High-frequency (≈20 MHz) high-intensity focused ultrasound (HIFU) has emerged as a complementary — and in some reports even stand-alone — method for ablative tattoo removal that is “color-blind.” Small clinical series report the removal of difficult multicolor tattoos in 1–3 sessions by producing a controlled superficial thermal lesion (eschar formation), which sloughs away carrying pigment. Tradeoffs include a longer wound-healing period than laser, operator training requirements, and possible skin surface changes; but for tattoos resistant to standard Q-switched or picosecond lasers, HIFU is an important addition to the removal toolkit.
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