Tattoo Removal

Tattoos have become part of American mainstream culture over the past couple of decades. It is estimated that more than 20 million Americans have at least one tattoo, including up to 36% of all individuals 18-30 years of age. The most common reasons to get a tattoo include the desire to feel more attractive and sexy. Interestingly, 48% of Americans surveyed claim that tattoos make people less attractive. It is estimated that 40-50% of individuals with tattoos regret the decision to get a tattoo and want them removed. The search term ‘Tattoo’ is always in the top ten on Google, even higher than Britney Spears, and the term ‘tattoo removal’ is not far behind.

What Is a Tattoo?

Tattoos involve permanently depositing pigments made of carbon (India ink), and organic dyes mixed with metallic elements into the deep layer of the skin called the dermis at a depth of 1-2mm. An electric machine vibrates a cluster of needles hundreds of times per minute to puncture the skin and deposit the pigment.

Why do people want their Tattoos removed?

Patients request tattoo removal for a variety of reasons, some social and others physical and cultural. Sometimes tattoos fade and don’t look good anymore. Some patients develop an allergic reaction to the dye or are scarred during the process of tattoo placement. Very commonly patients report that they have entered a different phase of their life, have a new job or a spouse and having a tattoo just doesn't suit them any longer.

What Methods Are Used for Tattoo Removal?

Before lasers became popular for tattoo removal starting in the late 1980s, removal involved the use of one or more of these often-painful, often scar-inducing surgeries:

• Dermabrasion , where skin is "sanded" to remove the surface and middle layers;
• Cryosurgery , where the area is frozen prior to its removal;
• Excision , where the dermatologic surgeon removes the tattoo with a scalpel and closes the wound with stitches (In some cases involving large tattoos, a skin graft from another part of the body may be necessary.

Although the procedures above are still used in certain cases today, lasers have become the standard treatment for tattoo removal because they offer a minimally invasive, low risk, effective alternative with minimal side effects. The type of laser used to remove a tattoo depends on the tattoo's pigment colors. The most common lasers developed specifically for use in tattoo removal use a technique known as Q-switching, which refers to the laser's short, high-energy pulses:

• the Q-switched Alexandrite(red light) , 755nm: Wavelength of choice for green, moderately effective for black, blue pigments.
• the Q-switched Nd: YAG(invisible light) , 1064 nm: Laser of choice for black pigment. effective for dark blue pigments.
• 532nm (green light) Wavelength of choice for red and satisfactory for black, dark blue and purple.
• Q switched ruby 694nm (red light): effective for black, blue and green pigments
• 585nm effective for sky blue pigment

How do Lasers Remove Tattoos?

Lasers work by producing short pulses (billionth of a second) of intense light that pass through the top layers of the skin to be selectively absorbed by the tattoo pigment. This laser energy causes the tattoo pigment to fragment into smaller particles that are then removed by the body’s immune system. Each laser has specific wavelengths used for different tattoo colors.

Does Tattoo Removal Hurt and What Can I Expect?

Advanced tattoo removal lasers are much faster and less traumatic to the skin than previous technologies, rendering the treatment much more comfortable. The impact of the energy from the laser's powerful pulse of light has been described as similar to getting snapped by a thin hot, rubber band. With each subsequent treatment, the discomfort fades.

Methods for anesthesia vary from a Zimmer air chiller, topical or injectable anesthesia.

In preparation for a laser procedure, we recommend that non-aspirin products, like Tylenol, be used for minor aches and pains prior to the procedure, because aspirin and nonsteroidal anti-inflammatory agents such as Ibuprofen can lead to bruising after treatment.
The laser treatment involves delivering intense pulses of light from the laser into the skin with absorption by the tattoo pigment which is fragmented. This can generally be accomplished in a matter of minutes.
The treatment will leave the skin mildly red and may result in pin point bleeding or blistering. One may notice a temporary whitening of the tattoo and swelling of the skin in the region. Over the next few weeks, the body's scavenger cells remove pigment residues. One begins to notice lightening of the tattoo approximately two weeks post treatment and this will continue for four to six weeks.
Several treatments are usually needed to remove an entire tattoo -- the number of sessions depends on the amount and type of ink used and how deeply it was injected, but can vary from approximately four to ten. Six week intervals between sessions are required to allow pigment residue to be absorbed by the body.
Following treatment, the doctor will apply an antibacterial ointment and dressing to the area. The skin should be kept clean with continued application of ointment as directed. A shower or bath the day after treatment is okay, but the treatment area should not be scrubbed. Your skin might feel slightly sunburned for a couple of days and the treated area may remain red for a few weeks. If the skin forms a blister or scab, this should be handled gently. After healing, the tattoo color will gradually and continually fade.
Side effects of laser procedures are generally few but may include hyperpigmentation, or an abundance of color in the skin at the treatment site, and hypopigmentation, where the treated area lacks normal skin color. Other possible side effects include infection of the site, textural changes in the skin and a low risk of permanent scarring. The biggest risk is incomplete removal of all pigment. Treatment of tanned skin increases the complication rate and should be avoided.

What are the reasons it is hard to predict how many treatments will be necessary?

The number of treatments required and the chance of incomplete tattoo removal depends upon several factors, including size of tattoo, location, the individual's ability to heal, how the tattoo was applied and how long it has been in place. For example, a tattoo applied by an inexperienced artist and a newer tattoo may be easier to remove.
Furthermore, we don’t generally know which of the over 100 tattoo inks available today were used to create the tattoo and sometimes the pigments undergo chemical changes after the tattoo is placed. Even two identically colored tattoos may be derived from very different colors and types of inks.
The easiest tattoos to remove are ones with solid colors of black or green. In contrast, the hardest are the multi-colored tattoos, especially containing floral and pastel colors.

If you have to get a tattoo, what should I know?

Go to a reputable practitioner who is using advanced and sterile instruments and choose a facility that is clean and up to date. Try to choose as few colors as possible and gravitate towards green, black and blue. Avoid pastel colors, yellow, orange and white as they are harder to remove. Consider having the tattoo placed in an area that is easily coverable with clothing in case you regret the decision later.
Candela Corporation is currently developing Freedom-2, a new tattoo ink that will be able to be removed more easily, often with only one laser treatment. When released, this will revolutionize the process of tattoo placement.

How does one choose a provider for laser tattoo removal?

There are several factors that will help ensure that you choose the right physician and facility for laser tattoo removal. First, make sure that the practitioner is indeed a physician. Next, ask the practitioner if he owns or rents the technology he will be utilizing. A physician who rents or uses a hospital based system normally doesn’t perform enough treatments to warrant purchasing the lasers. Rental lasers may also be improperly calibrated and result in bad outcomes. Make sure the technologies are indeed lasers (sometimes the term is used loosely) and are new.
Choose a physician who owns more than one tattoo laser and has the full complement of wavelengths to treat all tattoo colors. If this is not the case, it may compromise care and result in inadequate removal of the tattoo pigment or even scarring.
Lastly, choose a physician who focuses their time in Laser and Aesthetic medicine, not one who has a different area of interest and uses lasers part time. Look around the office carefully. Make sure it is clean and up to date. Look for other lasers used for hair removal, skin rejuvenation, acne, rosacea, skin resurfacing and acne scars, etc. This demonstrates experience and dedication to the field.

Laser Tattoo Removal at Awesome Aesthetics

The physicians of Reflections own several lasers for tattoo removal and utilize all wavelengths necessary to treat the variety of tattoo colors seen. Because of this, all colors will be treated on the same visit. This is in contrast to other facilities with only one laser, where only one color will be treated during each visit, thereby extending the time it will take to remove the tattoo.
The most commonly utilized Laser is Candela Alex laser. This is recognized to be most advanced in the world.