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Picosecond Laser vs Scar Revision

Picosecond Laser: A tattoo and pigment laser that fires in pulses lasting trillionths of a second. It works, and the marketing around the word “pico” has run well ahead of the evidence comparing it to the older quality-switched lasers.

Scar Revision: The whole set of procedures used to make an existing scar less noticeable — cutting it out and closing it more neatly, flattening it, releasing it, or resurfacing it. No procedure erases a scar. Revision trades the scar you have for one you would rather live with.

Reviewed by Dr. Schwarz, Board-Certified Dermatologist
Last updated: 10/22/2026
Editorial illustration for Picosecond Laser, based on the entry’s treatment or equipment reference.Editorial illustration for Scar Revision, based on the entry’s treatment or equipment reference.
Choose ifKey differencesWhat is it?What it treatsTreatment areasSkin tonesHow it worksBefore your treatmentDay of treatmentAfter your treatmentRisksCostQuestionsRelated

Choose Picosecond Laser if…

Choose for tattoo removal or sun spots — it works, but don't pay extra for the word "pico" alone.

  • A tattoo you want faded or removed
  • You can plan many sessions
  • Colored ink that older lasers struggled with

Choose Scar Revision if…

Choose to trade a scar you dislike for a neater one — no procedure erases a scar.

  • A wide, raised or puckered scar
  • The scar is at least a year old
  • You accept a new, better-placed scar
Often combined

Can you have both?

Picosecond laser is sometimes used weeks after scar revision to blend color and texture.

Key differences

● Picosecond Laser
● Scar Revision
DowntimeNone → 2+ weeks
3–7 days
1–2 weeks
PainMinimal → Needs anesthesia or sedation
Significant
Moderate
Results showImmediately → 3+ months
1–3 months
3+ months
How long it lastsWeeks → Years or permanent
Years or permanent
Years or permanent
Visits neededOne → Every few months
A longer series (4–6+)
A short series (2–3)
Cost per visit$ → $$$$$
$$
$$$
ReversibleYes, can be undone → No, permanent
No, permanent
No, permanent

What is it?

Picosecond Laser

Scar Revision

What is it?

It uses ultra-short pulses.

Picosecond lasers act on pigment or create fractional tissue effects.

It has several uses.

Tattoos, pigmentation and texture each need different settings.

Pigment needs a diagnosis.

Spots should be confirmed before fading.

Some pigments are tricky.

Cosmetic tattoos may darken; melasma needs careful selection.

It improves scars.

It aims to improve appearance, comfort or movement.

It uses several methods.

Surgery, injections and resurfacing may be combined.

It does not erase scars.

It modifies scar tissue rather than restoring unscarred skin.

Keloids need special care.

Excision alone can cause a larger recurrence.

What it treats

Evidence level
Picosecond Laser
Scar Revision
Strong evidenceMost established uses
Unwanted Tattoos on light skin.

Unwanted Tattoos

Fades most ink colors.

Scars on light skin.

Scars

Improves width, texture and color.

Moderate evidenceSome supportive research
AI-generated educational illustration of Sun Spots: 1. Sun Spots Header — Light Skin; Lighter skin. Not a clinical photograph.

Sun Spots

Clears spots.

A raised, smooth, firm scar on the upper chest on light skin. It is shiny pink-red and hairless, and its edges spread well past the small mark it grew from.

Keloids

Combined with injections to prevent return.

Acne scarring on light skin. Small sharply cut pits and broad shallow dips across a cheek, several sitting inside faint flat pink marks, with no active spots.

Acne Scarring

Punch excision for deep scars.

Limited evidenceEarly or small studies
Acne scarring on light skin. Small sharply cut pits and broad shallow dips across a cheek, several sitting inside faint flat pink marks, with no active spots.

Acne Scarring

Focus lenses improve texture.

—
Little evidence
—
Two areas of fair skin side by side on a hip. New pink-red bands sit above, and older flat silvery-white bands below, with only a small difference in color between the pale marks and the skin around them.

Stretch Marks

Usually treated with lasers or needling.

Not effective
Fine branching superficial spider veins on the lower leg.

Spider Veins

Doesn't target vessels.

—
Can make it worse
Flat tan patches with soft irregular edges across the forehead and upper cheek of an adult with light skin, the surface completely smooth.

Melasma

Pigment can rebound.

—

Treatment areas

Treatment areas

The tattoo or diagnosed pigment spot determines the treatment site; location varies.

The specific lesion, scar or affected patch determines the treatment site; there is no fixed body distribution.

Skin tones

Skin tone
● Picosecond Laser
● Scar Revision
Lighter skin
Low risk
Temporary whitening and swelling.
Low risk
Scar fades over a year.
Medium skin
Some risk
Temporary lightening or darkening.
Some risk
Dark marks possible.
Deeper skin
Some risk
Lightening of skin can occur; longer wavelengths and spacing help.
Higher risk
Keloids can return larger; injections or radiation are often combined.

How it works

Picosecond Laser

Scar Revision

How it works
Picosecond Laser mechanism diagram. Ultrashort pulses reach pigment: The wavelength and treatment mode are chosen for the target. Rapid energy delivery fragments pigment: Mechanical effects can break selected particles into smaller pieces. Clearance follows over time: The body clears some fragments; results depend on the pigment and skin.
Scar Revision mechanism diagram. The scar is assessed: Its shape, location, and tension guide the surgical plan. Tissue is revised or rearranged: A surgeon changes the scar and carefully closes the wound. A new scar matures: Appearance may improve, but scar tissue remains.
Diagram explanation

Ultrashort pulses reach pigment: The wavelength and treatment mode are chosen for the target. Rapid energy delivery fragments pigment: Mechanical effects can break selected particles into smaller pieces. Clearance follows over time: The body clears some fragments; results depend on the pigment and skin.

Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.

The scar is assessed: Its shape, location, and tension guide the surgical plan. Tissue is revised or rearranged: A surgeon changes the scar and carefully closes the wound. A new scar matures: Appearance may improve, but scar tissue remains.

Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.

Before your treatment

Picosecond Laser
Scar Revision
Earlier planning
Not specified

6 to 12 months: Waiting: Surgeons want 6 to 12 months of natural settling first.

2–4 weeks before

4 weeks before: Sun and tanning: Avoid sun, sunbeds and self-tanner on the area.

4 weeks before: Sun and tanning: Tanned skin postpones a session — surface pigment competes for the light and raises the risk of burns and pigment loss.

Before you book: Numbing and history: Ask for numbing to be arranged in advance.

Sun: Keep the scar out of the sun and use SPF 30 or higher.

2 weeks before: Smoking and vaping: Stop both at least two weeks before and after surgery.

The week before

3 to 5 days before: Actives and shaving: Stop retinoids and exfoliating acids.

3 to 5 days before: Actives and shaving: Shave the area.

Not specified

Day of treatment

Picosecond Laser
Scar Revision
Before you arrive

Clean skin: Clean, product-free skin.

What to bring: Old photos: Photographs from before the injury, if you have them.

Arrival & prep

The tattoo or pigment is examined, photographed, and its colors noted, since they decide the wavelengths.

The scar is photographed and examined relaxed and stretched.

Treatment

Everyone wears eye protection.

The provider fires overlapping pulses, with a snapping sound and a faint smell. Skin whitens at once — frosting — and fades within about 20 minutes. A small tattoo takes minutes; a large piece is split across appointments. It feels sharper than getting the tattoo but far quicker, and bony areas are worse.

A steroid injection takes minutes and meets real resistance.

Surgical revision cuts the scar out as a narrow ellipse and closes it in layers, usually 30 to 90 minutes. A Z-plasty swaps small flaps to change direction. Punch excision removes a small round scar. Laser or microneedling takes 20 to 45 minutes. Expect pressure, not sharpness.

Before you leave

The area is white and raised, then red and swollen as the frosting fades.

Tape over the line, wound care instructions, and a date for stitch removal — 5 to 7 days on the face, 10 to 14 days on the body.

After your treatment

Picosecond Laser
Scar Revision
First 24 hours

Days 1 to 3: Swelling peaks on day one or two and can be marked around the eyes, hands and ankles.

First 2 weeks: Swollen, bruised and tender.

Days 2–7

Days 3 to 14: Scabs form and fall away on their own, taking some ink with them.

Not specified
Weeks 2–4

Weeks 2 to 8: Skin looks normal while the immune system clears ink fragments underneath.

Weeks 2 to 8: The new line turns pink, firm and slightly raised — normal healing, not failure.

Beyond 1 month
Not specified

Months 3 to 18: Redness fades and the ridge softens from month 3 to 6, with massage and silicone doing the work.

Time to results

Fading over weeks after each session

Over 6–12 months

How long results last

Removed ink is gone

Permanent

Risks

Risks
  • Loss of pigment
  • Dark patches
  • A tattoo that got darker
  • Blisters that keep forming
  • A raised or thickened area
  • Itching, swelling or hives in the tattoo
  • A scar thickening or spreading again
  • Itching, burning or tenderness in the scar
  • A dent or pale patch after an injection
  • A new dark patch
  • Numbness or odd sensation

Cost

Per session

In the US, a picosecond session on a small to medium tattoo commonly runs $200 to $500, with larger pieces priced higher and often split into sections.

In the US this varies more than almost any other dermatology procedure, because "scar revision" covers a five-minute injection and a ninety-minute operation.

Insurance

Insurance does not cover tattoo removal or cosmetic pigment treatment.

Insurance often pays when a scar limits movement or vision, interferes with function, or follows cancer surgery or an injury.

Questions

Picosecond Laser

Scar Revision

Individual Questions
Is a picosecond laser better than an older Q-switched laser?

Not settled. Studies generally find picosecond devices perform at least as well, and some report clearance in fewer sessions, but the head-to-head trials are few, small and inconsistent. “Pico” is a marketing category, not a standard, so devices differ a lot. The provider's experience and the wavelengths available for your ink colors matter more than the category name.

How many sessions will my tattoo take?

Most professional tattoos need five to ten or more, six to eight weeks apart, so a year or longer. Amateur tattoos need fewer, cover-ups more. Nobody can give an accurate number at the first visit; how the first two sessions go is the best predictor available.

Will my tattoo disappear completely?

Sometimes, but heavily faded with a faint shadow is more common. Ink type, depth, color, age and location all matter, and none can be judged from the surface beforehand. Treat a guarantee of complete removal as a warning sign.

Which colors are hardest?

Black and dark blue clear most readily. Green and light blue are hardest and need specific wavelengths. Red, orange and yellow are unpredictable. White, flesh-toned and pastel cosmetic inks can turn dark instantly, which is why they get a test spot first.

Can it be used on deeper skin tones?

Yes, generally at 1064 nm, because surface pigment absorbs it least — the same reason the Nd:YAG laser is preferred there for hair and vessels. Multicolored tattoos are harder, because the wavelengths needed for some colors carry more risk of a light or dark patch. Conservative settings, test spots and longer gaps are standard.

Does it help melasma?

Sometimes, with mixed results. Melasma often improves during a course and then returns, and heat and light can provoke it. Most dermatologists lead with sun protection and pigment creams and add laser cautiously.

Can a scar be removed completely?

No. Every treatment replaces the scar with a different one — flatter, narrower, paler, or running in a less obvious direction. Often a large improvement, not removal.

How long should I wait before revising a scar?

Usually 6 to 12 months, because most scars keep improving on their own in that time. Scars that limit movement and raised scars still growing are treated sooner.

What is the difference between a keloid and a hypertrophic scar?

A hypertrophic scar is raised but stays within the original wound borders and often flattens over a year or two. A keloid grows beyond them, keeps going, and does not settle by itself. Keloids come back after surgery much more often, so they are usually injected rather than cut.

Will scar revision help my acne scars?

Some of them. Rolling scars respond to subcision, needling and laser; deep icepick scars often need punch excision or a targeted acid technique; boxcar scars sit in between. Expect a course and partial improvement, not one operation.

Does insurance cover it?

Sometimes — when the scar restricts movement or vision, causes symptoms, or follows cancer surgery or trauma. Revision for appearance is cosmetic. Ask the office to check with your insurer before you book.

I have deeper skin tone, and I keloid. Is anything safe?

Yes, but the order changes. Injections, silicone and pressure come first, elective surgery on high-risk sites is approached carefully, and if a keloid is removed, something is always done alongside to control the healing. Tell the provider at the first visit.

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