Methods of treating the skin and in particular removing pigment from a tattoo are provided. In preferred embodiments, a piezoelectric transducer is placed at a plurality of locations above the skin and focused acoustic waves at 7 MHz or more are transmitted into the skin. The focal point of the focused acoustic waves is between 0.1 mm and 5 mm below the surface of the skin. The design of the piezoelectric transducer along with the frequency of operation are carefully chosen to create points of treatment with a desired size and shape. The correct amount of energy is supplied to the points of treatment to produce a lesion of a desired size and shape. The lesions are spaced and located to effect the treatment of the skin.