Introduction to tattoo removal
Tattooing is a body art that has enchanted men
since time immemorial. And with this exciting art
comes its rather unexciting removal process; as
humans were born to be fickle and tattoos are also
a victim of their changing tastes and hence the
necessity for their removal.
The initial tattoo removal methods were abrasive
and skin damaging. They caused considerable skin
destruction, inflammation (since they involved
removing the outer skin layer), scarring and risk
of post treatment infection. Dermabrasion or salabrasion,
often with chemical accompaniments, were the commonest
processes. When the thermal ways of tattoo removal
began, there was no respite from skin damage, inflammation
and scarring either. Even the use of liquid nitrogen
used to target the skin in a nonspecific manner
involved risks of scarring and incomplete results.
Surgical removals caused large scars as well.
The first non-scarring process became possible
with the advent of selective photothermolysis.
Lasers began nonselective tattoo removal in the
late 1970s. The nanosecond pulse available with
Q-switched neodymium:yttrium-aluminum-garnet, alexandrite,
and ruby lasers were considered most favorable
for effective and non-scarring tattoo removal.
The older lasers or intense pulsed light sources
cause considerable scarring. The more modern Q-switched
lasers have been the biggest boon in laser tattoo
removal, coupled with the advancement in tattoo
inks and skin clearing mechanisms. There is continuing
research regarding the effectiveness of even shorter
pulse-duration lasers in tattoo removal.
First generation tattoo removal lasers
Before the advent of selective photothermolysis,
tattoos were removed with these initial relatively
destructive laser methods.
The continuous argon laser: This is a green or
blue continuous laser pulse of 488 and 514 nm.
The tattoo pigments that are
to be removed from the skin preferentially absorbs
the pulses, but since the passes are not too rapid
the heat generated in the process also damages
the surrounding skin tissues thus causing hyperpigmented
scarring. It also results in considerable tattoo
The CO2 laser: CO2 laser is almost a quarter of
a century old in the tattoo removal process. This
uses a pulse
of 10,600 nm and removes tattoos nonselectively,
by ablating the superficial skin layer with greater
control, uniformity and accuracy while targeting
the superficial skin layers. However, even the
most advanced CO2 laser is not free from inflammation,
hypopigmented scarring and attains only partial
removal of tattoo pigments
Recent second generation tattoo
Modern tattoo needles are designed to penetrate
the epidermis and reach the melanin pigment in
the middermis of the skin, which has the capacity
to preferentially absorb a large spectrum of wavelengths.
Multiple and broad spectrum of wavelengths are
necessary so that tattoos that come in a variety
of colors now-a-days can absorb the pulses of radiation
necessary for their effective removal. This apart,
tattoos often become refractory to some wavelengths
of laser pulses and hence alternative lasers may
be required to remove the residual tattoo pigments.
Herein the size of the laser beam on the skin
also has a great bearing on the extent of absorption
of laser rays, which is also linked to scarring
and side effects.
Color is also a key factor in the effective absorption
of lasers for tattoo removal. In the early days
of tattoo removal, black was the most common tattoo
pigment and since it was capable of absorbing a
wide spectrum of wavelength, red or infrared lasers
were effectively used for its removal. Red and
near-infrared wavelengths were good enough since
they penetrated great depths. However, with the
availability of variety of tattoos colors later,
it was theorized that the color of the tattoo is
not ideal for its removal. Hence, it became necessary
to use multiple lasers.
The most recent and standard laser tattoo removal
involves the Q-switched lasers, which includes
very short nanosecond pulses. Intense millisecond
pulses cause scarring and only partial tattoo pigment
removal. The ruby, alexandrite and neodymium:yttrium-aluminumgarnet
(Nd:YAG) lasers are the best Q-switched laser types.
The ruby laser has reported the most effective
but also shows the greatest incidence of hypopigmentation.
Of course comparative analysis is not foolproof.
Ongoing research with even shorter laser pulse
durations (like picosecond lasers) than Q-switched
type lasers brings future hope of greater effectiveness,
lesser side effects and reduction in number of
treatment sessions. This has been combined with
efforts in advancements in the optical aspects
of the procedure and improvement in degree of skin
Dos and don'ts in the laser removal procedure
There are a few essential aspects of the laser
tattoo removal process, which are:
Patient counseling: This is important so far as
any patient misconception regarding the procedure,
its outcome, the costs, mind blocks, fears, treatment
duration and pre and post-treatment care is concerned.
The laser sugeon should provide detailed information
on how the procedure will work and what to expect.
Treated skin care: This is also vital in order
to ensure a safe and effective process. It involves
pretreatment, during treatment and post treatment
wound care. The laser surgeon should provide detailed
Risks from laser removal of tattoos
There are certain
snags that may occur during the process and must
be safeguarded against. They are:
- Use of the wrong laser apparatus leading
to skin damage
- Use of too high an
energy pulse, which can result in temporary
pigmentary changes and scarring
- An allergic reaction
to tattoo pigments that become dispersed during
- Skin darkening in the area of the tattoo