Tattoos are becoming increasingly prevalent in Western society. One U.S. survey found that 24% of respondents had tattoos. The 2006 “Gen Next” Pew Research Center survey found that 40% of respondents aged 26 – 40 have tattoos. This number is expected to continue to rise, and along with it an increased number of patients will consult their dermatologist for tattoo removal.
Laser tattoo removal is probably better termed laser tattoo lightening, as only a very small percentage of treated tattoos ever completely disappear. It is much more difficult to remove a tattoo than it is to put one on. As the tattoo artists become more skilled, designs become more elaborate, and the ink combinations become more sophisticated. It makes the doctor’s job of removal more difficult. That being said, there still is a significant success rate with laser tattoo removal. Approximately 75% clearing is seen in half of the professional tattoos treated. The likelihood of the clearance is related to the color of the tattoo and the amount of ink used. Amateur tattoos with one ink or low concentration are the easiest to remove. Each color of ink, just as each color in the skin, is absorbed by a specific wavelength of light of the laser. The ink in the dermis of the skin absorbs the laser light, converts it to heat which then breaks up the ink. The body then does the rest by carrying the broken up particles away via the lymphatic system. The key is that each color ink needs a different wavelength. If the tattoo contains many different colors, each one needs to be removed separately. Sometimes, tattoos will contain a blend of multiple color inks. With the first treatment one color will be corrected, only to find another color left behind. Lasers can also change the color of some inks, causing darkening of light pigments and making the new oxidized pigment very difficult to remove.
Black or traditional tattoo ink is the easiest to remove with laser treatment. A Neodynium Yag (Nd:Yag) laser is used in the Q-switch mode (short pulse). Red and orange colored tattoos will be treated with a frequency doubled, Q-switched, Nd: Yag laser. Green and blue tattoos require a Q-switched Ruby or Alexandrite laser. The area is generally anesthetized, with either topical or numbing injection (lidocaine) or both, prior to the procedure. After the treatment, the area will scab and sometimes have bleeding, which will need to be kept covered until healed. Healing time is usually in the order of 7-10 days. Successive treatments should be scheduled 4-6 weeks apart. Most black tattoos can be removed in 5-10 sessions. Multi-colored tattoos will take more sessions, and may not ever be completely removed. Light colors, including tan, or white, or cosmetic tattoos, are notoriously difficult to remove. Test spots should always be performed on these colors, as permanent worsening is a possibility.
The most common side effects of Q-switched laser tattoo treatment include scarring and abnormal pigmentation. When utilized appropriately the incidence of scarring has been estimated at 4.5%.
As the frequency of tattoos increases, so likely will the technology as more people want to remove them. Newer shorter pulse width lasers, likely to be introduced in the coming years, will provide another method of clearing tattoos. Inks that are easier to remove were introduced to the market, but did not seem to gain popularity with tattoo consumers or tattoo artists. The use of other lasers, including fractional resurfacing, has also gained some recognition as an alternative to the Q-switch laser, or in cases where the Q-switch has failed.