Tattoos are more popular than ever. 90% of Hollywood seems to sport at least one tattoo and the
younger generations are huge enthusiasts. On the flip side, tattoo owners in their 30s and 40s now
want them removed in ever greater numbers. Hence the expansion of both tattoo parlors as well as
tattoo removal clinics. Those trends have not gone unnoticed by the laser industry as contemporary
tattoos treatments virtually always involve lasers of one kind or another, and often more than one.
Most tattoos are sought voluntarily by the patients and are thus cosmetic in nature.
Traumatic tattoos can be caused by gravel, glass, paint, shrapnel, ink markings
to guide radiation treatments, etc.
The type of laser treatment will be dictated by the tattoo’s colors (most important), size, amount
of ink used, its location and whether it was created by an amateur or a professional artist.
Amateur tattoos are usually monochromatic (one color, usually black), superficial and uneven.
Professional tattoos often contain higher concentrations of ink, multiple colors, are deeper and
occasionally have two layers as in one tattoo covering another.
Tattoos on hands, feet and ankles are more difficult because the lymphatic circulation is thinner
and slower, therefore less efficient at removing the tattoo particles.
Other difficult situations involve tattooed eyebrows, eyelids and lip liner.
Even more unusual are skin argyria (whole body blue-gray discoloration from over-ingestion
of colloidal silver) and chrysiasis (when skin turns grey-blue upon QS laser impact years following
injections of gold salts for juvenile rheumatoid arthritis)
Black and blue tattoos respond well to QS Nd YAG and picolasers
Green tattoos: QSRL (Q switched ruby laser) and QS Alexandrite laser
Purple and violet: QSRL
Orange, red and reddish brown: QS Nd YAG 532nm
Unfortunately, professional tattoo artists pride themselves on creating their own color mixtures,
further complicating their removal. Some can create downright dangerous allergic reaction, especially
chromium green, cadmium yellow, cobalt blue and cinnabar. Attempts by dermatologists to encourage
the use of predesigned pigments that are easier to laser out, have failed miserably.
• During treatment, the laser beam interacts with the pigment in the tattoo and shatters it into small
particles which slowly get scavenged away by cells called macrophages, via the lymphatic system.
• Multiple colors require multiple lasers. The easiest colors to remove are brown and black (5 to 10 sessions),
the hardest are yellow and green. The more complex the colors are, the more treatment sessions are necessary,
varying from 10 to 25. There is never a guarantee that all pigment can be removed.
Sessions are repeated every 8 to 12 weeks.
• Professional color tattoos are the hardest to remove, because of the number, density and depth of the pigments.