In recent years, laser tattoo removal has become the most common option for tattoo removal. The technique involves the use of a high-intensity light beam that breaks up the pigment of the tattoo.  The pigment is then slowly absorbed by your body’s immune system.

Typically, several follow up sessions are required. The number will depend on:

• Type of laser used
• Type of ink (they can contain iron oxide (rust), carbon, soot, cadmium, lead chromate, titanium or
  copper and ABS plastic (to increase color vibrancy) just to name a few tattoo pigment ingredients)
• Dye colors
• Skin type
• Location of the tattoo (forearm and ankle tattoos generally take longest).
• Amount of ink
• Layering
• Scarring or tissue change
• Your body’s ability to heal and rid itself of the ink
• Whether the tattoo was done professionally or by an amateur

Laser therapy is considered so effective because it can penetrate into the dermal layers where the ink is. These are the skin layers that contain our sweat glands, hair follicles, small blood vessels called capillaries, sebaceous glands (where skin oil or ‘sebum’ is produced) as well as nerve endings. When you get a tattoo it is this skin layer that ‘contains’ the tattoo ink (encased in fibroblasts) – making it a permanent part of your dermis.

Each laser treatment takes only a few minutes to complete and, if needed, an anesthetic may be used (often 1% lidocaine). Laser tattoo removal tends to work well with inks applied by professional tattoo artists since the ink is more apt to be at the same depth in the skin.  Darker pigments especially black, dark red and blue tend to remove well with lasers. Other colors not easily removed with lasers are greens, yellows, light reds, turquoise and oranges.

The type of ink used (there are currently over 100 on the market) can also affect results. Chemical analysis of tattoo dyes has found the most common elements to be aluminum, titanium, and carbon as well as many other elements and chemicals. A high concentration of titanium has been found to be a main reason for poor response to laser treatment.

Although, many people consider laser tattoo removal the best option, for many it is not possible because of its cost when compared to other options such as tattoo removal cream. As a rough estimate, the price can range somewhere between $125-$200 per visit for a small tattoo (say 2 x 2 inches). It can often take 5 – 10+ visits before you’ll see the best results. Fading products such as
Wrecking Balm and Tat G Gone have been used by many as a way to reduce the required number of laser treatments, possibly saving hundreds of dollars.

There seems to be evidence that waiting a longer period of time between sessions can lead to better results. Keep in mind that it isn’t the laser that removes the tattoo – it only fragments the ink.  Your immune system is what actually absorbs the smallest of these ink fragments and this process takes time.  Often patients are told to wait 4–6 weeks between visits but you may find waiting at least 8 weeks provides better results and saves you money. Pigment removal, after laser sessions, is actually done by macrophages and they need time to do their work.

The number of sessions and spacing between treatments will also depend on the area of the body treated and skin color. Forearm and ankle tattoos generally take longest.

Lasers (Light Amplification by the Stimulated Emission of Radiation) provide an effective, low risk alternative with minimal side effects.

Lasers started being used for industrial purposes in the early 1960s. When researchers developed lasers that emitted short wavelengths of light (called pulses), medical applications became viable. According to the American Academy of Dermatology these lasers could remove tattoos effectively with a low risk of scarring.

Tattoo removal by lasers was initially performed with continuous-wave lasers and later with Q switched lasers, which became commercially available in the early 1990s.

The technology has come along way in recent years. The most effective lasers (prior to the Q-switched varieties used today) were called tunable dye laser. They were effective at removing several ink colors using 1-microsecond light pulses. However, what seemed to be a very short blast of laser light (1-microsecond) caused widespread adjacent tissue necrosis (the skin tissue surrounding the tattoo was cooked) followed by fibrosis (tissue scarring). Following this, shorter pulses were used (in the nanosecond range) and this prevented thermal tissue damage.

It is of interest to note that even though these pulses are delivered in a nanosecond (one billionth of a second) they can deliver a temperatures higher than 500°C into the ink particles.

Q-Switched just means that the laser is very rapidly pulsed causing the ink to be heated to fragmentation temperature before its heat can dissipate to the surrounding tissue possibly causing burns or scars. For tattoo removal, this duration needs to be in the order of nanoseconds.

A bad comparison to this technique is the way casts are removed. When it’s time for the cast to come off the doctor will use what looks like an electric saw – roughly in the shape of a pizza cutter. If you didn’t know any better you would think the blade was rotating, rather than just vibrating. The blade can be held directly to your skin without damaging it, yet it saws right through the hardened plaster cast. Your skin will absorb a laser’s energy while the tattoo pigment wont.

The type of laser that is used should depend on the tattoo’s dye colors. All tattoo dyes have specific light absorption spectra. The laser must also be capable of emitting adequate energy within the ink color’s absorption spectrum in order to provide an effective treatment. Different types of lasers produce different light colors. The color produced by the laser is the key to the laser’s effect on tattoo ink, for example, green light is absorbed by red ink and conversely red light is highly absorbed by green tattoo ink. Black inks absorb all light wavelengths since the color has minimal reflectance.

Some lasers emit a light beam of only one color of light. If you have multiple colors and you’re treated with a single laser your results will likely suffer. Often two or more laser wavelengths will be used to solve this problem.

The first lasers used for tattoo removal were Argon and Carbon Dioxide lasers used in the late 1970′s. These were followed by the Q switched Ruby Laser (QSRL) type. Compared to modern devices they all had drawbacks including burning, textural changes, inability to treat a broad spectrum of colors as well as causing hypopigmentation (loss of skin color).

Lasers developed since 2007 produce multiple wavelengths which can treat a broader range of tattoo pigments than previous Q-switched lasers and enable deeper penetration for more effective treatment of deeper, denser tattoos. An example of this newer sort is the Versa Plus. It can produce a wide range of light colors to treat the full spectrum of tattoo ink colors.

Certain pigments, such as greens, yellows and fluorescents are usually more challenging to treat than the darker colors (blues and blacks).

There are a variety of Q-switched laser types:

• Q-switched Frequency-doubled Nd:Yag: 532 nm. This one creates a green light which is absorbed by red ink. It is however also absorbed by melanin (the chemical than gives skin color or tan). It can produce pigment changes to skin (lightening or darkening).

• Q-switched Ruby: 694 nm. This laser produces red light which is absorbed by green and darker tattoo inks. It is also highly absorbed by melanin and therefore can produce undesirable side effects for patients of all but white skin such as pigment changes.

• Q-switched Alexandrite: 755 nm. Similar to the Ruby laser, this laser also produces red light which is absorbed by green and dark tattoo inks. However, the light color it produces is much less absorbed by melanin, meaning a lower incidence of unwanted lightening or darkening of the skin.

• Q-switched Nd:YAG: 1064 nm. This laser creates a near invisible (infrared) light which is poorly absorbed by melanin, making it better suited for darker skin tones. Unfortunately, it’s wavelength is only absorbed by the darkest tattoo inks.

One of the newer and most effective methods of tattoo removal is Intense Pulsed Lightl (IPL) therapy. IPL was pioneered by Dr. Patrick Bitter Jr. and is based on emission of high intensity pulses of light (not lasers) in pretty well the same way as a laser. A gel is first applied to the target area then a wand is used to emit the light pulses. It’s considered less painful and more effective than laser technology. However, it is usually more expensive and can often cost up to $10 per pulse. Depending on the size of your tattoo, this cost could quickly add up.

The initial treatment may not be as intensive as your follow ups. This allows the technician to determine your skin’s tolerance for more intensive treatment. IPL treatments are often performed every 3-4 weeks.

Risks

While generally regarded as safe, rare complications of laser tattoo removal include:

• Burning the skin

• Discoloration of dark skin

• Hypo-pigmentation (lighter spots, more common with dark skin)

• Hyper-pigmentation (darker spots) and textural changes

• Burns resulting in scars

Darkening of a tattoo may also occur. This happens when the treated area becomes darker instead of lighter. It seems to occur more often with flesh tones and lighter-colored tattoos and may be avoided by testing one or more areas prior removing a full tattoo.

Some pigments (esp. yellow #7) are known to break down into toxic chemicals when fragmented by light – either UV or laser. The resulting degraded fragments can end up migrating to the kidneys and liver.