Laser Tattoo Removal
Tattow! The word tattoo has polynesian origins, however the art of tattooing has been practiced across cultures over the centuries. While tattooing is gaining popularity among the young adults, interestingly many seek removal of their tattoos as well. Throughout history, there have been many attempts to remove unwanted tattoos. The greek physician, Aetius practiced Salabrasion, which encompasses rubbing a salt mixture onto the skin to remove the pigment. However, this proved unsuccessful in many instances as the pigments are lodged much deeper within the skin. Moving forward, it was only in the 1960s that lasers were being developed to remove tattoos.
There are various types of tattoos, and the ease of removal using laser technology depends on many factors. These include the type of tattoo, tattoo colour, location on the body, amount of ink used and skin type. For example, a professional tattoo that is located on the ankle is more difficult to remove than an amateur tattoo located on the back.
Before you embark on a treatment, you need to understand more about laser tattoo removal before and after your treatment.
How Does Lasers Tattoo Removal Work?
We use an advanced FDA-approved Q-switch laser or Pico-second laser system that has been clinically proven to remove tattoos.
Lasers work by selectively breaking down the tattoo pigments into smaller fragments, allowing your body’s immune system to clear them away. The diameter of tattoo particles (20-200nm) are much smaller than melanosomes (structures within the cell where pigments are made and stored). A laser that is fast enough to break down tattoo particles effectively yet causes lesser surrounding damage is essential.
Pico-second laser tattoo removal is now deemed first line treatment. Pico-second lasers work by using an ultra-short wave pulse to break down the tattoo into much smaller fragments. It does this mainly by a photomechanical mechanism as opposed to a photo-thermal reaction (Q-Switched lasers) and therefore less collateral damage. Pico-second lasers for tattoo removal have the advantages of lesser treatment sessions required, faster healing time and lesser risk of side effects.
What can I expect during and after the Laser procedure?
A topical anaesthetic cream is applied to numb your skin, maximizing your comfort. The laser pulse feels like a rubber band snapping against your skin. You will experience some discomfort, redness and swelling after the laser, which will fade in a few days. Skin care and sun avoidance after the procedure is crucial to prevent complications like infection, scarring and pigmentation.
How many Laser sessions are needed to remove tattoo?
The number of sessions required is determined by the colour, depth, location and whether done by a professional or amateur tattoo artists. For example, an amateur tattoo usually requires less sessions as only one ink type is used and the ink is placed in a more superficial location in the skin.
The Kirby-Desai Scale gives the approximate number of laser sessions you may need. It is a validated practical tool that allows an individual to estimate the number of laser sessions needed and the costs involved. This scale takes into account your skin type, location of tattoo, layering, number of colours and history of skin scarring.
Laser treatments are spaced at least 3-4 months apart to enable healing of the skin and to allow clearance of the tattoo pigment by the body’s immune system.
A topical anaesthetic cream is applied to your skin prior to the procedure to optimize your comfort. A rubber snapping sensation is felt. From studies, pico-second laser is less painful than Q-switched laser tattoo removal.
There will be some redness, swelling and discomfort immediately after your laser tattoo removal procedure. However, this only lasts a few days. In some patients, a blister may form which can take up to 2 weeks to heal depending on the size of it. Uncommon side effects include hyperpigmentation, prardoxical darkening, hypopigmentation, infection, skin textural changes and scarring.
Yes. Laser tattoo removal is selective and causes minimal collateral damage to the skin. For darker skin individuals, laser treatments can be safely and effectively carried out. Dr Moses Ng usually advises a gradual step wise approach when it comes to laser tattoo removal in individuals with darker skin type.
Pico-second lasers are effective at removing multi-coloured tattoos. The removal of tattoos would depend on the wavelength of the laser. For example, the 1064nm picosecond laser is effective for black ink. The 532nm picosecond laser is useful for red, yellow, purple and orange colours.
Paradoxical darkening refers to the darkening of your tattoo after your laser procedure. This can occur with tattoos of various colours. This effect is due to a chemical reaction to compounds such as iron oxide that are contained within the tattoo. If this occurs, it can be treated with a 1064nm picoseond laser.
- Kilmer SL, Lee MS, Anderson RR. Treatment of multi-colored tattoos with the Q-switched Nd:YAG laser (532 nm): a dose response study with comparison to the Q-switched ruby laser. Lasers Surg Med Suppl. 1993. 5:54.
- Ross EV, Naseef G, Lin C, Kelly M, Michaud N, Flotte TJ, Raythen J, Anderson RR. Comparison of responses of tattoos to picosecond and nanosecond Q-switched neodymium: YAG lasers. Archives of dermatology. 1998 Feb 1;134(2):167-71.
- Jones A, Roddey P, Orengo I, Rosen T. The Q-switched ND:YAG laser effectively treats tattoos in darkly pigmented skin. Dermatol Surg. 1996 Dec. 22(12):999-1001.
- Reiter, O., Atzmony, L., Akerman, L. et al. Picosecond lasers for tattoo removal: a systematic review. Lasers Med Sci 31, 1397–1405 (2016). https://doi.org/10.1007/s10103-016-2001-0
- Wu, D.C., Goldman, M.P., Wat, H. and Chan, H.H. (2021), A Systematic Review of Picosecond Laser in Dermatology: Evidence and Recommendations. Lasers Surg Med, 53: 9-49. https://doi-org.abc.cardiff.ac.uk/10.1002/lsm.23244
- Kono T, Chan HHL, Groff WF, Imagawa K, Hanai U, Akamatsu T. Prospective Comparison Study of 532/1064 nm Picosecond Laser vs 532/1064 nm Nanosecond Laser in the Treatment of Professional Tattoos in Asians. Laser Ther. 2020 Jul 17;29(1):47-52. doi: 10.5978/islsm.20-OR-07. PMID: 32903983; PMCID: PMC7447827.