Frequently asked questions about laser tattoo removal

Laser tattoo removal is painful but at Dr. Undo Tattoo several measures are taken to reduce and even eliminate the pain of laser tattoo removal. We have another youtube video on the subject as well.

The pain of laser tattoo removal can be significantly reduced just by cooling the area to be lasered. This can be obtained using ice packs but I prefer using the Zimmer chiller that blows a continuous stream of air at -10 degrees.

Other methods include topical lidocaine which also serves to reduce the pain and in the proper circumstances lidocaine injections. If lidocaine injections are chosen the pain can be reduced to zero and completely eliminated but the tattoo has to be the proper size and no allergies to local anesthetics.

The reason we wait a minimum of 6 weeks in between sessions is to allow your immune cells to continue removing ink particles before the area heals again thus isolating the tattoo from the immune cells. The process of laser tattoo removal is based on the laser shattering the ink and the immune cells taking away, after the area re-heals your immune cells are stimulated and the next laser session unleashes them once again to attack the ink particles. It takes a minimum of 6 weeks for this to really occur so if you did come weekly it would not be of benefit because your immune cells would still be working full capacity. 

Again this has to do with the pairing of the wavelength of light emitted and the wavelength of light absorbed by the ink.

Black absorbs all wavelengths and reflects none thus the black appearance, since it absorbs every wavelength of light Black can be treated by a variety of lasers and thus the easiest color to remove with laser tattoo removal.

Red ink absorbs the 532 wavelength and needs that specific laser , the KTP laser in order to remove red ink with laser tattoo removal.

Blue ink absorbs between 1064 and 785 , the 1064 will take a long time to remove blue ink but the Ruby laser ad 695 will work nicely on blue ink.

Green ink absorbs the same wavelengths as Blue with a slightly more sensitivity to the Alexandrite laser at 744. 

Yellow ink absorbs 480 however no current lasers cary that wavvelength but many have the 532 so we treat yellow using the 532 but the results are variable. Laser tattoo removal on yellow ink is very variable, sometimes it responds other times it does not and I tell patients to expect difficulty.

White absorbs none and reflects all so white will not  respond to laser tattoo removal.

So you can see the problems we have with laser tattoo removal on multicolor tattoos and why a singel laser will not do the trick. There are also other colors that can be difficult, purple, brown and orange.

The risk of having a complication during your laser tattoo removal process can be minimized by going to a physician with a long history and understanding of the laser and the laser tattoo removal process. The risks are the greatest in local "Medi Spas" with a doctor somewhere in the wings and a technician performing the procedure.

1. Hypopigmentation
2. Hyperpigmentation ( often resolves in time)
3. Scar formation
4. Burns and blisters
5. Keloid scars
6. Allergic reaction to the ink
7. Itching 
8. Infection ( often from poor aftercare )

This is not a complete list but covers the most common adverse reactions to laser tattoo removal.

The interval between laser tattoo removal sessions depends on first your skin type and second the type of laser used in your laser tattoo removal process. The darker your skin color the longer you must wait in between sessions to avoid complications such as hypo-pigmentation ( loss of pigment), this period of time ranges from 8 to 12 weeks. Persons of fair complexion can have sessions 6 weeks apart provided a Q-Switched laser was used. If a Picosecond laser was used then even fair complected persons need 12 weeks in between sessions.

Lasers for tattoo removal are rapid firing making most sessions just a few minutes long. Large tattoos will require more time but on the average the process is under 5 minutes.

The number of treatments is very difficult to determine. I have a  Youtube video that describes the Kirby Score https://www.youtube.com/watch?v=P5IU6_aYDbg , a list of factors each with a point value that when added approximate the number of laser tattoo removal sessions you will need. There are some important factors such as placement, head and neck tattoos tend to respond faster than foot and ankle tattoos ( likely due to better blood and lymph flow). Multi-color tattos add to the sessions as would the volume of ink in the tattoo. Scar formation and lasering a cover up tattoo also add to your number. Finally your own complexion, that ranges from 1 to 6 sessions with 1 in extremely fair skin persons and 6 in extremely dark complected persons. The average number of sessions for both Q and Pico lasers is 10 sessions.

Yes, although not very common there are several reasons why someone is not a candidate for laser tattoo removal.

1. New tattoos under a month of age
2. Infections at the tattoo site
3. Allergy to the ink
4. Severe keloid Former
5. Pregnancy / Breastfeeding
6.  High level anticoagulation ( a potential concern)
7. Unrealistic expectations

There really isn't a limit but we must be mindful of how the immune system is being taxed. There is ink being released into the lymphatics with each tattoo and the risk of having an allergic reaction increases with every additional tattoo.  I restrict my patients to no more than 5 tattoos the size of my palm in a single session.There are some strict NO situations such as you never laser a full arm or leg in one session. The area can swell and create a compartment syndrome cutting off blood supply to the hands, feet , fingers and toes plus damage nerve and muscle.

This is when we fade a tattoo with the laser just enough for an artist to place a new tattoo over the now faded one. When the laser tattoo fade is properly performed you will not notice the original tattoo because we have reduced the ink load .

The fade to cover is very common and most times 3 sessions are enough to fade the tattoo enough for most artists to replace the tattoo. The decision as to if you need another laser session is made by your artist then after the last laser tattoo removal session the artist will make you wait several months to ensure good dermal healing and a smooth placement of a new tattoo.

The picture on the left is one of my patients that had the fade to cover.

During the laser tattoo removal session we should see the ink raise slightly due to dermal blood and a frosting of the tattoo to a white color, this is called cavatation and lasts only about 20 minutes. 

The tattoo will be raised for a few days afterwards. I prefer using Aquaphor to keep it moist for a few days and avoid itching or picking at the freshly lasered tattoo.

the restrictions are few, you can bathe, you can drink, continue your prescription medications and even smoke although as a doctor I do not encourage smoking.

If you have an ink allergy , most commonly seen in red ink not only will the tattoo itch but you may also have intermittent swelling and redness around the tattoo.

It is very dangerous to perform laser tattoo removal on a tattoo you are allergic to because the sudden release of the offending ink can cause a serious allergic reaction. If you are allergic to the ink the treatment is surgical excision of the tattoo.