Laser Tattoo Removal
For as long as humankind has performed tattoos, there’s been a need for a safe and effective method of removing them. Until the development of lasers, tattoo removal was performed by direct abrasion, or salabrasion-rubbing the tattoo with an abrasive material or rock salt. Besides being very painful, these methods were only partially effective and caused considerable scarring.
In the early 1980’s, the CO2 laser became the standard treatment for the treatment of tattoos. The laser beam was used to vaporize the tattoo pigment directly, along with the overlying skin. Although this technique was easier, safer and less painful than the “stone age” methods of dermabrasion or salabrasion, healing was prolonged, there was considerable risk of scarring, and in almost every case, some pigment was left behind, leaving a “ghost” of the original tattoo.
In the last 10 years, Q-switched lasers have been shown to be very effective at removing tattoos. Q-switched lasers deliver very high power but very short pulses of laser light, which pass through the skin and break-up the particles of tattoo pigment, which are then removed by the body, probably by white blood cells and the lymphatic system. It’s important to remember that the body tries to remove even untreated tattoos; that’s why tattoos normally fade over time. Q-switched laser treatments make the pigment particles small enough to be removed much more quickly. Multiple treatments, given about one month apart are necessary for best results.
The greater the absorption of the laser light, the greater the energy available to break up the pigment:
· Black ink absorbs all wavelengths of light
· Green and Blue ink absorbs red light best
· Red, orange, and purple ink absorb green light best
· Turquoise responds variably, depending on the pigments in the ink
· Yellow tends to reflect light and is difficult to treat.
The actual absorption of a given tattoo ink may vary considerably depending on the particular pigments in the ink, which are usually not known to the patient or tattoo artist. Also, the chemical pigments may undergo chemical changes after treatment. These factors often leads to variable and or inconsistent responses of a give color to a given laser wavelength.
Currently 4 different Q-Switched lasers are available for tattoo removal:
· Q-Switched Ruby Lasers- Red light @ 694nm> usually effective for most black, blue, and green pigments
· Q-Switched Alexandrite- Deep Red @ 755nm> usually effective for most black, blue, and green pigments
· Q-Switched Nd:YAG- Invisible (infrared) @ 1064nm> usually effective for most black and dark blue pigments
· Q-Switched Frequency-Doubled Nd:YAG- Green light @ 532nm< usually effective for red, satisfactory for black, dark blue, and purple pigments.
Many professional tattoo pigments contain metal salts, especially in older tattoos, and even identical colors may have different ingredients, and therefore may respond differently to a given wavelength of laser light. Occasionally, a tattoo color may change after the initial treatment, making it more difficult to remove.
· Multicoloured professional tattoos, especially on the arms and legs, tend to respond poorly to laser treatments, and most will need 10 or more treatment sessions for complete (95%) removal, regardless of which laser(s) is used.
· 50% of professional tattoos will be only 50% cleared after 10 treatments, especially those on the extremities.
· Amateur tattoos, which are usually composed of carbon compounds (pencil lead, ashes, india ink, etc) will usually clear completely in 4 to 12 treatments.
All of these Q-Switched Lasers cause discomfort during treatment, similar to being “snapped” with a rubber band, which fades within minutes. Some areas are more sensitive than others, such as the ankle and shoulderblade. Most patients equate the pain of removal with the pain of getting a tattoo. As treatments progress, the pain decreases because there is less pigment to absorb the laser energy. Anaesthetic creams such as EMLA can be applied between 1 and 4 ours before treatment for very effective “needle-less” anaesthetic.
There is usually come mild bleeding and blistering following the treatment, and the area is covered with antibiotic ointment and a light dressing for a few days. Fading of the tattoo is usually visible about 2 weeks after treatment, and the area can be re-treated as soon as a month later.
Although true scarring does not occur with Q-Switched Laser treatments of tattoos, occasionally mild changes in skin texture , may occur, especially with the Nd:YAG laser. The Ruby and Frequency-Doubled Nd: YAG lasers are absorbed by skin pigment as well as tattoo ink, so darker skinned patients may notice some lightening (depigmentation) of the skin, which usually returns to normal within a few months. Lighter skinned patients who are tanned should wait until the tan fades before treatment.
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