Laser Treatment

Many people automatically assume, incorrectly, that laser treatment is the “only sure way” of tattoo removal. Not so. It is now the most popular choice, however. Let’s look at the pros and cons of this relatively new method available today.

The word “laser,” like the word “scuba” is an acronym for a longer term that doesn’t sound as cool: “Light Amplification by Stimulated Emission of Radiation”  and “Self Contained Breathing Apparatus” aren’t that easy to say. I like “laser” and “scuba” better. There are many different types of lasers which fall into one of two broad categories; continuous wave and pulsed operation. Continuous wave lasers are just that, the beam is of constant output power and uninterrupted and is monochromatic (an unchanging wavelength). Pulsed power lasers are what we are interested in and they work on peak pulse power with short duration. Q-switching lasers are a prime example.

Not Q-Tips –> Q-Switched

The lasers now preferred for tattoo removal are called “Q-switched lasers.” This type of laser is most suited to tattoo removal because it works on using bursts of energy, or pulses, rather than one steady beam. By bottling up the energy and using an attenuator to suddenly release the charge, much higher watts of energy are released during the pulse.

Just enough energy is used to break down the pigment without heating up and destroying the skin around it. This is where operator skill comes into the picture. The more skilled the operator the less chance of scarring will occur from overheating the surrounding skin.

Each color of the tattoo requires a different laser color (wavelength) to ensure the ink itself is absorbing the energy and not the surrounding tissue. The pulse duration of the laser is measured in nanoseconds to allow just enough energy to break up the pigment and also to allow heat dissipation from the surrounding tissue. If not enough energy is released, the pigment will not break up and the tattoo remains in place. If too much energy is used the surrounding skin is cooked and scarring is likely to occur. Again,  the skill of your practitioner is vital to minimize the risk of scarring.

Which Color Ink Do Lasers “Like” Best?

That’s easy, lasers work best on black ink. One of the issues that argue against laser treatment, other than cost which we get to later, is they are not as effective in removing certain colors: yellow and green in particular are more difficult for the laser to break up. Lasers manufactured after 2006 have a better track record here. The newest lasers can produce four different wavelengths in one machine. Some clinics have lasers with the correct wavelength to target these colors or have the correct dye modules but you need to confirm this is the case with your practitioner before you commit.

Laser treatment is also less effective on darker skinned people. This is dark skin contains more melanin which diffuses and absorbs the laser radiation and can become either cooked and then scarred while the ink isn’t receiving enough energy to break apart. A Q-switched Nd:YAG 1064 nm laser is often used in this instance. This wavelength of the Nd:YAG is half that of the normal green colored Nd:YAG 532 nm laser making it infrared and invisible.

Side Effects?

Hypopigmentation, or permanent skin lightening at the area of treatment is also a higher risk for people with dark skin. In these cases, it is recommended that treatment intervals are even longer than the average six to eight weeks to ensure proper healing.

Another downside of laser treatment is that it works best on areas of thicker skin. That ankle tattoo you now hate may not respond well to laser treatment and the risk of scarring is higher.

Any Guarantees?

Again, because of all the different variables unique to each patient regarding age of tattoo, depth of ink, type of ink, color of ink, skin type etc, laser clinics will not offer a money back guarantee. They just don’t know if it will work 100% on a specific person or not. It will “fade” a tat for all the reasons mentioned but complete removal is a crap shoot.

After getting blasted by a laser some bleeding on the skin surface may occur. A white discoloration is often observed which is thought to be due to steam or gas released within the skin after laser contact. Afterward, a crust or scab forms over the treatment area which will fall off about two weeks post treatment. Some ink pigment may be seen in the scab itself. In order to avoid the possibility of scarring, it is very important you don’t “pick at” the scab. Let it go, baby, let it go.

Unfortunately, laser treatment requires multiple visits and is expensive. After each treatment time is needed for the lymphatic system to remove the now shattered pigment molecules from the dermis. On average, at least eight visits are needed with a healing period of up to eight weeks between each visit. Anecdotal evidence suggests treatment at four to six week intervals results in a much higher percentage of scarring. Depending on the color, complexity and size of a tattoo, up to 20 visits could be needed. Complete removal of a tattoo using a laser therefore, will take between 8 to 12 months for smaller tats and maybe two years or more for full trunk tattoos.

Like all tattoo removal options, laser treatment is not pain free. It is often described as having your skin being stunned by a big rubber band, or the feeling of being splattered with hot grease. Fun. Topical anesthetic gels are often applied for pain management purposes. Scarring from q-switched laser treatment is reported in about 5% of cases.

What Does It Cost?

Each session will range from $250 – $850 depending on where you live, the size of the tattoo and other complications that may be present. According to the ASPS (American Society of Plastic Surgeons) in a 2007 study, the average cost of laser tattoo removal was around $2,500. This depends again on the colors and size of the tattoo, how deep the ink was applied, the kind and amount of ink used and the type of skin of the patient in question. Results will vary. Also, there were wide regional differences in cost with the lowest average cost of $2,250 found in the Mid-Atlantic states and the highest costs on the west coast of around $2,900. For large, multicolored tattoos the costs could reach up to $10,000. A rough rule of thumb for laser treatment is to budget about ten to twenty times what the tattoo originally cost.

That can add up to a lot of money and money is scarce these days. Is laser the only way to go? No, there are other tattoo removal methods out there that we will look at in turn.

Read on.

Image credit: The Washington Post