Picosecond Laser vs Surgical Excision

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.

Surgical Excision: The growth is cut out along with a measured border of normal-looking skin, and the wound is stitched closed. The whole piece goes to a laboratory and the result comes back in about a week. The scar is a line, and it is longer than the spot was.

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 Surgical Excision, based on the entry’s treatment or equipment reference.

Choose if Key differences What is it?What it treats Treatment areas Skin tones How it works Before your treatment Day of treatment After your treatment Risks Cost Questions Related

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 Surgical Excision if…

Choose to remove a skin cancer or suspicious growth completely with lab-checked edges — the scar is a line, longer than the spot.

Melanoma or a suspicious mole
Skin cancer on the trunk or limbs
You want the whole growth checked

Alternatives, not combined

Can you have both?

Both can remove a tattoo. Laser fades it over many sessions; excision removes small tattoos in one go but leaves a scar.

Key differences

● Picosecond Laser

● Surgical Excision

DowntimeNone → 2+ weeks

3–7 days

1–2 weeks

PainMinimal → Needs anesthesia or sedation

Significant

Mild

Results showImmediately → 3+ months

1–3 months

Immediately

How long it lastsWeeks → Years or permanent

Years or permanent

Visits neededOne → Every few months

A longer series (4–6+)

One

Cost per visit$ → $$$$$

ReversibleYes, can be undone → No, permanent

No, permanent

What is it?

Picosecond Laser

Surgical Excision

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 removes a lesion surgically.

A planned incision removes the lesion and a rim of tissue.

It diagnoses or treats.

It provides tissue or removes a known lesion.

Margins depend on the diagnosis.

They should not be chosen from a generic chart.

Mohs is different.

Standard excision and Mohs assess tissue differently.

What it treats

Evidence level

Picosecond Laser

Surgical Excision

Strong evidenceMost established uses

Unwanted Tattoos

Fades most ink colors.

Basal Cell Carcinoma

High cure rates.

AI-generated educational illustration: Crusted red raised lesion on a light-skinned sun-exposed hand.

Squamous Cell Carcinoma

Removes the cancer with margins.

Melanoma

The main treatment.

A smooth, dome-shaped lump about two centimetres across on the upper back on pale skin, with a tiny dark pore at its center and faintly pink skin over it.

Epidermal Inclusion Cyst

Removes the sac.

Moderate evidenceSome supportive research

Sun Spots

Clears spots.

—

Limited evidenceEarly or small studies

Acne Scarring

Focus lenses improve texture.

—

Little evidence

—

Acne Scarring

Punch excision is used for small scars instead.

Not effective

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.

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

Keloids often return larger alone.

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

● Surgical Excision

Lighter skin

Low risk

Temporary whitening and swelling.

Low risk

A fine line scar.

Medium skin

Some risk

Temporary lightening or darkening.

Low risk

Scar fades over a year.

Deeper skin

Some risk

Lightening of skin can occur; longer wavelengths and spacing help.

Some risk

Raised or keloid scars possible, especially on chest, back and shoulders.

How it works

Picosecond Laser

Surgical Excision

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.

Surgical Excision mechanism diagram. The area is planned: Diagnosis and location guide the removal border and depth. The lesion is cut out: The clinician removes the selected tissue as a specimen. Closure and tissue review follow: The wound heals, while pathology helps guide further care.

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 area is planned: Diagnosis and location guide the removal border and depth. The lesion is cut out: The clinician removes the selected tissue as a specimen. Closure and tissue review follow: The wound heals, while pathology helps guide further care.

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

Before your treatment

Picosecond Laser

Surgical Excision

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.

Not specified

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.

Supplements and alcohol: Non-essential blood thinners such as fish oil, vitamin E and ginkgo are commonly stopped about a week before, and alcohol the night before.

Smoking and vaping: Stop for a week before and two weeks after if you can.

Day of treatment

Picosecond Laser

Surgical Excision

Before you arrive

Clean skin: Clean, product-free skin.

Eating and clothes: Eat normally and take your usual morning medicines.

Arrival & prep

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

The site is confirmed against the biopsy report and you point to it yourself.

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.

The surgery: The skin is cleaned and draped.

The surgery: The ellipse is cut out in one piece, bleeding points sealed, and the edges freed so they meet without tension. Closing is in layers — dissolving stitches deep, stitches on the surface. You feel pressure and tugging and hear instruments, but nothing sharp. Most take 20 to 45 minutes, and the site feels tight afterward rather than sore.

Before you leave

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

A dressing, written wound care, a stitch removal appointment, and a plan for how the pathology result reaches you.

After your treatment

Picosecond Laser

Surgical Excision

First 24 hours

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

Not specified

Days 2–7

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

First week: Keep the dressing dry and in place for 24 to 48 hours, then start daily care — gentle wash, petrolatum, non-stick dressing.

Days 5 to 14: Stitches come out — face at 5 to 7 days, trunk and arms at 10 to 14, legs and back sometimes longer.

Weeks 2–4

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

From week 2: The scar is hardest, pinkest and most raised at around three to six weeks.

Time to results

Fading over weeks after each session

Lab result in about a week

How long results last

Removed ink is gone

Permanent

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 thick, raised or widening scar
Numbness or a firm cord under the skin
A stitch that surfaces months later
A margin that was not clear
A pucker at one end of the line
When to contact your provider

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.

An excision costs more than a scrape-and-burn and less than Mohs surgery.

Insurance

Insurance does not cover tattoo removal or cosmetic pigment treatment.

In the US the surgical charge is priced by the size of the excision and the body site, with a separate charge for a more complex layered closure.

Questions

Picosecond Laser

Surgical Excision

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.

Why is the scar so much longer than the spot?

Because a round hole cannot be closed flat. The piece taken out is an ellipse roughly three times as long as it is wide, so the edges meet evenly instead of puckering at each end. A spot the size of a pencil eraser becomes a line an inch or more long. It is geometry, not technique, and no surgeon avoids it.

How long until I get the result?

Usually 3 to 10 days, depending on the laboratory. Ask before you leave how and when you will be told, and call if you have heard nothing after about two weeks.

What happens if the margins are not clear?

A further procedure — a re-excision with a wider border, or a referral for Mohs surgery — usually within a few weeks. It is not a mistake. It is the reason the specimen went to a laboratory in the first place.

When can I exercise again?

About 2 weeks for most sites, longer for the back, shoulder and shin. The visible stitches come out sooner, and the deep stitches are still carrying the tension. Lifting or straining is what stretches or splits a wound.

Should I have Mohs surgery instead?

On the face, particularly the nose, eyelids, ears and lips, or for a tumor that is large, has vague borders, has an aggressive subtype on the biopsy, or has come back before, Mohs is often better. For a small low-risk cancer on the trunk or limbs, an excision achieves the same result in a fraction of the time and cost. Ask which category yours is in.

Will the scar fade?

It flattens and pales substantially over about a year, with most of the change in the first six months. Keeping it out of the sun and using silicone gel or sheeting once it is closed are the two things with reasonable evidence behind them. Scars on the chest, shoulders and upper back stay red and raised longest and are the likeliest to widen.

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