Mapperley Park Clinic

Tattoo Removal: How does it work?

Tattoo removal - how does it work?

Lasers have been used for tattoo removal for more than 20 years and we have used a Q-switched ruby laser since 1993. This laser is still our preferred choice for straight forward blue, green or black tattoos, however reds, oranges and yellows are best treated with a Q-Switched ND:Yag laser. The following information is designed to cover the most commonly asked questions.

Why is a tattoo so difficult to remove?
The tattoo pigment injected into the lower layers of skin (the dermis) becomes sealed away by a tough network of collagen fibres. It is very difficult to remove the tattoo pigment without affecting the surrounding tissue. The alternatives to laser treatment are, either to physically remove the pigment with the surrounding skin by surgical excision and skin grafting, or chemically destroy the pigment using concentrated salts or acid. In either case the surrounding skin is damaged and significant scarring would be an expected outcome to these non-laser removal methods.

What lasers are used at the Mapperley Park Clinic?
We use both Q-switched Ruby and Q-switched Nd:YAG lasers to provide the complete range of options for effective laser tattoo removal.

How are Q -switched Lasers different to other lasers used for tattoo removal?
Q-switched lasers produce extremely short pulses of high-energy, light. This light is absorbed strongly by the tiny particles of tattoo pigment but not very well by the surrounding skin. The tattoo pigment particles heat up and break down into smaller particles; these minute particles are targeted by the body's own immune system and removed. Because the energy is selectively absorbed by the tattoo pigment, surrounding tissues are not heated up to such a high temperature and there is no lasting damage to the skin.

I have seen other light treatments offered for tattoo removal, what are these?
In some cases Intense Pulsed Light (IPL) systems are advertised for tattoo removal. These systems were designed to target melanin in hair follicles for hair removal and differ from tattoo removal lasers in producing non Q-switched energy. This energy is not delivered in such a way as to crack up the tattoo particles and much more heat is absorbed and accumulates in the skin tissue than is the case with our lasers. More energy in the skin equates to skin damage and an increased risk of scarring. Unlike the Ruby, where over 20 years of scientific study backs the process, there is little, or no evidence for the efficacy of IPL systems for the removal of tattoos and such treatments should be avoided.

There are also 'soft' or 'gentle' Q-switched YAG lasers. These are re-badged, low powered hair-removal lasers and are marketed on the basis that they are pain free. This is because they use very low powers (2 joules compared to our 20). All the clinical evidence indicates that high powers are required to clear tattoo pigment - if this was not true, then we would turn our own systems down and achieve the same results at lower powers.

Can a tattoo be removed in just one treatment?
Only very rarely; some amateur (pin and ink) tattoos may disappear after only a small number of treatments; professional tattoos usually take a higher number.

How many treatments will be required to treat the average tattoo?
There is no such thing as an average tattoo; every tattoo is different and every individual responds differently. As a guide, amateur tattoos can take anywhere from 1-10 treatments; professional tattoos from 5-20, although they may take more than this. Without seeing the tattoo it is impossible to be more accurate and even then, we will only be able to give an estimate.

What are the costs likely to be?
The cost of a single treatment will depend solely on the size of the tattoo. The bigger the area, the more time it will take to treat and the higher the charge. Again, until we can see the tattoo, we cannot measure the area or price the treatment.

Is the treatment cost fixed throughout the course of the treatment?
As the tattoo fades away, the size of the tattoo will normally reduce (although this is not always the case; some tattoos will fade evenly without reducing in size). Consequently, treatment cost is re-assessed on an individual basis as the treatment progresses. If the size of the tattoo reduces significantly during treatment, the price will be reduced accordingly.

Do all tattoos respond to treatment?
Unfortunately not; most pigments, especially blacks and blues, do respond very well to the Ruby laser with reds and yellows responding to the Nd:YAG. However some green pigment can be resistant to treatment with any laser.

How will I know if there are any resistant colours present?
In most cases it will be apparent to the assessor whether there is likely to be a problem. Where there is any doubt, a test patch will be required to determine the likelihood of successful treatment. If required, a test patch will be included in the consultation fee as it is better to find out about potential problems before the whole tattoo has been treated and a larger sum of money has already been spent.

How long does the treatment take?
This depends on the size of the tattoo; a small tattoo might take 5 minutes, where a large, or multiple tattoos could take an hour or more of treatment. Again, the assessment will provide this information.

Does it hurt?
Yes, but the amount of pain felt will depend on the type of tattoo, the amount of treatment required and your own pain threshold. Some clients would describe it as no more than uncomfortable, where others would describe it as painful. Clients' descriptions range from an elastic band flicked against the skin to splashes of chip fat: the truth is that you won't know how painful you find it until you try it! Advice on pain relief will be given during your assessment. We prefer not to use anaesthetic cream on the skin before treatment as it tends to over hydrate the skin, raising the surface and making it diffiult for the laser to reach the tattoo pigment. The water in the epidermis also reflects and scatters the light differently, thereby reducing the effectiveness of the laser.

Does the laser cause scarring?
Although there is a risk of scarring with any laser, in most cases, scarring is not a significant risk for tattoo removal with the ruby laser. Tattoo removal has become associated with scarring because the first lasers used for tattoo removal were very aggressive and carried a very high risk of scarring. The ruby laser does not heat the surrounding skin significantly and the risk of scarring is much reduced. The risk of scarring is mainly associated with a genetic pre-disposition to forming scar tissue and the presence of resistant, green pigment. To reduce the risk, we carry out an extensive medical evaluation to identify high-risk clients; we also have an adjunct treatment that can stop scar tissue forming and even improve existing scarring.

Are there any other side-effects?
After each treatment, the area may blister; this is quite normal and usually resolves in a few days. Once any blisters or crusts have subsided, the skin around the tattoo will look shiny for a number of weeks. Treatment cannot be repeated until your skin has returned to normal; this will usually take from 4 to 8 weeks.

The highest-risk side effect is skin de-pigmentation (loss of natural skin colour). Because the lasers target pigments, the energy is also absorbed by the melanin in the skin. The most frequent side effect is for the natural colour in the skin to 'bleach' after a number of treatments.

While normal skin pigment will usually recover, it can take months, or even years to do so. This is why, where there is a risk of skin depigmentation, we will tailor our treatment to take advantage of the fact that the Nd:YAG laser does not target melanin as aggressively as the Ruby. As a general guideline, the darker the skin or the more treatments required, the more risk there is of long term de-pigmentation.

Because of the risk of damage to skin pigment, we will not treat tanned skin and will postpone treatment until any sun-tan has faded, this includes fake tan and sun-bed tan. We need a minimum of four weeks since exposure to the sun or a sunbed to allow the pigment producing cells to reduce in activity. Experience has shown us that pigment cells treated by laser when active, ie when recently exposed to sunlight, can be damaged permanently, resulting in permanent white patches.

Is the treatment safe?
Ruby and Nd:YAG lasers have been used around the world for more than 20 years and have treated millions of tattoos safely. Our clinic alone has delivered more than 50,000 treatments to 8,000 individuals with the only problems encountered being these outlined above; ruby laser energy is really just a strong red light and there is no linkage with any skin disorder or any increased risk of skin cancer.