We have the latest equipment, maintain the highest standards, and make your comfort and privacy our highest priority.
Our clients receive the best possible outcomes in the safest and most beautiful of environments.
What is Laser Tattoo Removal?
Tattoos consist of thousands of particles of tattoo pigment suspended in the skin. While normal human growth and healing processes will remove small foreign particles from the skin, tattoo pigment particles are too big to be removed automatically.
Laser treatment causes tattoo pigment particles to heat up and fragment into smaller pieces. These smaller pieces are then removed by the patients immune response, where certain cells called Macrophages digest the pigment particles that are cleared through the lymphatic system. Lasers produce bursts of infrared light at specific frequencies that target a particular spectrum of colour in the tattoo ink. The laser passes through the upper layers of the skin to target a specific pigment in the lower layers.
How effective is Laser Tattoo Removal?
The colour of the light must penetrate sufficiently deep into the skin to reach the tattoo pigment. Pigments deeper in the skin are harder to remove than those near the surface.
The colour of the laser light must be more highly absorbed by the tattoo pigment than the surrounding skin. Different tattoo pigments therefore require different laser colours. For example, red light is highly absorbed by green tattoo pigments, while yellow tends not to absorb light.
The time duration (pulse duration) of the laser energy must be very short, so that the tattoo pigment is heated to fragmentation temperature before its heat can dissipate to the surrounding skin. Otherwise, heating of the surrounding tissue can cause burns or scars. For laser tattoo removal, this duration should be on the order of nanoseconds.
Sufficient energy must be delivered during each laser pulse to heat the pigment to fragmentation. If the energy is too low, pigment will not fragment and no removal will take place.
There are a number of factors that determine how many treatments will be needed and the level of success one might experience. Age of tattoo, ink density, colour and even where the tattoo is located on the body, all play an important role in how many treatments will be needed for complete removal.
However, a rarely recognized factor of tattoo removal is the role of the client’s immune response. The normal process of tattoo removal is fragmentation followed by phagocytosis which is then drained away via the lymphatics. Consequently, it’s the inflammation resulting from the actual laser treatment and the natural stimulation of the hosts’ immune response that ultimately results in removal of tattoo ink; thus variations in results are enormous.
How many treatments are required?
Complete laser tattoo removal requires numerous treatment sessions, typically spaced at least seven weeks apart.
Treating more frequently than seven weeks increases the risk of adverse effects and does not necessarily increase the rate of ink absorption. At each session, some but not all of the tattoo pigment particles are effectively fragmented, and the body removes the smallest fragments over the course of several weeks or months.
The result is that the tattoo is lightened over time. Remaining large particles of tattoo pigment are then targeted at subsequent treatment sessions, causing further lightening. The number of sessions and spacing between treatments depends on various parameters, including the area of the body treated, skin colour and effectiveness of the immune system.
Tattoos located on the extremities, such as the ankle, generally take longest. As tattoos fade, we may recommend that patients wait many months between treatments to facilitate ink resolution and minimize unwanted side effects.
Pre-treatment might include the application of an anaesthetic cream under occlusion for 45 to 90 minutes or cooling by ice or cold air prior to the laser treatment session.
Immediately after laser treatment, a slightly elevated, white discoloration with or without the presence of punctuate bleeding is often observed. This white colour change is thought to be the result of rapid, heat-formed steam or gas, causing dermal and epidermal vacuolization.
Pinpoint bleeding represents vascular injury from photoacoustic waves created by the laser's interaction with tattoo pigment. Minimal oedema and erythema of adjacent normal skin usually resolve within 24 hours. Subsequently, a crust appears over the entire tattoo, which sloughs off at approximately two weeks post-treatment. As noted above, some tattoo pigment may be found within this crust.
Post-operative wound care consists of simple wound care and a non-occlusive dressing. Since the application of laser light is sterile there is no need for topical antibiotics. Fading of the tattoo will be noted over the next eight weeks and re-treatment energy levels can be tailored depending on the clinical response observed
Side Effects & Complications
About half of the patients treated with lasers for tattoo removal will show some transient changes in the normal skin pigmentation. These changes usually resolve in 6 to 12 months but may rarely be permanent.
Hyperpigmentation is related to the patient's skin tone, with skin types IV, V and VI more prone regardless of the wavelength used. Twice daily treatment with hydroquinones and broad-spectrum sunscreens usually resolves the hyperpigmentation within a few months, although, in some patients, resolution can be prolonged. Hypopigmentation is more commonly observed in darker skin tones. It is more likely to occur with higher fluence and more frequent treatments. Sometimes lighter skin exhibits hypopigmentation after a series of treatments. Allowing more time between treatments reduces chances of hypopigmentation. Since it is more likely to see hypopigmentation after multiple treatments, some practitioners suggest waiting a few additional weeks, after a few sessions. Usually treatment stops until hypopigmentation resolves in a matter of months.
Transient textural changes are occasionally noted but often resolve within a few months; however, permanent textural changes and scarring very rarely occur. If a patient is prone to pigmentary or textural changes, longer treatment intervals are recommended. Additionally, if a blister or crust forms following treatment, it is imperative that the patient does not manipulate this secondary skin change. Early removal of a blister of crust increases the chances of developing a scar. Additionally, patients with a history of hypertrophic or keloidal scarring need to be warned of their increased risk of scarring.
Local allergic responses to many tattoo pigments have been reported, and allergic reactions to tattoo pigment after Laser treatment are also possible. Rarely, when yellow cadmium sulfide is used to "brighten" the red or yellow portion of a tattoo, a photoallergic reaction may occur. The reaction will be confined to the site of the red/yellow ink. Treatment consists of strict sunlight avoidance, sunscreen. Oral antihistamines and anti-inflammatory steroids have been used to treat allergic reactions to tattoo ink.
Studies of various tattoo pigments have shown that a number of pigments (most containing iron oxide or titanium dioxide) change colour when irradiated with Laser energy. Some tattoo colours including flesh tones, light red, white, peach and light brown containing pigments as well as some green and blue tattoo pigments, changed to black. The resulting grey-black colour may require more treatments to remove. If tattoo darkening does occur, after 8 weeks the newly darkened tattoo can be treated as if it were black pigment.
The use of Q-switched lasers could very rarely produce the development of large bulla. However, if patients follow post care directions to elevate, rest, and apply intermittent icing, it should minimize the chances of bulla and other adverse effects.
We have the latest equipment, maintain the highest standards, and make your comfort and privacy our highest priority. Our clients receive the best possible outcomes in the safest and most beautiful of environments.