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50% of the persons that have a tattoo have regretted it, while 30% wants to remove it.

tattoo removal

All you should know

Tattoos are really famous from the Palaeolithic period; usually tattoos are for decoration but they may also be the result of injury or a medical intervention.

No matter how they were created and how popular they are, it is also quite common for people to want to remove a tattoo for aesthetic, personal, social and mainly professional reasons. There are also cases that tattoo removal is essential (e.g. development of allergy to the ink used for the tattoo).

50% of people who have tattoos have regretted it, while 30% wants to remove it.

Until today tattoo removal methods that have been used are empirical (use of caustic substances with the use of various acids) or surgical, such as dermabrasion, diathermy, cryosurgery, surgical removal and old style Lasers, all of which are particularly painful methods and the results are not good (especially in larger tattoos). Furthermore many times side effects may occur, such as scars and alterations of skin texture and colour (hyperpigmentation and hypopigmentation).

Today the methods for tattoo removal have changed.

It is possible to remove a tattoo with almost no pain, effectively and without any side effects.

We have the solution even for the most difficult to remove, polychromatic tattoos through the combined application of different Laser devices.

Advanced pulsed Q-Switched LASER, which work based on selective photothermolysis principle, acting on the target and leave intact the surrounding skin. The enhanced LASER beam is selectively absorbed by the tattoo chromophores which are crushed into tiny pieces and then removed from the body through the lymphatic pathway (phagocytosed by special defence cells in the body called macrophages). For the effective removal of the different tattoo colours different wavelengths should be used, i.e. different Laser devices. The extremely small duration of laser beam does not cause permanent skin damage.

Therefore only rarely there are scars, skin pigmentation alterations or atrophy, contrary to other methods that these phenomena are often observed. The process is well tolerated through the use of advanced topical anaesthetic products.

Effective tattoo removal depends of various factors (colour, type of ink used, oldness, type of tattoo – cosmetic or professional – anatomical area, skin “quality”).

Usually fewer sessions are needed for older tattoos (around 6 treatment sessions) as compared to newer ones, with an interval between sessions of 20-30 days. For newer tattoos more sessions are essential.

The ideal candidate for tattoo removal and pre-treatment care

The ideal candidate for laser tattoo removal has the following characteristics:

  • White race
  • Use of sun protection
  • Monochromatic tattoo
  • Has the tattoo for at least one year

A complete clinical assessment of the tattoo is performed during the initial consultation, which should include visual inspection and palpation of the skin to check for any induration or scarring. In case of scarring, which is not that rare when the tattoo is made due to the pigment on the skin, it should be taken into consideration when Laser is used for tattoo removal? Furthermore, skin induration may be an indication of a possible allergic reaction on the tattoo. In this case it may be necessary to use a different Laser device.

As far as amateur and professional tattoos are concerned, another factor that should also be considered is that professional tattoos in most cases have deeper placement of larger amounts of ink and multiple pigments with various compositions and additives. According to many research studies, while amateur tattoos frequently clear after only 4-6 treatment sessions, for professional tattoos it is usually necessary to have 6-10 treatment sessions, while in certain rare occasions it may be necessary to perform 20 treatment sessions.

Patients should be informed that sometimes it is possible to develop a pale contour at the point of the original tattoo, which may persist for some time despite the successful removal of the tattoo. After sun exposure that the skin pigment is restored, the outline disappears.

Removal of smaller tattoos is usually well tolerated by the patients. However, laser treatment of larger tattoos may require the application of topical anaesthesia to increase tolerance. Eye protection is also critical and should always be used to prevent retinal damage. In case of cosmetic/eyeliner tattoo removal, metal shields are required to effectively protect the eyes.

Full or partial tattoo removal with Laser

The development of Lasers with ultra-short pulse durations has allowed targeting of the small granules of tattoo ink. Today, Q-switched lasers are the treatment of choice for all types of tattoos. Conversely, the use of long-pulsed Lasers, IPL (Intense Pulsed Light) systems or lasers that are used for hair removal are contraindicated, as they are associated with a high risk of scarring with greater frequency.

Removal of different colours within the same tattoo can theoretically be achieved when lasers are used in accordance with the absorption spectra of the inks. However, this is slightly more complicated in clinical practice and additional considerations should also be taken into account. Firstly, certain wavelengths, such as purple and blue laser light many not be able to penetrate deep enough into the dermis to reach the corresponding pigment particles. Second, the choice of laser beam colour is presently limited to the commercially available Laser devices. Thirdly, the colour of a tattoo may be produced by a combination of several different compounds with different absorption spectra, resulting in competing chromophores during the tattoo removal process. Moreover, certain added pigments may cause significant reflection or scattering of the laser beam.

Therefore, when a tattoo is examined so that to be removed all the above factors should be considered, as they influence the final result as well as the skin texture and appearance.

Why choose tattoo removal with the use of Q-switched Laser?

Tattoo removal through the use of specialised Q-switched Laser works based on the selective photothermolysis principle to eliminate the chromophores of the tattoo through degradation, leaving intact the surrounding skin and tissue. In simpler words Laser acts by focusing energy of a Laser to achieve the cleavage of the dye and the colour of the tattoo whilst avoiding scarring and adverse reactions.

About the author:

Christofer Tzermias

Specialised in the UK (Oxford & London) and in North America (New York & San Diego) in the field of LASER Dermatology, Dr Tzermias, has been providing dermatological state-of-the-art treatments using cutting-edge LASER and Energy based Devices for over 20 years. He has been Director of Interventional and LASER Dermatology Department at the Athens Medical Center for over 18 years and for the last 9 years is the Scientific Director of IQ - Intensive Quality Dermatology & Cosmetic Surgery Clinics, which at the 2017 Healthcare Awards won the ‘Innovation Award for Innovative Services’ for their pioneering contributions. Since 2018, IQ Dermatology & Cosmetic Surgery Clinics has also been operating in London, UK and in Muscat, Oman. Dr Tzermias is a Fellow of the world-renowned American Society for LASER Medicine and Surgery (ASLMS), a Founder Member of the European Society LASER Dermatology (ESLD), the Vice President of the ‘Open Health Alliance’ and he is also on the Board of Directors of Elitour - Greek Medical Tourism Council.

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