While lasers have been the gold standard for tattoo removal, selecting the best modality can be challenging because of the varying efficacies and adverse effects.To evaluate all lasers used to remove tattoos and assess their efficacies and side effects.Our systematic review searched PubMed, Medline, Embase, Scopus, CINAHL, Cochrane Central Register of Trials, and ClinicalTrials.gov for all laser treatments. The outcomes measured included laser parameters, treatment methods, patient and tattoo characteristics, clearance rate, and adverse effect rate. The quality of the included papers was appraised using specific assessment tools and given a high, moderate, or low risk of bias.Our search led to 3037 studies, with 36 being included in the systematic review (7 randomized controlled trials, 2 non-randomized controlled trials, and 27 case series). While Q-switched Nd:YAG lasers are safe and effective, picosecond lasers have shown superiority with blue, green and yellow tattoo pigments. Both are safe and effective for black tattoos.Variability amongst studies.Picosecond lasers demonstrate superiority when treating blue, green and yellow tattoos. The R20 and R0 novel techniques can effectively reduce treatment time. Further RCTs are required to make a more definitive recommendation.