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Rethink Ink

Excerpt from the March edition of American Spa magazine, Rethinking Inking by Mitchell Chasin, M.D.

Laser Tattoo Removal has come a long way in the past few years, as technology continues to improve and the demand for removal continues to grow. But technology is only part of the equation. Good decision-making and setting clear expectations are key to achieving satisfying results. In the past, physicians have used carbon-dioxide lasers, pulse-dyed lasers, IPLs, and even dermabrasion to try to break up tattoo ink under the skin. Unfortunately, these devices and procedures proved to have shortcomings, and poor ink clearance and scarring were often the result. These days, physicians are using an assortment of quality-switched laser devises (Q-switched lasers) to safely deliver energy into the skin to shatter tattoo ink, allowing the body's lymphatic system to methodically carry the particles away. A Q-switched laser emits short, high-power pulses, allowing a laser to produce a pulsed beam of light. The technique produces light pulses with very high power -- much higher than would be produced by the same laser operating in a constant output (continuous wave) mode.

Matching Wavelengths and Ink Color

Q-switched lasers emit a unique wavelength of light energy, each of which is better absorbed by different colors of ink. Getting the best results requires matching the right Q-switched laser and laser wavelength to your skin type and the color of your tattoo. Despite manufacturers' claims, there is no one laser that is equally effective for all tattoo colors and skin types. Be wary of inexpensive tabletop tattoo removal lasers, as they generally don't utilize a large enough spot size to get adequate penetration of energy, and scarring often results.

Setting Expectations

Most people don't understand what laser tattoo removal entails when they walk through the door. Many expect to receive one treatment and leave with clear skin and a fresh start. The reality of tattoo removal isn't a nearly that simple, and it's important that you understand how the process works. It takes many treatments over the course of many months to clear the ink, and there are no guarantees that the tattoo will be fully removed in the end. Clear expectations is key to staying satisfied through a long, expensive and potentially painful series of treatments. Even when confronted with the realities of tattoo removal, most start threatment determined to get rid of their unwanted tattoo. The number of treatments it takes to clear a tattoo depends on the type of tattoo and color of the ink(s). Professionally inked tattoos typically have mulitple colors and take the most sessions to clear (usually six to 12 and possibly more), because the ink is injected at a high density and penetrated deeper in to the skin. Amateur tattoos are usually easier to remove because they use less ink. These typically take two to six sessions to clear.

Permanent makeup usually takes one to three sessions to clear, because it uses less ink than professional tattoos, and the injections occur more superficially into the skin. Sometimes the cosmetologists who perform this unregulated beauty treatment use ink containing iron, which can turn blue when hit with laser energy, so testing a small spot before treatment is highly recommended.

Traumatic tattoos result from froeign matter being driven into the skin, such as when a motorcyclist has a spill on asphalt or the skin is punctured with a lead pencil. The number of treatments required to clear a traumatic tattoo can vary greatly -- if they can be cleared by lasers at all -- depending on what substances are embedded in the skin. Two to six treatments is a good place to start. For those with medicinal tattoos, which are used to mark sites on the body for radiation treatment or for catheter placement, they often view it as a reminder of ill health that they want removed after recovery. These usually take just one or two treatments to erase.

Understand that you may need more or fewer sessions, depending on your specific tattoo. With all the formulations of ink and individual tattooing styles available, you never really know how long treatment will take until you have a few sessions under your belt. Treatments should be spaced at least six to eight weeks apart. You can go months between treatments without affecting the eventual outcome, and if you insist on tanning during the summer, it is advisable to put laser tattoo removal on hold for this period, because having a tan can interfere with the delivery of energy and potentially lead to complications.

Learning to Say No

If you have a history of keloid scarring, have had an allergic reaction when you received a tattoo, or have dark skin and a red, pink, and yellow tattoo, it is not advisable to have laser tattoo removal. More scarring could result.


Jeff said…
One reason I have never got a tattoo is the fear that I will want it removed some time later. I hear myself telling friends "The flaming skull on my chest seemed like a good idea at the time."

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