Laser tattoo removal: is there light at the end of the tunnel or is it just the light of an oncoming train?

The market for tattoos continues to boom, despite the latent health hazards, which are not to be underestimated. At the same time, a survey in Germany, Austria and Switzerland showed that at least 5% of tattooed people polled were considering having their tattoos removed.1 In Germany alone, this translates to an estimated 10 million people with tattoos and a half‐million potential patients – or rather clients – for the laser market. For decades, physicians applied quality‐switched nanosecond laser devices to destroy the pigment particles inside the dermis and lighten the tattoo colour. This procedure offers a low rate of permanent side‐effects, but the lightening of the colour often remains incomplete. Thus, it was with great enthusiasm and equally great expectations that the first commercially available picosecond‐domain laser for tattoo removal was launched in 2012. This new generation of lasers was developed to increase the efficacy of treatment in comparison with quality‐switched nanosecond lasers used so far. It was also intended to shorten the overall number of treatment sessions as well as minimize adverse effects. In the meantime, two other lasers of this kind are on the market as well. All three of them have since been the focus of extensive advertising, not only by the industry, but also among dermatologists and plastic surgeons at professional conferences as well as in (scientific) articles. However, to date, no randomized comparative clinical trials have been published to confirm the superiority of picosecond pulses to nanosecond pulses.