Laser Tattoo Removal In Great Lever

The use of light as a medical treatment has grown significantly in recent years. There are now a number of devices which can deliver different types of light for an ever-increasing array of new cosmetic uses.

The use of laser light for medical procedures began in the 1960s when they were first used in operations as cutting tools by some surgeons. Laser technology has developed over the last few decades to treat patients with a variety of different skin problems including the effects of sun damage, removal of body hair and tattoo inks, and recently the treatment of psoriasis and acne.

Many people decide to get tattoos, often when they are young and impetuous, and can then go on to regret the decision later in life, especially where the tattoo features a name or symbol which they later do not want to be associated with, and which can result in psychological distress. All of this can, at worst, impact on their quality of life with regards to friends and family, or the progression of their career.

The removal of tattoos using lasers has been carried out for approximately 20 years, and has become more widespread since the mid-1990s.

Professional tattoos are those where the inks are injected deep into the lower layer of the skin or dermis, where they become surrounded by a network of collagen fibres that effectively lock them away, making removal without damaging the rest of the tissues in the skin quite difficult.

Other ways of removing tattoos have relied on more extreme methods such as surgical excision and skin grafting, dermabrasion or chemical removal through salts and acid tattooing which carry significant risks of damage to the surrounding tissue, and which often result in scarring. Also, these may not remove all the tattoo pigment, thus providing disappointing results.

There has been a recent resurgence of acid tattooing using lactic acid tattooed into the unwanted tattoo; marketing messages, claiming treatment to be ‘organic’ or ‘natural, confuse the reality which is that aggressive chemicals are injected into the skin with the aim of creating a deep chemical burn. It is claimed that unwanted tattoo pigment is rejected with the damaged tissue and that the healed result will be pigment free – this may be so but it is certainly not guaranteed.

Beware as these services often claim to be scar-free, and may be carried out by people with no experience of tattoos or tattoo removal.

Above Image: Unusually, the entire tattoo had been treated with lactic acid tattooing (usually, only 20% of the tattoo is covered with each treatment). Silicone gel was provided to try and flatten the scarring.

Image Courtesy of The Mapperley Park Clinic.

The use of certain lasers, which do not damage surrounding skin and which can, with multiple treatment sessions, produce good results, have become the preferred method for tattoo removal treatment.

According to 2017 statistics from the American Society for Aesthetic Plastic Surgery (ASAPS), 15,745 tattoo removal procedures were performed in the U.S., a decrease of 42.2% on 2016 figures. They chose not to gather data for this treatment in 2018.

 If you are considering Laser treatment for tattoo removal, the following information will give you a basic understanding about what's involved. It can't answer all your questions, since a lot depends on the individual patient and the practitioner. Please ask a practitioner about anything you don't understand.

Amateur, or simple blue/black professional tattoos will respond to Ruby, Alexandrite and Nd:YAG lasers but as soon as coloured pigments are present, the question should be asked – how do I know that this laser will remove this particular pigment?

Tattoo pigments respond to laser treatment in a variable manner. Some pigments respond well to one wavelength but not to another: some colours (particularly certain green pigments) do not respond to treatment at all.

Where coloured tattoos are involved, it is a good idea to have treatment at a clinic that has more than one Q-switched laser (and therefore more than one wavelength) at its disposal. The commonest laser combination is the Ruby (694nm) and Nd:YAG (532nm and 1064nm), which together deliver 3 wavelengths, greatly increasing the chance that there is an effective wavelength available for each pigment.

Some pigments will not respond to any available wavelength and some pigments, especially modern, pastel, white or ultra-vivid pigments may respond by turning brown or black. These residues then may, or may not respond to further treatment.

Semi-permanent or micro-pigmentation pigments may be particularly difficult as they are often blends of ‘earth’ toned pigments, often containing iron-oxide compounds which commonly turn black on exposure to laser light. It is essential that careful test patching is carried out on any micro-pigmentation inks to ensure that the pigment will respond without making matters worse.

In anything but the most predictable case (blue/black), it is essential that you have a clear idea of the worst-case predicted outcome. A skilled practitioner will be able to help you to predict the worst case, which if acceptable to you, will be the basis of the agreement to treat. If the worst case scenario is not acceptable, you should be wary of continuing because you are unlikely to be happy with the outcome.

Test patching potentially difficult colours is the only way to check response and it may take multiple visits to find out whether a particular pigment will respond.

Some clinics may advertise the use of IPL machines or non Q-switched lasers for tattoo removal, however clinical data so far doubts that these devices are suitable or safe for tattoo removal as they do not produce the targeted bursts of high energy required to break down the pigment particles without affecting the surrounding tissue. You should therefore be wary of any clinic offering tattoo removal who claims this can be done using an IPL device.

Most patients will be able to return to work immediately following this type of procedure, although the area will be sore and tender and may be covered by a dressing for up to a week. If you are working in dirty or unhygienic conditions, extra care must be taken, especially where tattoos are on the hands.

It is very important that you follow the advice of your practitioner carefully after any laser treatment for tattoo removal to help make the procedure as successful as possible and to reduce the risk of complications.

Post-treatment advice may include:

• redressing any bandages as recommended by your practitioner;
• not picking at any scabs or crusting that appears on the skin of the treated area, as this can increase the potential for scarring;
• not scrubbing the area when showering or bathing;
• not exposing the area treated to the sun without a sunscreen for at least 4 weeks to reduce the risk of disturbing pigmentation in that area. A high factor sun block should be used daily to protect the skin;
• staying out of public swimming pools while the treatment site is fresh;
• contacting your practitioner immediately if you notice any signs of infection.

As a general rule – once scabs and blisters are dry, the area is safe from infection. If scabs and blisters are still wet or glistening the risk of infection is high.

When post-treatment advice is followed, the risks of infection are very low. In case of any infection, intervention is usually the prescription of a topical antibiotic cream.

Generally light systems for the removal of tattoos are used by doctors, surgeons or nurses, although anyone who is ‘appropriately trained’ may legally use a laser. The key is experience. Tattoo removal is probably the laser treatment with the most variability – both in terms of how good the end result is and the cost. In everything but the simplest blue/black tattoo, there are many challenges and you should be comfortable that your practitioner has the correct range of equipment and the experience to use it. Be wary of anyone who makes it sound too good to be true – it probably is!

Treatment costs for tattoo removal vary depending on the size of the tattoo and the type of tattoo ink used, as this will have a bearing on the number of treatment sessions required.

There may be an initial consultation fee, or fee for a test patch of skin to be evaluated. This will normally be in the region of £25 - £50.

Private prices for tattoo removal start from approximately £50 to £300 per session, with total cost running from a few hundred pounds for very small, blue/black tattoos, to many thousands for large multi-coloured tattoos. Multiple treatment sessions are almost certainly required, so a programme of several treatment sessions paid as a package is usually cost effective.

Case Study 1

An old, professional tattoo with predicted difficult colours on a male patient.

After 7 treatment sessions with Ruby and YAG lasers - only greens (darkened), red and yellow remain resistant.

After 15 treatment sessions - greens and red continue to fade slowly - yellow is not going to respond.

Note: skin depigmentation - this will improve but may not recover completely (freckled skin-types recover poorly).

After 7 Treatment Sessions and After 15 Treatment Sessions

Case Study 2

A modern professional tattoo with predicted difficult colours on a female patient.

After 5 treatment sessions - all black gone - green, red and yellow remain.

After 8 treatment sessions - fading continues

After 10 treatment sessions - fading continues

This tattoo will fade to completion.

Again, depigmentation is an issue - the background colour will return but freckling will not.

After 5 Treatment Sessions. After 8 Treatment Sessions. After 10 Treatment Sessions

Images provided courtesy of The Mapperley Park Clinic.

All before and after photographs are real patients, your results may differ.