Dr. Jason
Medical Aesthetics Director
Dr Jason believes in lifelong learning and has attended dozens of conferences both locally and overseas to keep up-to-date in new research findings and techniques which he adapts for use in his own patients.
He has also attended hands-on cadaveric dissection courses held locally and overseas in order to improve his anatomy knowledge.
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Tattoo Removal
Before getting a tattoo done, remember it is going to take way longer and cost you much more to have it removed.
For those who have decided they want to remove their tattoos for various reasons, I will share in this post how laser tattoo removal works and common questions you may have.
How does tattoo laser removal work?
The laser energy is selectively absorbed by the tattoo ink particles within the skin, causing the pigment particles to shatter into tiny fragments. The body’s immune system then removes the ink pigments over the following weeks. Each additional laser tattoo removal treatment breaks down the pigment particles further.
How many sessions will it take to remove my tattoo?
Clinicians use the Kirby-Desai scale to estimate the number of sessions it will take to remove a tattoo. This scale was developed and published in 2009. There are 6 parameters that play a role in this calculation. The number of points within each parameter are added up to give an estimate of the total number of sessions required.
Kirby-Desai Scale
Points are listed below each column and assigned depending on 6 parameters: Fitzpatrick skin phototype, location of the tattoo, colour, amount of ink used in the tattoo, scarring and tissue change, and presence or absence of tattoo layering.
Calculate the number of points listed below each column to arrive at an estimate for number of treatment sessions needed for laser removal (plus or minus 2.5)
# - Professionally done tattoos with deeper and more ink pigment placement will require more sessions to remove.
* - Layering refers to having multiple tattoo sessions/cover-up done at the same area.
For example, a skin phototype IV individual with a black only professionally done (with moderate ink amount) tattoo on his finger (proximal extremity) done only once and without scarring will require 4 + 4 + 1 + 3 + 0 + 0 = 12 sessions of laser tattoo removal.
What are the intervals between each session?
Normally, sessions are separated for a minimum of 6-8 weeks.
This allows sufficient time for the skin to heal and for the body’s immune system to remove the shattered ink pigments. Stacking treatment sessions too close together can result in skin damage and scarring which will make subsequent treatments more complicated.
Hence a full course of laser tattoo removal can take more than one year to complete.
How much improvement will I expect to see?
The tattoo will gradually lighten over the course of a few sessions. The most dramatic improvements will be seen in the first few sessions. This is, however, also dependent on some of the factors mentioned above in the Kirby-Desai scale.
Individuals who have developed scarring from the tattoo process or have had cover-up tattoos (layering) on the same area will not have such significant improvements as the scarring affects the body’s own immune system in clearance of the ink pigments. Certain colors are also more difficult to remove.
How to achieve the best results?
In order to achieve the best results, a combination of laser wavelengths may be required in the treatment of various tattoo colors. This is because certain color pigments absorb particular wavelengths of laser better than others.
For instance, 1064nm Nd:YAG laser is used to treat and remove dark pigments, while 532nm KTP laser for red, purple and orange tattoo ink, 650nm for green tattoo inks and 585nm for blue colored ink.
A combination of nano-second and pico-second lasers has also been shown to give superior results. Studies have shown that tattoos recalcitrant to nano-second laser treatment have responded well to the pico-second laser.
Apart from this, good post procedure care (refer below) is almost important to aid healing.
What is the procedure of a tattoo removal session?
On the initial consultation for tattoo removal, an assessment will be made, and photographs taken.
Laser tattoo removal involves some degree of pain or discomfort. Topical numbing cream will be applied to ease the discomfort. For patients who are more pain sensitive or who are having a large area to be treated, local anesthetic injections can be performed to make the procedure painless.
The laser tattoo removal treatment itself will take about 5-15mins depending on the size of the area to be treated. During the procedure, a cold air spray will be directed towards the skin to protect it from injury or thermal burns.
After the procedure, a cooling gel or ice pack will be applied to cool the skin.
Which areas can be treated with laser tattoo removal?
Apart from the usual body tattoos, eyebrow embroidery and eye-liner tattoos can also be treated in the same fashion.
For such hair-bearing areas as the eyebrow or eyelashes, the hair may need to be trimmed first, and will turn white as the pigment in the hair shaft also absorbs the laser energy.
This is temporary and the new hair that grows out will retain its original pigment color. Individuals are advised to consider the social downtime involved in these procedures.
What is the post-procedure care like?
You may apply cool compresses as necessary for 24 hours after treatment to help reduce discomfort and inflammation.
Keep the area clean for the next few days. You may cleanse with mild soap and pat dry. Avoid rubbing on the treated areas. A topical antibiotic cream may be prescribed to prevent infection.
Do not pick on any scabs that form. This is very important to prevent hyperpigmentation or scarring. Avoid any activity (such as shaving) in the treated area that may disturb the scabs. They will fall off naturally once the underlying skin has healed.
Exercise is generally safe after treatment, as long as all other aftercare instructions have been followed.
Use of a high SPF sunblock in the week after is important. Avoid wearing makeup or creams near the treated area for the first few days after treatment. Some itching may occur as a result of inflammation. Use of moisturizer or mild topical steroid creams will help to alleviate the itch.
Watch for any signs of infection. This may include crusting, oozing pus, spreading redness or increasing pain.
What are the potential risk and adverse events?
The most common expected side effects are redness, swelling and tenderness at the treated areas. They appear soon after treatment and typically subside within a few days.
Pin-point bleeding (petechiae), blisters and scabbing may occur as well. These usually settle within several days to a week.
Less common adverse events include hyperpigmentation and hypopigmentation. Another uncommon adverse event resulting from laser tattoo removal is scarring. This may occur with excessively strong settings or poor post-procedure care.
Adherence to recommended energy settings and protocols and good post-procedure care greatly reduces the chances of post procedure scarring. Pre-existing scarring that occurred as a result of the initial tattoo procedure will not be altered with the laser tattoo removal procedure.
Individuals with a history of hypertrophic scars or keloids have an increased tendency of scarring. Superficial skin infection can occur if there is poor post procedure care following the treatment, but this is a rare event.
What is the cost of tattoo laser removal?
The cost of the tattoo laser removal depends on the size of the tattoo, the complexity of the treatment and the number of sessions required.
Large tattoos with multiple colors will generally cost more to remove. The price can range from $198 to $588, depending on size and colour, for each session.
Overall, laser tattoo removal is a safe and effective procedure, but requires multiple sessions. So, think twice before getting inked!