What is Laser Tattoo Removal?
Laser tattoo removal technology has matured significantly since the late 1960s, when it was first introduced. Initially, it often led to less-than-desirable results, with a lot of damage to the surrounding skin and resultant scarring. However, with the introduction of a principle called selective photothermolysis in the 1980s, we learned how to use lasers to pinpoint and heat up the tattoo ink under the skin, leading to better results.
This method involves heating up the target (in this case, the tattoo ink) very quickly before the heat can dissipate, in order to essentially obliterate the ink particles. However, the amount of heat, and how quickly it needs to be applied, depends on the characteristics of the ink particles. In general, we need to apply a very high amount of heat for a very short time—so short, in fact, we measure it in nanoseconds.
This is where a technology called Q-switching comes in. Only Q-switched lasers can produce the extremely short and powerful bursts of light required for this procedure. And lasers have now been made that can output even shorter and stronger pulses, leading to more accurate targeting with less damage to the surrounding skin.
The exact type of laser used will depend on the color of the tattoo and the patient’s skin type. Q-switched (QS) lasers, such as the QS Ruby, QS Nd: YAG, and QS Alexandrite, were once the most effective devices. But more recently, picosecond lasers have emerged as the gold standard, due to their improved effectiveness and shorter treatment times.
However, extra care needs to be taken when treating people with darker skin types to avoid skin discoloration after treatment. Certain lasers, like the Nd: YAG 1064-nm laser, are less likely to damage the top layers of the skin or cause skin discoloration in these patients.
These lasers can target tattoo ink of various colors:
* 532 nm – red, orange, yellow, brown
* 694 nm – black, blue, green
* 755 nm – black, blue, green
* 1064 nm – black, blue
To get the best results from laser removal, the most responsive colors are black, brown, dark blue, and green. But, it is toughest to remove colors like red, orange, yellow, and light blue.
Risk Factors and Frequency for Laser Tattoo Removal
Tattoos have been gaining popularity over time. The number of adults in the United States with at least one tattoo has risen from 20% in 2012 to 30% in 2016, based on a report by the 2016 Harris Poll. Tattoos these days are often more complicated, consisting of various colors and dyes. The rule of thumb is, the more intricate and colourful the tattoo, the harder it is to get it removed. Tattoos done casually are typically placed in the papillary dermis, the upper layer of the skin, and are easier to get rid of with a laser. On the other hand, professional tattoos are usually in the reticular dermis, the deeper layer of the skin.
Signs and Symptoms of Laser Tattoo Removal
A comprehensive medical history is necessary to gather information related to previous scarring and wound healing, recent isotretinoin medication, history of gold salt intake for rheumatoid arthritis (which can lead to blue-grey skin discoloration, also known as chrysiasis in laser treatment areas), or history of infectious diseases. It’s also important to ask about the presence of “double tattoos” as they may increase the risk of scarring when removed by laser.
Testing for Laser Tattoo Removal
When considering tattoo removal, it’s important for patients to understand that the process often involves between 4 and 15 treatment sessions. The specific number of treatments can vary depending on a few factors. These include the age and color of the tattoo, as well as the quality of the tattoo and how it was applied.
Something else to keep in mind is the need to avoid sun exposure before and after treatments. This is because the sun can increase the risk of skin lightening or darkening (also known as hypo- and hyperpigmentation), which might affect the look of the skin where the tattoo once was.
Before starting treatment, your doctor will take photographs. They will also ask for your consent before each session. This is because tattoo removal does carry some risks. These can include changes to skin color (either lightening or darkening), blisters forming on the skin, scars, the treated area getting darker rather than lighter (which is the opposite of what’s expected), and an unpredictable response to treatment.
Speak to your healthcare provider to make sure you’re fully aware of what to expect before deciding to go ahead with tattoo removal.
Treatment Options for Laser Tattoo Removal
Before starting a skin treatment procedure, the skin should be cleaned with alcohol or chlorhexidine, a type of antiseptic. It’s crucial to allow any alcohol used to completely dry to avoid a fire hazard. To make the procedure more comfortable, a numbing cream or anesthetic can be applied to the skin.
Sometimes, it can be difficult to predict how the skin will respond to the treatment so a small test area might be treated first. The goal during the procedure is to see an immediate whitish color, which is caused by the quick heating of particles under the skin. This usually fades away within half an hour after the treatment. The treatment should be performed with as low an intensity as possible to avoid damaging the skin’s surface. Picosecond lasers, which use very short pulses of light, tend to require less intensity due to their fast pulse speed.
Occasionally, certain tattoo colors like white, tan, red, or pink can become darker after treatment. This happens due to chemical changes in some pigments inside the tattoo. Tiny spots of bleeding may also appear, indicating the laser intensity might be too high.
The R20 method could be used for effective treatment. It involves exposing the skin to the laser four times, with a break of 20 minutes after each session. Also, different types of lasers can be combined for optimal removal of tattoos. Sometimes, a kind of laser called an ablative laser can help improve darkening effects, as well as allergic reactions to tattoo ink. If darkening is very persistent and resistant to further laser treatment, surgical removal of the tattoo might be necessary.
What else can Laser Tattoo Removal be?
There are several risks and potential complications associated with surgery, including:
- Difficulty with wound healing
- Changes in skin color that may be permanent
- Less than ideal cosmetic outcome
- Scars that are displeasing or problematic
