Laser Tattoo Removal Clinical Perspectives

Laser Tattoo Removal Procedures
Considering the Process
Tattoo art is growing ever popular, with new shops opening daily. Unfortunately, with the increasing number of tattoos also grows the increasing risk of art mistakes, bad timing, and unforeseen placement issues. Perhaps a tattoo needs to be removed because of a new job restricting visible tattoos, yet it can’t be easily covered. Sometimes the decision to have a tattoo removed revolves around maintaining a certain image in social circles, or simply the presence of negative feelings toward past tattoos. Whatever the reason may be, there are several aspects to consider with tattoo removal.

Tattoo Variations
There are a few types of tattoos that truly do make a difference when it comes to how easily and thoroughly they can be removed. Some extend deeper into the skin than others, which renders removal more difficult, while others are easier by comparison.

How is a tattoo created?
Tattoos are made of a pigment injected into the dermal layer of the skin. This is where the capillaries and nerves lay, which is why tattoos are painful and bleed during the process. Tattoos are typically placed with intent, but can sometimes be a result of an accident or trauma.

It is the placement within the dermal layer that gives tattoos their permanency. As the epidermis flakes over the years, the ink remains trapped within the dermis for long-lasting art. Therefore, for removal, the ink must be destroyed, which is much harder and more painful than the initial application.

Professional Tattoos
As for the types of tattoos, the first and most common would be the professional tattoo. These tattoos are created with a tattoo machine and set within the deep layer of the dermis, with the intention of permanency. Generally, these types of tattoos require numerous removal treatments to be effective.

Cosmetic Tattoos
Permanent makeup is the most common use of cosmetic tattoos. Though it’s usually on a much smaller scale than other tattoos, pigmented ink is still injected into the skin for enhancing facial features and saving time on makeup application. For instance, common uses of cosmetic tattoos are permanent eyeliner, filled eyebrows, lip liner, and lipstick. Oftentimes, colors other than black or blue are used for these tattoos, which can result is a greater removal difficulty. Colors such as red, white, green, nude, or brown can be very difficult to effectively remove.

Amateur Tattoos
Amateur tattoos often result when someone tattoos out of their home. These are risky and can come with a number of complications. However, these tattoos also tend to be easier to remove due to the fact that they are usually set in a more superficial skin layer. Additionally, they are often placed by using homemade needles or homemade machines, so they aren’t as permanent as professionally done tattoos.

Traumatic Tattoos
Though perhaps lesser-known, there is a type of tattoo that occurs in various types of traumatic situations. These tattoos are deposited within the skin after a traumatic injury, abrasion, explosion, etc., deep within the dermis. When these tattoos occur, they often result in the rise of blue or black tattoos. Traumatic tattoos are also referred to as “natural” tattoos because ink isn’t placed into the skin, but rather a deep scarring and natural pigmentation occurs in the dermis. These tattoos are extremely difficult, if not impossible, to remove due to how deep they are in the skin.

Medical Tattoos
Occasionally, tattoos are used in the medical field. This can be for identification, such as when a Medical Alert ID is tattooed onto the skin in replacement of a bracelet, or for marking in certain situations or experiments. The removal of medical tattoos more than likely has an average effectiveness, as they are placed by professionals.

The Process of Laser Removal
In past times, the removal of tattoos has been destructive and damaging, ranging from a number of procedures and commonly involving the surgical excision of the tattoo. As tattoos are deep within the skin, these practices often resulted in extensive scarring. Laser technology has completely revolutionized tattoo removal nearby most major cities, and though it is still painful, it doesn’t compare to the invasive procedures of past years.

When tattoos are created, the ink is absorbed by macrophages, mast cells, and fibroblasts. The ink granules remain bound within them, which keeps your tattoo in place within the dermal layer of your skin. Laser removal uses short bursts of light to rupture these cells, which in turn, releases the ink. The ink is then disposed of through the lymphatic system, or scavenged by other cells, eventually lightening the tattoo.

As treatment is continued, varying wavelengths of the light can be used in reaction to the tattoo’s response to previous treatments, the color of the ink, and the skin type of the patient. If all goes well, laser treatments are usually repeated once every eight weeks.

There are three laser types that are commonly used today in current dermatology practices. The first is considered the QS (Quality-switched) ruby laser, which was first available in 1983. This laser was soon followed by the QS Nd: YAG laser and the QS alexandrite laser. All of these lasers are considered effective, though the lasers have different purposes for tattoo removal, such as the size, depth, age, and color of the tattoo. Additionally, there have been studies recently showing the difference in picosecond lasers versus the traditional nanosecond lasers. Picosecond lasers can make a great difference in the pigmentation by having a shorter pulse duration, which results in more focused targeting and rupturing of the capsules.

Recently, there have been procedures known as combination laser treatment, which has been thought to be quite practical for greater success with tattoo removal. The idea behind this procedure involves applying laser treatment, and then within a few days, following up with a skin resurfacing and exfoliation. This combination has shown great results for removing pigmentation.

Traditional tattoo removal usually requires numerous visits with several weeks in-between for healing. However, there is another alternative procedure being explored, which is called the “multi-pass” technique. In a nutshell, this means cutting down on the number of visits by going over the tattoo with the laser multiple times in the same visit. This is completed with four “passes” over the tattoo, after twenty-minute increments between the treatments. The twenty-minutes gives time for the initial whitening to fade so the remaining tattoo ink reappears, and is ready for another go.

Tattoo and Patient Evaluation
Before treatment, a thorough history of the patient must be taken for analyzing the tattoo and skin type. This is necessary for knowing how to target the pigmented cells and how the skin will react to the type of laser. Various infections, tendencies, and habits need to be taken into account, as well as medication, and family history. Regarding their expectations of the treatment results, patients typically should be counseled as a clinic during their consultation based on the aforementioned factors. Additionally discussed within the consultation should be treatment options, possible risks, downtime, and aftercare. A clear written expectation of risks and benefits will protect both the patient and the doctor.

Possible Concerns
There are always possible complications to any procedure, and tattoo removal is not an exception. The first concern would be the number of treatments needed. Patients could enter into this process without having in mind a realistic vision of how many treatments the procedure will require. The first step to addressing concerns is projecting an accurate estimate of how many treatments may be needed for that particular tattoo and skin type.

Additionally, it is important to note that a shadow or outline of the tattoo may indeed remain after the treatment is complete, and that textural changes in the skin may occur. Patients should be counseled that there will most likely be local skin reactions to the tattoo removal, such as pain, blistering, crusting, and more. There may also be permanent scarring, hyper- or hypopigmentation, and ink color change. All of these are common potential side effects, which must be addressed and acknowledged.

Tattoo Removal Preparation

he patient’s skin must be thoroughly cleaned and prepped before the procedure. This involves the complete removal of cosmetic and skin care products. For pain management, topical lidocaine creams can be used, as well as cool air, local lidocaine anesthesia, a regional nerve block, or even a combination of these. The entire medical staff and the patient must wear wavelength-specific protective goggles during the procedure as well, with extra care taken with the patient by means of eye shields if the tattoo is on the eyelid or near the eye.

Patients need to take great care in looking after the treated area, which will be red and swollen immediately after treatment. Antibiotic ointment should be applied for ten to fourteen days following treatment to prevent infection. For managing the pain, cold compresses may provide relief. As blisters and crusting are likely to occur, patients should be advised that large blisters may be pricked with a sterilized needle and then bandaged with antibiotic ointment.

The Bottom Line
In the end, the success of tattoo removal greatly depends on the type of tattoo, the type of skin, and the laser used. Some lasers, such as the QS ruby laser, are more effective on dark black and blue tattoos, while others, such as the QS Nd: YAG are more effective on colors such as red and green. The patient’s consultation should provide answers for the best approach to removing the tattoo, whether in numerous, multi-pass, or combination treatments. With laser removal, there will always be the potential of a remaining outline or shadow, but it does provide an option for individuals looking for a less noticeable tattoo.

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