title: Neodymium-doped yttrium aluminium garnet (Nd:YAG) 1064-nm picosecond laser vs. Nd:YAG 1064-nm nanosecond laser in tattoo removal: a randomized controlled single-blind clinical trial.
abstract: BACKGROUND
  For decades, nanosecond lasers (NSLs) have been used to remove tattoos. Since 2012, pulses of picosecond lasers (PSLs) have been available for tattoo removal. Based on a few observational studies, the claim has been made that PSLs are considerably more effective while showing fewer side-effects in comparison with NSLs.
  
  
  OBJECTIVE
  To compare the efficacy and side-effects of a PSL side by side with an NSL for tattoo removal.
  
  
  METHODS
  Twenty-one patients with 30 black tattoos were treated with PSL and NSL in a split-study design in two sessions at intervals of 6 weeks. The safety and efficacy of laser treatments were determined by blinded observers assessing randomized digital photographs in this prospective clinical study. The primary end point was the clearance of the tattoos ranging in quartiles from 0% to 100%; secondary end points were side-effects and pain.
  
  
  RESULTS
  The average clearance overall as evaluated showed no statistical difference between NSL and PSL (P = 1·00). Using a visual analogue scale (0 = no pain, 10 = maximum pain), a value of 3·8 ± 1·0 was reported for the PSL, which was statistically different from NSL (7·9 ± 1·1, P < 0·001). Transient side-effects were observed, as well as hypo- and hyperpigmentation, but there was no statistically significant difference between PSL and NSL.
  
  
  CONCLUSIONS
  After two treatments of black tattoos with a neodymium-doped yttrium aluminium garnet laser (1064 nm), the use of picosecond pulses does not provide better clearance than nanosecond pulses. However, pain is less severe when using a PSL.
authors: Pinto Medical Spa, Centro Laser Dermatologico Roma, Rome, Italy.
authors: F
authors: F
authors: Pinto
authors: Laserklinik Karlsruhe und Medizinisches Versorgungszentrum, Karlsruhe, Germany.
authors: S
authors: S
authors: Große-Büning
authors: Department of Dermatology, Klinikum Darmstadt, Darmstadt, Germany.|Department of Dermatology, University Hospital Greifswald, Ferdinand-Sauerbruchstraße, Greifswald, Germany.
authors: S
authors: S
authors: Karsai
authors: Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors: C
authors: C
authors: Weiß
authors: Department of Dermatology, Regensburg University Hospital, Regensburg, Germany.
authors: W
authors: W
authors: Bäumler
authors: Laserklinik Karlsruhe und Medizinisches Versorgungszentrum, Karlsruhe, Germany.
authors: S
authors: S
authors: Hammes
authors: Department of Dermatology, Venereology and Allergy, University Medical Centre Mannheim, Centre of Excellence of Dermatology of Baden-Wuerttemberg, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany.
authors: M
authors: M
authors: Felcht
authors: Laserklinik Karlsruhe und Medizinisches Versorgungszentrum, Karlsruhe, Germany.
authors: C
authors: C
authors: Raulin
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D017496:Hypopigmentation / Q000209:etiology; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D053844:Lasers, Solid-State / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D016037:Single-Blind Method; D013653:Tattooing; D016896:Treatment Outcome; D055815:Young Adult