Procedure

PicoSure

PicoSure is Cynosure's brand of picosecond laser, built around a 755 nanometer alexandrite beam. It was the first pico laser on the market and it is still one of the better ones for pigment. The single-wavelength original is a real limitation for multicolored tattoos.
At a Glance

PicoSure is a brand of pico laser made by Cynosure. Its defining feature is the 755 nanometer alexandrite wavelength, which melanin and green and blue inks absorb well. Pulses run in the region of 550 to 750 picoseconds. The Focus lens array turns the beam into a grid of concentrated dots for skin texture work, and it is the part clinics tend to sell hardest. The newer PicoSure Pro adds optional 532 and 1064 nanometer wavelengths, which matters: the original single-wavelength machine struggles with black ink and is riskier on deeper skin tones.

Key Facts

What It IsA branded 755 nm alexandrite picosecond laser from Cynosure, with optional 532 and 1064 nm on the PicoSure Pro
Best ForBrown spots and freckles, green and blue tattoo ink, dermal birthmarks such as nevus of Ota and Hori's macules; skin texture with the Focus lens
Sessions Needed1-3 for sun spots, 4-10 for tattoos at 6-8 week intervals, 3-6 for texture and acne scars
DowntimeA few hours of redness and swelling for pigment work; 1-2 weeks of scabbing for tattoos
CostAbout $400-$700 a session for a full-face Focus treatment; $250-$800 a session for tattoos by size
Results TimelineSpots darken and flake within 1-2 weeks; collagen change from Focus builds over 3-6 months
Evidence LevelGood for flat pigment and tattoos. Modest for acne scars and wrinkles. Melasma results are inconsistent and often temporary

How It Works

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The physics is the same as any pico laser: a pulse short enough that pigment shatters under a pressure wave instead of heating up and cooking the skin around it. What makes PicoSure specific is the 755 nanometer alexandrite wavelength it was built around.

At 755 nm, melanin absorbs strongly, which is why the device does well on brown spots, freckles and the deep dermal pigment of nevus of Ota. That same absorption is a double-edged property: it means the beam is also drawn to the melanin in your ordinary skin, which is why the original 755-only machine needs more caution on brown and Black skin than a 1064 nm device does.

For tattoos, 755 nm is a good match for green and sky-blue inks, which are the ones that defeat older lasers. It is a less efficient choice for dense black ink, where 1064 nm penetrates better. That is the main practical reason Cynosure added 532 and 1064 nm as options on the PicoSure Pro.

The Focus lens array is a separate mode. It splits the beam into a grid of high-intensity points that create tiny zones of injury under an intact surface. The skin repairs those zones with new collagen. Nothing is ablated, so the surface stays closed and downtime stays short — which also caps how much change you get.

What It Treats

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Moderate evidence
For PIH, PicoSure is used cautiously and at low settings. The picosecond pulse limits how far heat spreads, but 755 nanometers is heavily absorbed by melanin, so on darker skin — where PIH is most common — a 1064 nanometer device is usually the safer pick. Settling the underlying inflammation matters more than the laser does.
Moderate evidence
For melasma, PicoSure is used at low energy, often through the Focus lens, to break up pigment gradually. Its 755 nanometer wavelength is strongly absorbed by melanin — effective on pigment, but less forgiving on deeper skin tones than a 1064 nanometer device, and melasma is common in exactly those skin tones. Expect partial lightening and relapse; it is an add-on, not a fix.
Moderate evidence
PicoSure addresses the pigmented part of photoaging — spots break apart and clear over the following weeks. Vascular damage needs a light- or laser-based vascular device instead, and deep lines need fractional or ablative resurfacing. Sun protection afterward is what keeps the result.
Moderate evidence
Pigment is a secondary use for a device designed around tattoo ink. At 755 nanometers, melanin absorbs strongly, so superficial and some deeper brown spots respond well. That same absorption is why the original 755-only machine needs extra caution on brown and Black skin; the Pro's 1064 nanometer option is the safer choice there.
Limited evidence
Acne scarring is a stretch for a laser built for tattoo ink. Focus mode gives modest smoothing with little downtime, and that is the tradeoff: nothing is ablated, so nothing changes dramatically. Results vary and independent evidence is thin; it tends to help the discoloration inside a scar more than the dent.

Who It's Right For & Who It's Not

Who it's right for

People with flat brown spots and freckles from sun exposure, on light to medium skin.

Green, teal and sky-blue tattoo ink, where 755 nm is genuinely a better tool than a 1064 nm device.

Nevus of Ota and Hori's macules, where the alexandrite wavelength reaches dermal pigment well.

Anyone wanting a mild, low-downtime texture and pore treatment and who understands "mild" is the honest word for it.

Who it's not for

Anyone with a tan, real or self-applied. Wait until it fades.

People with Fitzpatrick V or VI skin who are offered the 755 nm handpiece. Ask for 1064 nm instead — on a PicoSure Pro, on a PicoWay, or on a Q-switched Nd:YAG. A 755 nm beam on very deep skin tones has a meaningful risk of leaving pale patches.

Anyone hoping for a melasma cure. Results are inconsistent, relapse is common, and topical treatment comes first.

Large dense black tattoos, if only the 755 nm handpiece is available. Ask what wavelengths the clinic's machine actually has before you book a course.

Anyone with deep boxcar or ice-pick acne scars expecting resurfacing. Focus softens; it does not rebuild.

How to Prepare

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Before you start

Ask which PicoSure they have and which wavelengths. If your skin is deeper than about Fitzpatrick IV and the answer is "755 only," it is reasonable to look elsewhere.

Ask for a test spot if you have brown or Black skin or any history of pigment problems, and wait two to four weeks before reading it.

Take your own before photographs in consistent light.

In the two weeks before

No sun exposure, no sunbeds, no self-tanner on the area.

Pause retinoids and acids on the treatment area for several days.

Antiviral tablets from the day before if you get cold sores and the area is around the mouth.

On the day

Bare, clean skin — no makeup, moisturizer or sunscreen.

Allow 30 to 60 minutes for numbing cream if you are having a tattoo treated. Focus treatments are usually tolerable without it.

What Happens During It

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Everyone in the room wears protective eyewear.

The provider fires test pulses at the edge of the area and watches the response before treating the whole thing.

Pigment and tattoo work. Each pulse feels like a hot snap. Treated pigment usually turns white for a few minutes. A handful of spots takes minutes; a tattoo takes 10 to 20.

Focus treatments. The handpiece is passed over the face in overlapping rows, usually two to four passes. It feels like fine hot pinpricks with a rubber-band sting, warmer as the passes build up. A full face runs about 15 to 30 minutes.

Cold air is usually blown over the skin throughout.

You leave red and warm. Focus patients often look flushed and slightly swollen for the rest of the day, similar to a moderate sunburn.

Recovery

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Throughout: gentle cleansing, plenty of moisturizer, no scrubs or acids until the skin is calm, no saunas or heavy exercise for 48 hours, and daily sunscreen on treated skin for at least a month. Sessions are spaced four to eight weeks apart depending on what is being treated.

Focus treatments
Redness and mild swelling for a few hours to a day, sometimes with a light sandpaper texture and a fine bronzing that sheds over three to five days. Most people wear makeup the next day. Some people are pink for two or three days; the face is more visibly affected than the neck or chest.
Pigment spots
Treated spots darken over the first day or two, feel crusty, and flake off between about day five and day fourteen. Let them come off on their own.
Tattoos
Redness and swelling for a day or two, often blistering, then scabs that lift over one to two weeks. Keep them covered and greasy; do not pick.

Side Effects & Risks

Common and expected
  • Redness, warmth and mild swelling for a few hours to a day or two
  • Whitening of treated pigment immediately after the pulse
  • Darkening, crusting and flaking of treated spots over one to two weeks
  • Fine bronzed dots and light shedding after a Focus treatment
  • Blistering over dense tattoo ink
Uncommon but possible
  • A pale patch appearing where pigment used to be
  • A treated area that is still darker than the surrounding skin two months on
  • A cosmetic tattoo or microbladed brow that turned gray or black after the first pulse
  • Blisters that are large, painful, or on the face
  • Any firm, raised ridge developing in a treated area
Rare but serious
  • Spreading redness, increasing pain, pus or yellow crusting after a few days — that is infection
  • A broken blister leaving a raw area that is not closing after several days

Results

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Sun spots and freckles
Reliable. Most flat brown spots on light to medium skin lift in one to three sessions and stay gone if you stay out of the sun. This is the least oversold thing PicoSure does.
Tattoos
Good on green and blue, decent on black, better still if the clinic has the Pro with 1064 nm. Four to ten sessions is typical. A faint shadow is a common endpoint on dense professional work.
Nevus of Ota and Hori's macules
This is where the 755 nm wavelength earns its reputation. Clearance is often substantial, though it takes a course.
Focus for acne scars, pores and wrinkles
Real but modest, and slower than the before-and-afters imply. Expect smoother-looking skin and slightly softened shallow scarring after three to six sessions, with collagen change building over three to six months. Deep scars need subcision, TCA CROSS or a fractional CO2 laser. If you have been sold Focus for deep boxcar scars, you have been sold the wrong thing.
Melasma
Inconsistent. Some lightening during a course, frequent relapse afterwards, and occasional worsening. It should never be step one for melasma.
How long it lasts
Removed ink is gone permanently. Cleared sun spots stay clear unless you re-earn them. Focus results fade as you keep aging; most people who like it come back once or twice a year.

At-Home Versions

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None. PicoSure is a medical laser in the six-figure price bracket and there is no consumer equivalent.

Home "pico" pens sold online are not picosecond lasers, do not remove tattoos, and can burn. For brown spots, a consistent routine of sunscreen, a retinoid and a lightening agent such as azelaic acid or tranexamic acid is the real at-home option, and it also prevents new spots, which the laser does not.

FAQ+
What is the difference between PicoSure and PicoWay?Wavelength and pulse length. PicoSure is built on 755 nm alexandrite with pulses around 550 to 750 picoseconds. PicoWay is built on 1064 and 532 nm with shorter pulses, roughly 300 to 450 picoseconds, and offers 730 and 785 nm options. PicoSure suits melanin-driven pigment and green-blue ink; PicoWay's 1064 nm is the safer starting point on deeper skin tones. For most ordinary sun spots, either does the job.
Is PicoSure safe for brown or Black skin?With the 1064 nm handpiece on a PicoSure Pro, yes, with care. With the 755 nm handpiece on Fitzpatrick V or VI, the risk of permanent pale patches is real enough that another wavelength is the better plan. Always ask which one they intend to use.
Does the Focus treatment hurt?It stings — fine hot pinpricks that build with each pass. Most people manage a full face without numbing cream. Tattoo treatments are a different level of discomfort and usually get numbed.
How many sessions will I need?One to three for sun spots. Four to ten for a tattoo. Three to six for texture and acne scars, then maintenance if you want to keep it.
What does it cost?Roughly $400 to $700 for a full-face Focus session and $250 to $800 for a tattoo session depending on size. Clinics push packages; ask for the per-session price too so you can compare.
Can it remove my microbladed eyebrows?Sometimes, and this is the riskiest use of any pico laser. Cosmetic pigments containing iron oxide or titanium dioxide can turn black or gray on the first pulse. Insist on a single test pulse in a hidden part of the brow and wait before doing more.
Will it get rid of my melasma?It may lighten it for a while. It commonly comes back, and it is not the right first treatment. Creams, strict sun protection and sometimes oral tranexamic acid do more of the work and cost less.
Is PicoSure better than IPL for brown spots?For discrete brown spots, generally yes, and it is far safer on deeper skin tones. IPL covers larger areas more cheaply and also treats redness, which a pico laser does not. They are different tools, not competitors.
How long until I see results?Pigment spots are visibly gone once the crust flakes off, within about two weeks. Focus results are slow — three to six months for the collagen change, which is why judging it after one session is unfair to the treatment and to your wallet.