We read the recent review regarding the use of picosecond lasers for tattoo removal with interest. Whilst the evidence underlying tattoo treatment is equivocal, there are promising results for other indications [1] for which picosecond laser use may be better tolerated or more effective.The ultra-short pulse duration of the picosecond laser imparts a predominantly photo-acoustic effect on the tissue and has fewer side effects (such as dyspigmentation, scarring) and shorter postprocedural downtime. As such, picosecond lasers could become more widely used by clinicians than longer-established laser modalities, with the added benefit of less downtime and higher efficacy.To date, there is evidence of use of picosecond lasers in both pigment clearance [2,3] and tissue remodeling with cases published showing efficacy in the appearance of nevus of Ota [4], minocycline-induced pigmentation [5], photo-aging [6] and acne scars [7].Picosecond lasers used in all of the above conditions lead to improvement of dyspigmentation and/or textural change, with tolerable side effects of mild transient erythema and oedema [1].The sample sizes of the studies [4][5][6][7][8] were however small, ranging from 3 to 20 patients with an average follow-up of 3 months.Practitioners should be aware of the range of uses of picosecond lasers beyond tattoo removal in order to ascertain their full potential; larger randomized control trials and split face studies could further inform future practice.
Compliance with ethical standardsConflict of interest The authors declare that they have no conflicts of interest.