Clinical outcomes of a vacuum-assisted multimodal picosecond tattoo removal protocol: a retrospective case series

Laser tattoo removal often requires multiple treatment sessions despite advances in picosecond laser technology. Multimodal approaches aimed at improving treatment efficiency are increasingly being explored. This study retrospectively evaluated the clinical outcomes of a vacuum-assisted multimodal picosecond laser tattoo removal protocol. A retrospective observational case series was conducted including 16 tattoos that completed treatment with standardized photographic follow-up. The protocol combined fractional ablative laser pretreatment (1064 nm, 3-5 stacks), followed by two full-beam picosecond 1064 nm passes with application of a vacuum-assisted device between passes. Standardized images were acquired using the Quantificare imaging system. Treatment outcomes were independently evaluated by three blinded experts. Kirby-Desai estimated treatment sessions were additionally calculated as a historical comparative reference. Sixteen tattoos completed treatment and were included in the final analysis. Mean pigment clearance exceeded 90% following a mean of 3.19 treatment sessions, with high interobserver agreement among blinded evaluators. The observed number of treatment sessions was lower than Kirby-Desai estimated values used as historical reference. No severe long-term adverse events were observed. This retrospective case series suggests that a vacuum-assisted multimodal picosecond laser tattoo removal protocol may be associated with high tattoo clearance rates using relatively few treatment sessions. However, given the retrospective design, absence of a control group, and multimodal nature of the protocol, the independent contribution of vacuum assistance cannot be determined. Prospective controlled studies are needed to further evaluate the role of adjunctive mechanical approaches in tattoo removal optimization.