Factors affecting laser tattoo removal

• Age of the tattoo: it is easier to remove older tattoos
• Location on the body: the closer it is to the heart, the better are the results of removal. However, tattoos located on extremities are difficult to treat since the circulation is relatively poor.
• Ink colour: it is easiest to remove black tattoos as this pigment absorbs all laser wavelengths. However, green, yellow, and fluorescent inks are very difficult to remove.
• If the tattoo is professional or amateur (overall, amateur ones are easier to remove)

Pain

A lot of people worry about the level of pain they will experience during the tattoo removal process. However, the level of pain you'll experience depends on the location of your tattoo, your threshold for pain, and the kind of removal treatment used.

Some of the methods used to manage the pain are:

• Ice packs: Ice packs are an easy and cost-efficient method to numb pain. However, 5-10 minutes of compression numbs the skin adequately.
• Topical numbing creams: These include benzocaine, lidocaine, and others. They are available in different strengths and formulations. They help to numb the skin. These creams are applied about 30-45 minutes prior to treatment.
• Cold air machines: These provide fast and convenient numbing. Unlike ice packs, they can be applied before, during, and after treatment. Zimmer Cryo 6 cold air machine is the gold standard for tattoo removal. It works by blowing cold air (-30°C) on the skin for a few minutes, after which the skin is thoroughly numbed for treatment.
• Drinking plenty of water, avoiding caffeine, and keeping your skin hydrated throughout the course of treatment can also help reduce the pain.

Post-procedure care

Your skin may feel sunburned and remain red for a few days. A scab may also form before healing occurs. Moreover, the doctor will apply an antibacterial ointment. The same pain reduction measures described above can be used after treatment as well. In addition, strict photoprotection is advised on the treated area to avoid post-inflammatory hyperpigmentation (PIH).

Side effects of Tattoo removal

Some of the possible side effects are -

• Redness
• Swelling
• Bleeding
• Raising of the tattoo
• Blisters
• Temporary darkening of the skin
• Unwanted change in pigmentation - lightening or darkening of skin
• Scarring
• Infection
• Textural changes of skin

Also, if you wish to get a new tattoo to replace the original, you need to wait for about one to four weeks after your last laser session. This will give your skin time to heal.

Tattoo removal Treatments

Tattoos are not as permanent as they used to be. Dermatologists can safely remove tattoos with several techniques. Moreover, there is no scarring or damage to your skin after tattoo removal. 

 Some of the tattoo removal methods are:

• Laser tattoo removal:

Laser is the best, easiest, and the most commonly used method for tattoo removal. It uses short pulses of intense light to target the tattoo pigment. They pass the top layer of skin harmlessly and break the pigment into smaller pieces. Subsequently, the body’s immune system removes these pieces. The tattoo particles are broken up over multiple sessions to no longer be visible.

It works on the theory of selective photothermolysis. When the right wavelength of light and pulse duration are used to target the pigment, it will heat the pigment to the point of destruction. This causes minimal damage to the surrounding skin. While most of these lasers operate on a nanosecond, the newer picosecond pulse duration lasers remove tattoos by a photomechanical effect. This physically fractures the tattoo particles.

1. Q switch:

This laser produces an intense, focused beam of light onto the pigment in the skin. It delivers light energy in short ‘pulse durations’. Additionally, it has a specific wavelength for each pigment. Moreover, it allows every pigment to absorb the light energy at their respective corresponding wavelengths. 

This causes the tattoo pigment to disintegrate into tiny particles. These pigment particles are then absorbed by immune cells of the body called macrophages and eliminated quickly. 

Three types of Q-switched lasers are used to customize the wavelength for different pigments, these are:

• Ruby laser (694 nm): blue, green, and pigments
• Nd:YAG laser (532 nm, 1064 nm): red, yellow, orange, black and blue pigments
• Alexandrite laser (755 nm): black, blue and green pigments

A combination of all three ensures coverage of the full spectrum of pigments.

2. Intense pulsed light (IPL) therapy:

IPL therapy uses a broad spectrum light to remove the top layer of skin. Consequently, the skin regenerates itself in that area. Because the therapy emits larger light pulses, it is suitable for bigger tattoos. However, since permanent loss of colour (hypopigmentation) may occur it is not advisable for dark-skinned individuals.

• Cryosurgery:

Although less expensive, it is not as good a method for tattoo removal as laser. Cryosurgery uses liquid nitrogen to freeze the pigment. This removes the top layers of skin. However, this treatment is likely to damage even normal tissue. It is not suitable for individuals with sensitive skin. Moreover, it is also not effective on green and yellow pigments. 

• Dermabrasion:

This method abrades the top layers of skin to reach down to the pigmented skin. It uses a high-speed brush or wheel. Hence. there is a high risk of infection and scarring. 

• Plastic surgery:

This quick fix is relatively less expensive and painful. This process involves planting a graft another layer of skin on your tattooed skin.

• Saline tattoo removal:

This treatment uses an injection of saltwater/saline solution. The salt extracts the inked skin cells without causing too much pain. This procedure takes about 4 - 6 weeks.