steroid cream (betamethasone 0.1%), SPF 50+ religiously. Treatment: hydroquinone + tretinoin, azelaic acid, time. More common than complications, but treatable.
• Postinflammatory Hypopigmentation (PIpO): Reverse situation — skin lightening, depigmentation. Very rare, rare with pico-laser. Prevention: excessive fluence, no repeat sessions. Correction: difficult; topical therapies (tacrolimus) + long-term sun protection + cosmetic camouflage.
• Allergic Granulomatous Reaction: When tatu pigment (special inorganic pigments with allergenic potential) breaks down, dermal granuloma may occur. Clinical: firm nodule, slightly pruritic. Rare, not like PLLA/PMMA filler. Treatment: intralesional steroid injection, laser removal, surgical excision rare.
• Infection (Very Rare): If technical / post-care standards are poor, bacterial secondary infection. Prevention: sterile technique, proper post-care instructions.
• Temporary Tattoo "Eyebrow" Darkening: During tatu removal, melanin + tatu pigment breaks down and the unnoticeable "shadow" or darker appearance may be temporary - 2-4 weeks fade.

Tatu Deletion Specific Risks:

• Ink Particles Traveling (Rare): Fragmented tatu pigments can theoretically travel through the lymphatic system and accumulate in regional lymph nodes. Clinical significance is minimal, but occasionally colored columns ('tattoo pigment tracks') may be observed.
• Explosive Release of Pigment: Excessive fluence will cause the pigment to "explode" and "splash" may occur. Protective glasses and patient counseling are mandatory.
• Resistive Inks / Non-Responsive Tatu: Some tatu pigments (special industrially-graded pigments, those containing heavy metals) are resistant to pico-laser. Total removal is 80-90% possible, leaving 10-20% persistent shadow. It should be explained in consultation.

Pico-Laser vs. Q-Switched Nanosecond Laser Comparison

Pico-Laser vs. Q-Switched Laser — Technological Comparison

Parameter	Pico-Laser (10⁻¹² sec)	Q-Switched (10⁻⁹ sec)	Advantage
Pulse Duration (Pulse Width)	10-100 picoseconds	20-100 nanoseconds	Pico: 1/1000 shorter = more precise mechanical damage
mechanism	Photomechanical (LIOB, mechanical fragmentation)	Thermomechanical (heat + mechanics)	Pico: minimal thermal, pigment particles smaller fragmental
Thermal Relaxation Hazari	Minimal (pulse < thermal relaxation time)	Medium-high (pulse ≥ thermal relaxation time)	Pico: less skin damage, low risk of PIH (especially IV-VI skin)
Number of Tatu Deletion Sessions	3-8 sessions (depending on tattoo age, color, depth)	40-50 sessions average	Pico: 40-50% fewer sessions
Resistant Colors (Brown, Green, Blue)	Superior (755/532/1064 nm options, better fragmentation)	Medium-weak (black/grey optimal, color pigment less responsive)	Pico: metallic, resistive pigments break down better
Downtime	2-3 days minimal (minimal crust, less erythema)	5-10 days (crust, erythema more)	Pico: faster social recovery
Pigment Fragment Size	100-500 nm (very thin, immune clearance fast)	1-10 microns (larger, slower immune clearance)	Pico: macrophage absorption more effective
PIH Risk (Fitzpatrick IV-VI)	Low (5-10%)	Medium-high (15-30%)	Pico: safer on darker skin
Atrophic Scar / Rejuvenation	Yes (Fractional mode + LIOB collagen stimulation)	Minimal (scar improvement is not an indication)	Pico: scar treatment primary use
Device Cost (USD)	$60,000-150,000	$30,000-100,000	Q-switched: cheaper to start, higher pico ROI across a variety of indications
Patient Comfort	Painful ("snapping" sensation, photoacoustic wave)	Painful (thermal "hot" sensation)	Subjective; pico pain quality "sharp" different

Summary: Pico-laser shows technical superiority over Q-switched in the indications of tatu removal, resistant pigment, dark skin and atrophic scar. Q-switched is still adequate and cost-effective for black tattoos and simple pigment lesions. Selection is made according to device cost, patient volume, indication portfolio.

Alternatives and Combination Therapies

Alternative Technologies (Instead of Pico-Laser):

• Q-Switched Nanosecond Laser: Discussed in previous section — more convenient, similar result but more sessions
• Intense Pulsed Light (IPL): For benign pigment lesion (lentigo, freckle) — broad-spectrum light, non-laser. Not as accurate as Pico, but more cost-effective after ruling out malignant risks
• Topical Laser Refractive Surgery (TLRS) / Chemical Abrasion: For lentigo, superficial lesion — creams (hydroquinone, tretinoin, azelaic acid). Slow but non-invasive
• Excision + Reconstruction: Very large, congenital nevus—definitive but scar trade-off
• Microdermabrasion / Dermaplaning: Texture improvement, fine line — non-laser alternative

Combination Therapies (Synergistic):

• Pico-Laser + Microneedling: Acne scar treatment. Fractional pico → 2 weeks recovery → gentle microneedling maximize collagen induction. Synergy: LIOB (pico) + mechanical injury (needle) = maximal dermal remodeling.
• Pico-Laser + Topical Retinoids: Post-pico, tretinoin/retinol regimen (1-2 weeks later) increases collagen remodeling and maximizes melasma toning effectiveness.
• Pico-Laser + Chemical Peel: Lentigo/melasma treatment. Pico → 1-2 weeks → light chemical peel (lactic/glycolic acid) epidermis remove + remaining pigment. Combined indication rare.
• Pico-Laser + Radiofrequency (RF) Microneedling: Maximize rejuvenation. RF collagen contraction (thermal) + pico LIOB (photomechanical) = comprehensive remodeling.

Pico-Laser Devices: Clinical Technology Differences

Handpiece Type: Fractional vs. non-fractional — mandatory in fractional (holographic lens array) acne scar / rejuvenation, optional in tatu removal (but non-fractional is for faster tatu's). User ergonomics: light handpiece, fast treatment time, intuitive menu.

Fluence Range (Adjustable Energy): 2-15 J/cm² typical. Wide range provides physician flexibility — low fluence (dark skin at risk of PIH), high fluence (resistant pigment, accelerated treatment). Display clear, real-time feedback.

Cooling System: Cryogen (cold gas) blow, contact cooling, or air cooling for dermal protection. Cryogen (e.g., similar to Zimmer air chill) is ideal, highest patient comfort.

Wavelength Flexibility: Single (755 nm Alexandrite, PicoSure) etc. Multi-wavelength (1064/532/785 nm Candela PicoWay). Multi-wavelength coverage is more versatile, but the device is complex. Single-wavelength, fine for initial clinics (tatu, pigment lesion dominance).

Spot Size and Contact Area: 2-12 mm spot size, large areas treated quickly. Large spot (8-12 mm) tatu removal, small spot (2-4 mm) precision work (eyeliner, eyebrow).

Related Terms

• Q-Switched Nd:YAG Laser
• Laser Hair Removal
• Fractional CO2 Laser
• IPL (Intense Pulsed Light)
• PicoSure Device
• PicoWay Laser
• Tattoo Removal Treatment
• Acne Scar Treatment

Frequently Asked Questions

Q: Can tatu be completely removed with pico-laser?
A: Yes, mostly. Professional tatu, with standard pigments, complete removal or light residue (5-10% visible "shadow") after 3-8 sessions. Some old, deep, amateur tatu's can be erased 80-90%; Minimal shadow may remain. It is important to explain this initially in the consultation — the patient's expectation management.

Q: How much swelling will there be after pico-laser?
A: Minimal — less than Q-switched. 24-48 hours slight redness + optional minimal edema. Crusting less than Q-switched. Social recovery 2-3 days, oh my.

Q: How many sessions does pico-laser cost?
A: Tatu removal: 3-8 sessions, 6-8 weeks depending on the tatu color and age. Pigment lesion (lentigo, freckle): 1-2 sessions. Melasma toning: 6-10 weekly sessions (biweekly). Acne scar: 3-4 sessions, monthly. Total cost: number of sessions × session fee (typically ₺1,500-3,000 per session tatu, ₺1,000-2,000 rejuvenation in Türkiye).

Q: Does pico-laser pose a risk of PIH (darkening)?
C: Fitzpatrick I-III (light skin): very low (2-5%). Fitzpatrick IV-VI (dark skin): moderate (5-15%), but lower than Q-switched. Prevention: low fluence, post-op topical steroid (betamethasone 0.1%), SPF 50+ daily. If PIH occurs: hydroquinone + tretinoin cream, time (3-6 months recovery).

Q: Is Pico-laser painful?
A: Yes, the "snapping"/"popping" sensation — the acoustic effect of a photomechanical wave. Thermal "hot" pain in Q-switched; "sharp snap" is different in pico. Anesthesia is mandatory (topical lidocaine cream or local block). Post-pain is minimal.

Q: Is pico-laser safe on dark skin?
A: Yes, much safer than Q-switched. Low thermal damage = less risk of PIH. However, careful fluence selection is mandatory (protocol: start low, titrate up), post-op steroid, SPF 50+. In Fitzpatrick IV-VI, pico is the preferred choice for dark skin patients—for tatu erasure, pigment lesion.

Q: How many sessions does it take to heal an acne scar?
A: Fractional pico, 3-4 sessions, monthly interval. Scar depth may improve by 30-50%. Some deep, ice-pick scars may benefit after surgical excision + scar revision. Combination (pico + microneedling after 2 weeks) synergist effect — scar improvement better.

Q: I have a metallic filler in a pico-laser tooth; Is there a problem?
A: Dental metal implant (amalgam, gold crown) does not cause problems in the dental area — not in the dental dermal area. However, if pico is applied to the dermal metal implant (gold threads, permanent makeup gold-based pigment) area, the metal may absorb the laser energy, risking thermal injury. Optional: cover or avoid the implant area with a mask. Disclosure in consultation.

Q: Pico-laser vs. tattoo removal cream (topical)? Which is better?
A: Topical removal creams (henna-based, chemical) clinical evidence minimal — mostly cosmetic claim. Pico-laser, dermatology standard treatment, proven efficacy. Although topical creams are safe, they are not slow or effective. Pico-laser meal.

Q: How much does Pico-laser black tattoo cost, how many sessions?
A: Black tatu, optimally responsive to pico (melanin + carbon pigment). Typical: 3-5 sessions, ₺1,500-2,500 per session = ₺4,500-12,500 total. Dependent: tattoo size, depth, age (old = fewer sessions, new = more). An estimate is given at the consultation.

Q: Can Pico-laser be performed during pregnancy?
A: No, contraindication. No laser injury, fetal risk, safety data. It is postponed until the pregnancy is over. Breastfeeding: similar contraindication — does not apply.

Q: Can permanent makeup (eyeliner, eyebrow) be removed with pico?
A: Yes, but with caution. Pigment (usually iron oxide or carbon), pico responsive. Risk: sensitive skin of the eyelid area, proximity to the cornea → eye protection mandatory. Small spot handpiece, low fluence, experienced physician mandatory. Frequently: 2-4 sessions.

Dr. Hamza Gemici Comment

"Pico-laser is a revolution in tatu removal and pigmentary lesion treatment. Its biggest advantage over Q-switched: photothermal (thermal) damage is minimal, collagen remodeling is maximum. Especially in Fitzpatrick IV-VI skin (dark skin), pico is the safe choice — the risk of post-inflammatory hyperpigmentation is dramatically low. Fractional mode in acne scar, dermal plasma formation via LIOB mechanism, collagen induction therapeutic ideal. In the clinic: pulse duration low = Mechanical fragmentation is certain, but technical skill is mandatory. Resistant tatu colors (green, blue, brown) are more responsive than Q-switched. Patient selection is critical: Fitzpatrick I-III has minimal risk of PIH, but in IV-VI, careful fluence, post-op steroid, SPF 50+ protocol is essential in my clinical practice. dominant, then we turned to scar rejuvenation indications — the protocol is standardized.”

— Op. Dr. Hamza Gemici

Resources and References

This content has been prepared based on FDA device approvals, peer-reviewed dermatology journals, clinical trials (2012-2025) and Turkish Ministry of Health medical aesthetic guidelines.

Last update: 21 April 2026 · Medical editor: Op. Dr. Hamza Gemici