Tattoo Removal
Tattoos, mainly carbon, are clumps of pigment suspended just below
the skin's surface. Considering this an intrusion and being unable
to remove such a large concentration, the body isolates the tattoo
behind a protective wall of scar tissue.
Lasers are now utilised in many ways. When a laser light is blocked
by tissue, thermal energy is produced and used on the area to produce
the desired laser treatment. Such treatments include not only skin,
but also the eyes, brain, etc.
YAG and Ruby Q-Switched lasers provide a very short, powerful pulse
of colour controlled light. The energy from this light is absorbed
by a specific colour only and not the surrounding skin.  Hence,
the pigment is broken into minute particles beneath the surface
of the skin, allowing the body's own defence mechanism to disperse
them. This is known as phagocytosis. The abovementioned lasers,
however, should not be confused with Carbon Dioxide lasers, which
are surgical and used for cutting and burning. If used for tattoo
removal, significant scarring has often resulted.
There are varying techniques and inks used in tattooing so the
precise type of tattoo will determine the ease of its removal. The
aim is, therefore, to break down the pigment of the tattoo and allow
the body's own defence mechanism to disperse the particles over
a period of treatments. A number of treatments may be necessary
to achieve this, dependent upon density, type and age of the tattoo,
the skin's reaction to laser light and even the presence of other
conditions. A general fading is to be expected after each treatment,
until no ink remains. It is not possible, however, to predict the
number of treatments any given tattoo will require, or to give any
guarantee or timescale on success. This is partly due to the individual's
own reaction to ink absorbtion but all leading dermatologists agree
modern laser treatment is the choice for tattoo removal.
Green, however, is a particularly difficult colour to treat although
recent advances in laser technology have been significant improvements.
Certain types of fluorescent tattoos do not respond. It is therefore
important that all relevant information regarding a tattoo is disclosed.
Prior to any treatment, a free, detailed consultation will be
held and a decision taken on suitability for treatment. Great attention
to safety will be evident, both prior to and during laser treatment.
During treatment, the patient, onlookers and staff will all wear
specially design eye protection which should not be removed until
the operator indicates it is safe to do so. Although not completely
painless, laser treatment produces only mild discomfort/mild pain
and is usually conducted without the need for local or general anaesthesia.
Treatment involves careful aiming of a variable number of laser
pulses across the affected area, the duration of treatment varying
from a few minutes to an hour or more, although short breaks may
be taken if necessary. Skin test patches may be used to assess optimum
power level and best settings although this is not always necessary.
In some cases, due to a marked local skin flush caused by laser
light masking the blemish it may not be possible to treat an entire
affected area at one time. However, the treatment may be completed
within a few weeks, prior to the resolution of other treated areas.
Treatment can take up to 6 - 8 weeks (or even longer) to settle
completely and further laser treatment is not recommended until
this has occurred. The effectiveness of the treatment is reduced
in inflamed tissues. The timescale of the natural resolution of
the skin after laser treatment varies between individuals and also
depends on the power setting needed to produce best results on the
skin. Immediate skin reaction can vary with each laser.
YAG: The treated area is covered with white laser pulse marks,
after which a small amount of pin point bleeding usually develops.
A light dressing may be applied which can be removed the next day.
The area should be kept clean and dry. A small amount of scabbing
will appear in the first week which thereafter heals to some general
dryness and pinkness before finally settling.
RUBY: The treated area may well slight but does not tend to bleed,
although a light dressing may be necessary. The area should be kept
clean and dry. Some blisters generally appear within 24 hours which,
if simply left alone will settle very quickly.
During healing skin may feel itchy but scratching must be avoided.
Dabbing gently with cold water or calamine lotion will soothe. The
normal minimum interval is six weeks, which allows sufficient time
for skin to settle and for the treatment to be effective. As with
most forms of surgical treatment, the possibility exists that some
scarring can occur. Every effort is made to keep this to an absolute
minimum by careful choice of best power setting for an individual.
In comparison with other types of laser treatment available, treatment
with this type of laser carries a far lower possibility of scarring.
However, whilst the risk is minimal, it is not possible to guarantee
it cannot happen in isolated cases. In a small number of instances,
little or no affect on the treated tattoo may be noted, despite
accurate and appropriate treatment, or the tattoo may require numerous
treatments, dependent upon depth and intensity of colouration but
this will be discussed during the consultation. As noted before,
certain tattoo inks will not respond to laser treatment and unfortunately
it is not always possible to identify these due to the particular
nature of the way tattoos are applied.
 If
you are unhappy or concerned after the treatment you must notify
the clinic or, if there is no response, your GP. You should afterwards
advise the clinic at the earliest opportunity. During the course
of treatment, lightening of tissue may occur but the natural colour
of the area should return within a few months of completion of the
treatment. Exposure to direct sunlight should be avoided for the
first few weeks after each treatment. It may always be possible,
even under close examination, that a foreign body was previously
present. Laser therapy of tattoos carries definite advantages over
many conventional treatments.
Alternative therapies do exist for tattoo removal but each carries
its own potential hazards. Plastic surgery may be possible although
this invariably leaves scarring which may be significant. Duration
of each treatment may be prolonged if skin stretching needs to be
undertaken and anaesthesia is almost always required for each surgery.
Acid/Caustic Etching is particularly dangerous and is commonly
applied by inexperienced and non-medical personnel. Like any other
chemical burn, significant and usually unsightly scarring is produced.
The application of such noxious chemicals may well reduce the possibility
of other treatment on affected areas being successful.
Over Tattooing with lighter inks, attempting to match surrounding
skin colour may be temporarily helpful but this seldom looks normal
and gradually, the underlying mark will reappear.
Co2 Lasers are well proven but by their very nature are only able
to burn out tattoos, thus leaving significant scarring. Almost all
successful medical treatments are associated with a degree of risk
ñ however, risks associated with laser therapy are minimal and fall
into two main categories.
All devices producing laser light are potentially dangerous and
must be treated with respect by all involved. Eye protection is
essential as the eye is most at risk from stray laser light beams.
However, the light does not pass deeply into or through body tissues
and very at a short distance is safe to the rest of the skin. As
already discussed, there is a possibility of minimal scarring in
certain treated areas, marginally more likely is the tattoo is particularly
deep. However, from experience to date, there are no known indications
of any side-effects from this form of laser treatment.
There is a possibility of poor response to laser treatment of seemingly
suitable marks, despite adequate skin response. In a few instances
the result of laser therapy is minimal, at least in the early stages
of treatment although subsequent good results may be produced.
Clinical trials and treatments throughout the 1980s and 1990s have
concluded this form of treatment is by far the most successful way
of removing
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