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Current Options in Tattoo Removal

Today, the most widely used method for tattoo removal involves the use of specially designed lasers.  These lasers specifically target the pigments from the tattoo inks and break them down into smaller pieces that can be absorbed by the body.  There are several different types of lasers available, and some other treatments are still occasionally used for tattoo removal.

Q-switched Lasers: 3 main types

There are three main types of Q-switched laser, though they all work on a similar principle.  Each laser delivers a very short (typically nanosecond or a billionth of a second) burst of light energy into the tattoo.  The wavelength of the light and the amount of power delivered by each laser type varies among the types of lasers.  The energy from the light causes the ink pigments in the skin to heat very quickly and then break apart into smaller pieces that are more easily absorbed by the body.  Removing a tattoo may require treatment with one or more of these lasers, depending on the colors that are present in the tattoo.

The newest technological breakthrough after many years of research is the picosecond laser (called PicoSure®).

Nd:YAG Lasers

The Nd:YAG laser differs from other lasers in that it uses two wavelengths of light.  The longer wavelength (1064 nm) is invisible infrared light effective for destroying black and some blue pigments, while the second wavelength (532 nm)  is green visible light and can selectively destroy red pigments and some brown and earth toned pigments.  The pulse duration on these lasers is also shorter, at around 10 nanoseconds.  The 1064 nm wavelength is especially good for treating black tattoos on skin of color patients.

Ruby Lasers

Ruby lasers were among the first developed for laser tattoo removal.  They are a red colored light (wavelength of 694 nm), and this works best for tattoo pigments that are black to blue in color, although they can also fade some green pigments.  They typically pulse the laser light “on” for around 40 nanoseconds.  Ruby lasers are infrequently used now, having been replaced by alexandrite lasers.

Alexandrite Lasers

Alexandrite lasers are red light at wavelengths of 755 nm.  This wavelength is particularly effective at breaking up pigments in the black, blue, and green range as well.  This laser differs from the ruby laser in that the pulse duration is typically longer, from 50-100 nanoseconds for the traditional Q-switched alexandrite laser and shorter for the new picosecond PicoSure laser.

PicoSure™

The newest device on the market is the PicoSure™ laser.  This laser was designed specifically for removal of tattoo pigments, although it can also be used for some brown spots and some other applications.  The PicoSure laser is an Alexandrite laser (755 nm) that offers a shorter, faster pulse than the Q-switched lasers, measuring in the picosecond (trillionth of a second) range rather than the nanosecond range, so it is 70 X shorter than the standard Q-switched alexandrite laser.  The energy is delivered to the pigment more rapidly, which causes a photoacoustic shock-wave effect that shatters the pigment particles into very small pieces.  This laser is more effective than traditional Q-switched lasers as removing green, blue, and purple pigments, and can also be used to treat tattoos that could not be completely removed with another method.  PicoSure is a major advance in laser tattoo removal technology.

Picosecond pulses—why does this matter?  In comparison to traditional lasers which primarly work by a thermal effect, picosecond pulses cause mechanical disruption of tattoo ink.  Shorter picosecond pulse durations create shockwaves which shatter the ink into very small particles.  This means we can treat tattoos using lower energy, fewer treatments, and significantly better clearance—as well as treat previously stubborn colors such as greens and blues.

Other Laser and Light Energy Sources for Tattoo Removal

In selected cases, yellow pulsed dye lasers may be used for resistant pigments (primarily red).  IPL (Intense Pulsed Light) devices may also have a role for special situations for resistant inks.  Infrared coagulators are rarely used due to issues with skin damage or scarring.

Surgical Removal

Some patients opt for surgical removal of their tattoos.  This procedure may be relatively quick and simple for very small tattoos, but surgical removal of large tattoos is not usually recommended, as this may require multiple surgeries or skin grafts.  As with any surgical procedure, scarring may occur.

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