A PicoSure Experience: On the Cutting Edge by Rutledge Forney, MD

Our PicoSure machine arrived in the office early this week. It got jostled in transit so the installation took two days instead of one. The technician and engineer (the machine is so cutting edge that they sent the chief engineer to make sure it is installed correctly) cautioned us to be extremely careful with it since the optics in the arm are so complex. The engineer called it a “lab machine” — fresh from the lab!
Our PicoSure trainer is in the office today for her first complete orientation. We have four patients coming — three new, untouched tattoos from blue to black to multicolored; two very old black and blue/green tattoos, still hanging on; and one black tattoo, which has had several Qswitched Nd Yag treatments in the past year. Three physicians are participating in our training today.
The first question as we begin to plan patients’ treatments is how to manage pain. The trainer says pain is not a big issue if we use our Zimmer cold air machine, but we are apprehensive. One patient insists on her usual intralesional lidocaine as numbing. Another applied topical anesthetic at home to 80% of one of her tattoos, leaving 20% un-numb so we can compare the difference. One guy didn’t want to numb his extensive, old tattoos so we just used cold air for a couple of 1000 pulses. The blue butterfly owner was more apprehensive than we were, and she was willing to do ONE pulse and one pulse only, with cold air.
Our blue butterfly lady went first. She is worried about keloids from the treatment, so we did one pulse. You can see before and immediately after pictures below. After 48 hours, the spot was completely healed and blue ink-free (see below).

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