Side effects of laser removal? I’m so glad you asked. The American Academy of Dermatology says there is a low risk of scarring when using lasers to remove a tattoo – a 5 percent chance. Then again, there was a low risk of scarring associated with getting the tattoo in the first place. With any of the old style removal techniques, scarring was pretty much expected. Other things that you might look for include hyperpigmentation (an abundance of skin color that might appear darker than normal), hypopigmentation (not enough natural skin color, which makes the skin seem too light), a remainder of some portion of the tattoo pigment, and as always, the risk of infection. It’s not perfect but it sure beats sandpaper or stitches.

Where you’ll feel the real bite, though, is in the wallet. Even though it’s done in a doctor’s office, most insurance companies won’t insure something that is considered cosmetic. Laser tattoo removal ranges from several hundred dollars to several thousand. Be sure that you have, in writing, how much the total cost is going to be at the end of the process. On the bright side, at least you don’t have to tip.

Choosing a dermatologist for your outpatient procedure is as important as choosing a great tattooist. As with a tattooist, the best referrel is a personal one, someone you know who has had a tattoo satisfactorily removed (remember that no one will guarantee thay can completely remove your tattoo or prevent scarring). failing a personal referral, you could ask your personal physician. You can also try the American Society for Laser Medicine and Surgery for recommendations.

Make sure that you are getting a medical doctor who specializes in laser surgery, and it would also be fabulous if you found somebody who has done thousands of tattoo removals. There’s a learning curve just as with tattoo applications, and experience does count.

Other related Q-switched lasers used for brown pigmentation and tattoos include the Q-switched Alexandrite laser which goes slightly deeper than the Ruby laser, and the Q-switched Nd: YAG laser, which goes deeper still and can treat red tattoo ink.

Long-pulsed lasers
Once it was discovered that the Q-switched lasers were effective for treating sunspots and removing tattoos, but that they were less so for biopsy-proven benign moles and hair removal, the next step was to extend the pulse duration. Other safe lasers for the removal of brown spots and tattoo pigments were developed. The result was known as long-pulsed or normal-pulsed Ruby, Alexandrite or Nd: YAG lasers. This has given us lasers that can remove hair and treat proven benign moles and brown birthmarks in addition to tattoos of widely varying colors.

Before, during and after laser treatment

Before
If you have olive or darker skin or a suntan, special precautions need to be taken before this form of treatment. In such cases a lightening cream and sunscreen should be used in order to prevent the laser from being absorbed by the tan. Some people with dark skin may not be suitable for this treatment.

During
You will be required to wear laser-protective goggles. The laser physician targets the skin area to be treated and activates the laser. A skin-pricking or snapping-sensation is felt. If this is uncomfortable you will be offered a local anaesthetic cream.

Length of Procedure: this depends on the size and location of the tattoo area being treated, however most tattoo removal sessions only take several minutes.

After
Some crusting and weeping may occur but should mostly heal quickly over a three-to-four day period. Some tattoo treatments may take longer to heal. You may return to work immediately after treatment. You will most likely be given band-aids or non-stick dressings as well as antibiotic ointments or creams to be used for up to four to five days. Use a sunscreen once dressings have been removed. If you have been treated for sunspots or brown birthmark, you should be given a skin-lightening cream to use for a week.

Possible Complications
Scarring can occur (particularly with some tattoos) or loss of your natural skin pigment. Results may be poor with some darker birthmarks.

Some of these fragments will literally fly out through the skin’s surface while other remaining pieces will be removed by your immune system over a period of time, usually weeks to months. Because skin normally absorbs very little of this heat energy, produced by the laser, it targets and destroys the ink while leaving the surrounding tissues intact. The following two lasers are currently among the most popular laser tattoo removal methods in the world.

Q-Switched ND: YAG Laser

This laser’s light is designed to be absorbed by both blue and black melanin (or natural pigments). It causes the melanin to be heavily fragmented – so small that the particles are able to be metabolized by your body’s lymphatic system (or be discharged or excreted from the body).

The pigment mass expands quickly and causes the ink molecules to shatter. They are then absorbed by what are called phagocytes. This process causes the tattoo pigmentation to be removed without causing injury to normal surrounding tissues.

The Q-switched ruby laser

This equipment emits intense red light that passes without harm through the epidermal skin layers where it is targets specific pigments of tattoo ink. Just like the YAG, and others, its energy causes heat upon impact with the tattoo ink shattering it into tiny particles that are then absorbed by your immune system. Larger particles that are not fragmented can require additional laser sessions, often several are needed to completely remove the ink.

The ruby laser is FDA approved and although there may be some temporary skin lightening, it has not been known to affect the surrounding skin structures because the skin will not absorb the energy generated by the laser light, only the tattoo ink will. This technology is endorsed by the American Academy of Dermatology as the treatment of choice.

After the laser treatment, the area will turn white and often swells slightly. This white color will usually fade within less than an hour. A scab may form in the days following but will usually return to normal within 7 – 10 days.

In terms of wavelengths of light (as measured in nanometers) the following rules apply:

532nm – Is a laser that emits a green light. It is targeted to reds, oranges and pinks.
755nm – This red laser light is attracted to greens, turquoise (one of the most difficult colors to remove), light blue and teal
1064nm – this invisible radiation wavelength emits infrared laser light that is attracted to black, darker blues and browns.

All of these three laser wavelengths may be used concurrently, similar to
ipl tattoo removal since they will only work on the colors that they are attracted to naturally.

When considering laser therapy it is very important to understand the specific types of equipment that you practitioner has in order to determine your success.

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.