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Tattoo Removal

When should lasers/energy-based devices be used to remove tattoos?

Tattoos are meant to be permanent. Yet as one ages and one’s professional and personal situation changes, removing them may become desirable. 

What devices are used to remove tattoos? 

Various lasers can be used to lighten and fade tattoos. The standard for years has been a type of laser called a “Q-switched” laser.  This laser uses an internal switching mirror to generate a laser pulse much faster than a typical aesthetic laser.  

Recently, an even faster picosecond laser has become available to completely remove some tattoos that could only be faded previously. Picosecond laser tattoo removal generally requires fewer treatment sessions, may offer better results, and typically has faster patient recovery times compared to traditional tattoo removal lasers.

Description of treatment

Topical anesthetic creams are usually applied approximately an hour before the treatment. Some patients prefer to have a local anesthetic injected into the tattoo prior to laser therapy. Pinpoint bleeding, crusting, redness, and blistering are commonly associated with the procedure. Pulses of laser energy are directed onto the tattoo, breaking up the pigment. Over the next few weeks, the body's scavenger cells remove pigment residues.

Patients must not be tan during their treatment sessions. Following treatment, wound care and sun protection of the treated area are necessary. A change in the color of the treated area is likely, and may be permanent. As with any laser procedure, there is a risk of a scar, and this risk will be increased if the area gets infected.  However, scarring in the area has often already occurred as a result of the process used to create the tattoo, and may only become visible once the tattoo fades.

Success rates/potential complications

  • Some colors of tattoos are more difficult to remove than others. Because black pigment absorbs all laser wavelengths, it's the easiest to remove. Other colors, such as green, selectively absorb laser light and can only be treated by selected lasers based on the pigment color. White tattoos are the most difficult to treat with laser, as some of them could even turn black with treatment. The Picosecond laser tattoo removal offers an innovative treatment for these colors.
  • Professional tattoos are usually harder to remove than amateur tattoos, as they are often placed deeper and use a greater density of ink.
  • It is much easier to have a small tattoo removed than a large one
  • The risk of scarring is always present, and as discussed may already be present but hidden by the ink.
  • Both getting a tattoo and having it removed can be uncomfortable. The impact of the energy from the laser's powerful pulse of light has been described as similar to getting hot specks of bacon grease on your skin or being snapped by a thin rubber band.
  • Because it is actually a person’s own white blood cells that remove the ink, results can vary not only by the tattoo or the laser, but also from person to person based upon how well their own immune system works to clear the damaged pigment.  Smoking will negatively affect this process.

What outcome should patients expect?

More than one treatment (each treatment actually only takes minutes) is usually needed to remove an entire tattoo. The number of sessions depends upon the laser and the settings used, the amount and type of ink used and how deeply it was injected, and the effectiveness of the patient’s white blood cells. Six to eight week intervals between sessions are required to allow pigment residue to be absorbed by the body. Anywhere from six to more than 10 treatments may be necessary to achieve maximum lightening, and full resolution of the tattoo may never be achieved for some individuals.

Updated June 2, 3016

The American Society for Laser Medicine and Surgery is the world’s largest scientific organization dedicated to promoting research, education and high standards of clinical care in the field of medical laser applications. It provides a forum for the exchange of scientific information and participation in communicating the latest developments in laser medicine and surgery to clinicians, research investigators, government and regulatory agencies, and the public.

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