OBJECTIVE To study a picosecond 755-nm alexandrite laser for the removal of tattoos to confirm the efficacy of this therapy, focusing on the effect of therapy on the target lesion as well as the surrounding tissues and quantifying the number of necessary treatments. DESIGN Fifteen patients with tattoos were enrolled. Treatments were scheduled approximately 6 ± 2 weeks apart. Standard photographs using 2-dimensional imaging were taken at baseline, before each treatment, and 1 month and 3 months after the last treatment. SETTING Dermatology clinic at SkinCare Physicians in Chestnut Hill, Massachusetts. PATIENTS Fifteen patients with darkly pigmented tattoos. MAIN OUTCOME MEASURES Treatment efficacy was assessed by the level of tattoo clearance in standard photographs. These photographs were assessed by a blinded physician evaluator and based on a 4-point scale. Efficacy was also assessed based on physician and patient satisfaction measured on a 4-point scale. RESULTS Twelve of 15 patients with tattoos (80%) completed the study. All 12 patients obtained greater than 75% clearance. Nine patients (75%) obtained greater than 75% clearance after having 2 to 4 treatments. The average number of treatment sessions needed to obtain this level of clearance was 4.25. All 12 patients (100%) were satisfied or extremely satisfied with the treatment. Adverse effects included pain, swelling, and blistering. Pain resolved immediately after therapy, while the swelling and blistering resolved within 1 week. Hypopigmentation and hyperpigmentation were reported at the 3-month follow-up. CONCLUSION The picosecond 755-nm alexandrite laser is a safe and very effective procedure for removing tattoo pigment.