Tattoos have
become extremely common
in today's society. People
from the teenagers to senior
citizens are now getting
tattoos. Tattoo studios
have proliferated across
the country, offering an
ever-expanding range of
artistic expression for
one's own body. The public
has also become more familiar
with the possibility of
removing an unwanted tattoo,
especially with laser tattoo
removal. This has also fueled
parallel growth in the tattoo
removal industry.
Tattoo removal
has been around almost as
long as tattooing. Old methods
of removal included surgical
excision, sometimes with
skin grafting. This is one
tried and true method and
requires only one treatment.
However, the side effect
is an unsightly scar, and
possibly another scar from
where the skin graft was
obtained. Other older methods
of removal include abrasives,
such as salt crystal scrubbing.
Dermabrasion is a similar
method, and uses a power
sanding device to abrade
the skin down to below the
tattoo. This can also be
effective but may most certainly
leave a scar depending on
the depth of dermabrasion
required. Acids, such as
glycolic acid or TCA, have
also been used and work
by a similar mechanism,
through a chemical burn.
One method of tattoo removal
favored by tattoo artists
involves over-tattooing
with an acid or saline.
This is variably effective
and can lead to severe scarring
in some cases.
Laser tattoo
removal was first widely
performed with the CO2 laser.
This laser works by burning
off a superficial layer
of skin with each pass.
A clean cloth is used to
wipe off the layer, with
extra focus on picking out
the tattoo pigment fragments.
Unfortunately, This method
fell out of favor due to
the superficial scarring
that is inherent to how
this method and other caustic
techniques work. However,
a single CO2 laser session
may completely remove a
tattoo.
Q-switched
lasers are currently the
state of the art for laser
tattoo removal. Q-switching
means that a very short,
high-energy burst of laser
light is directed at the
tattoo. It works on the
principle of selective photothermolysis.
The ink preferentially absorbs
the laser light and has
to expand, as would any
substance does when heated.
However, the q-switched
burst of light is so rapid
that it fractures the tattoo
ink instead, much like very
cold ice cubes cracking
when placed in a glass of
warm water. As the tattoo
ink is broken down into
finer particles that are
small enough for the body's
immune cells to absorb,
the tattoo is gradually
lightened with each treatment.
This process has to be repeated
multiple times in order
to completely remove a tattoo.
Some colors, such as yellow,
that do not absorb the laser
light well may not be able
to be completely removed.
Also, if the ink is too
deep in the skin, the light
may not be able to penetrate
far enough to affect it.
Finally, this process depends
on a functioning immune
system and good lymphatic
flow, so impairment of these
would probably impair effectiveness.
The Q-switched
lasers that have been on
the market include the ruby,
alexandrite and Nd:YAG.
The ruby was the first laser
available and has affinity
for blue ink but has the
disadvantage of a high-degree
of melanin absorption. This,
unfortunately, can lead
to burns in darkly-pigmented
individuals at higher energies.
The alexandrite functions
at a slightly longer wavelength
and has a greater affinity
for green pigment. The Nd:YAG
has affinity for black pigment
at 1064 nm and the least
melanin absorption. It can
also be used with frequency
doubling to 532 nm in order
to treat red pigment. For
multicolor tattoos, a combination
of different lasers may
be necessary for the greatest
range of effectiveness.
As with any
laser, even q-switched lasers
can have side effects. The
most common are hypopigmentation
and hyperpigmentation. These
improve with time and usually
resolve. It is possible
to completely remove a tattoo
using these lasers without
causing any scarring, however
one must not be tempted
to turn up the laser's energy
excessively. For patrons
that have the patience to
return for multiple visits,
q-switched laser treatment
offers the best chance for
scar-free complete tattoo
removal.
Research
in tattoo removal is focusing
on alternative inks. Some
inks have been micro-encapsulated
so that a single laser treatment
would completely remove
them. Other inks are made
to fade over different lengths
of time. The latter does
not give you the option
of keeping the tattoo if
you decide that you really
like it. Research on new
lasers is also ongoing.
