What is Laser Tattoo Removal?
Definition: The principle of selective thermolysis can be applied towards the removal of tattoos. The energy delivered by a number of different lasers is targeted towards the carbon particles or dyes that are found in skin tattoos, allowing selective destruction of the foreign pigment while minimizing damage to the surrounding skin.
Lasers may be used on professional, amateur, cosmetic, medicinal, and traumatic tattoos. The different colors present in the tattoos may respond differently to laser tattoo removal. Lasers offer a non-invasive and effective treatment for unwanted tattoos.
- Is Laser Tattoo removal painful?
That depends on your pain threshold. When a lower fluence is used, the degree of pain is often described as comparable to that of a rubber band snapping against the skin. You may need local anesthesia with higher fluences. This will eliminate any discomfort during the procedure. A topical anesthetic cream (such as EMLA®) or the infiltration of the surrounding skin with lidocaine may be necessary.
- How many treatments are necessary for tattoo removal?
Tattoos require multiple treatment sessions, usually performed at 4-8 week intervals or longer. Tattoo lightening may continue for several months after the last treatment session. Amateur black tattoos typically respond better than professional tattoos.
You should expect some swelling and blistering during the first day or two after the procedure.
Immediately following treatments, white crusting may occur. Any resultant scab generally resolves in 10-14 days.
Continued lightening of the tattoo can be observed for 4-8 weeks after each treatment session.
Wound care is required to aid the healing process and to prevent infection. Typically an antibiotic ointment and dressing changes are recommended.
Recommendations include acetaminophen (Tylenol®) for pain, elevation of the treated area to counteract any local swelling, and sun avoidance to prevent tanning.
Multiple wavelengths are necessary to treat multicolored tattoos.
Pigmentary changes may occur following laser treatment because the wavelengths used are also absorbed by melanin (the natural pigments in your skin). Your skin may either lighten or darken. The latter is more common following sun exposure. These changes may be transient or permanent.
Who is a candidate for Tattoo Laser Removal?
Anyone with an undesired tattoo is a candidate for laser tattoo removal. Most tattoo colors can be eliminated or lightened to a large degree. However, skin colored tattoos may undergo irreversible ink darkening. This is seen with some white, pink, flesh-toned and light brown tattoo inks. Red ink tattoos may turn black. A test dose is a good idea in these situations, and the tattoos may be improved with subsequent laser treatments.
Virtually any tattoo that is located on the surface of the skin can be treated with a laser. If you are getting treatment in a sensitive area you may need to have topical or intralesional anesthesia. If you are getting treatment near your eyes, application of an eye shield for protection may be necessary. Hair bearing areas may be protected with an aqueous gel.
What Can I do About Tattoo Removal?
- Understand the objectives of laser tattoo removal
- Complete clearing of all tattoos is not always possible. However, you can expect to see a dramatic lightening.
- Multiple treatments are typically necessary to obtain the maximum benefit. Amateur black tattoos respond more quickly than professional and multicolored tattoos.
- Doubly treated tattoos may require additional treatments.
- Multicolored tattoos may require several different wavelengths because of the selective absorption characteristics of tattoo pigment.
To increase the benefits of this procedure and avoid complications, you should strictly avoid sun exposure and tanning prior to and during the treatment period.
- Q-switched Ruby Laser (QSRL)
This laser emits a red light that is well absorbed by most amateur and professional tattoo ink colors except red and yellow. Dark blue and black inks respond best. The response of green tattoos is variable. Excellent results are observed, especially with amateur black tattoos. Amateur tattoos respond in fewer treatments compared to professional tattoos. The QSRL is also effective in treating medicinal and traumatic tattoos.
- Q-switched Nd:YAG
This laser is effective for both amateur and professional tattoos of all colors. Like the ruby laser, the Q-switched Nd:YAG is most effective for black tattoos. This laser has the advantage of being useful for darker skinned individuals. At the frequency doubled setting (532 nm), the Q-switched Nd:YAG is highly effective for treating red and orange tattoos. The Q-switched Nd:YAG laser at 1064nm can cause more pain, and a higher degree of textural changes to your skin than the QSRL.
- Q-switched Alexandrite Laser
This laser is comparable to the QSRL when it is used to treat tattoos, particularly when treating green tattoos. Up to 50% of patients can experience textural changes in their skin after treatment.
- Flashlamp-pumped Pulsed Dye Laser
With a wavelength of 510 nm, this laser does not penetrate into the deeper tattoos. However, it is effective for the treatment of brightly colored tattoos such as those that use red, purple, and orange inks. The major side effect of this laser is bruising.
510-mm, 300-nanosecond Candela pigmented lesion dye laser
The flashlamp-pulsed laser (510 nm, pulse width of 300 ± 100 ns) was developed as a companion to the Q-switched alexandrite laser to treat epidermal melanocytic lesions. This wavelength is also well absorbed by red pigment, and the pulse width is short enough to fragment ink granules. Successful clearing without scarring usually occurs in 3-7 treatments performed at 1-month intervals using 3-3.75 J/cm2. Purple, orange, and yellow pigments require an average of 5 treatments for complete ink removal. No hypopigmentation, textural change, or scarring is noted. Histologically, fragmentation of red pigment particles is observed, followed by macrophage engulfment. In addition, because of the epidermal absorption of this laser, transepidermal ink loss occurs.
- Q-switched laser treatments
Early on, patients were treated every 4 weeks. In the alexandrite study, of the 4 patients unable to return for their scheduled treatment, 2 patients went 3 months and 2 patients went 5 months between treatments. Two of these 4 patients reported progressive and gradual clearing of the tattoo during the prolonged interval between treatment sessions; the other 2 patients noticed immediate improvement only, which then stabilized without further clearing.
The appropriate treatment interval is critical and yet poorly understood. To study different treatment intervals, one group of patients received 3 treatments within 7-10 days and then no treatment for 3 months, a second group had single treatments at 2-month intervals, and the third group had single treatments at 1-month intervals. No difference in the rate of tattoo clearing was seen. All 3 treatment intervals resulted in approximately 50% clearing after 3 treatment sessions; however, as the number of treatments increases, the potential for tissue reaction also increases.
Occasional rest periods or longer treatment intervals of 2-3 months allow melanin to recover and transient textural changes to normalize, which may help avoid unwanted adverse tissue responses. Higher fluences and shorter pulse widths appear to remove tattoo pigment more rapidly but may induce excessive shock wave tissue reaction; therefore, they must be balanced with the desire to remove pigment without scarring or hypopigmentation. The current recommendation is to treat at 6- to 8-week intervals unless a longer period is needed for tissue recovery.