Laser Tattoo Removal - The Facts

Recent developments in laser therapy have finally made it possible to remove tattoos with minimal risk of scarring. Unfortunately, in the past, a small number of laser clinics attracted adverse publicity causing doubts in the minds of those seeking help.

We hope this Fact Sheet will help restore confidence and benefit anyone who is currently considering the options that are now available for tattoo removal.

Why is a tattoo so difficult to remove?
A tattoo results when the skin is punctured and pigment is inserted into the lower layer of skin. The body's own defence mechanism reacts to this 'injury' but is unable to cast out the larger particles of pigment.

Before the development of laser therapy, the only alternatives available to patients seeking to have their tattoos removed were surgical excision, skin grafts and the use of salt, acid and other chemical abrasives. Not only do these techniques cause considerable discomfort, they usually require a lengthy period of after-care and will typically replace the original tattoo with a scar.

How does the Q-switched Ruby Laser work?
By firing a beam of light through the skin in extremely short pulses. The light is absorbed by the tattoo ink creating a reaction which breaks it down into very tiny particles. This allows the body's defence mechanisms to take over and gradually remove the pigment over a period of time.

Because each pulse is so short (typically 25 billionths of a second!) and is targeted directly onto the pigment, there is normally no lasting damage to the skin or surrounding tissue. The whole procedure is repeated several times, usually at four to six weekly intervals, sometimes longer, so allowing time for the body to remove as much pigment as possible.

Can a tattoo be removed with just one treatment?
Only in rare cases - for example, with an amateur (self-inflicted) tattoo where there is only a fine layer of blue/black pigment lying just beneath the skin's surface. With most tattoos, this is the exception rather than the rule.

How many treatments are required to remove the average tattoo?
Due to the very many variations in size, colour and type, there is no such thing as an average tattoo. The number of treatments required will also depend on the body's own defence mechanism and how effective it is. As a guide, most indian ink amateur tattoos should respond with between one and ten treatments. Coloured professional tattoos can take rather longer - usually between eight and fifteen treatments.

What are the costs likely to be?
The actual cost of a single treatment will depend on several factors such as the size of the tattoo and the number of pulses required to treat it. Most tattoos are irregular in shape and the pigmented area cannot readily be converted and rounded up to square inches or centimetres. Without first examining the tattoo it is impossible to give an accurate guide to cost.

The total cost will depend on the number of treatments required. This is determined by the physical make-up of the tattoo which not only varies enormously from patient to patient, but can also vary as the course of treatment progresses. It is therefore impossible to predict the number of treatments required and it would be misleading to quote examples of total cost which are based merely on assumptions.

Is the treatment cost fixed throughout?
The number of pulses required for each treatment can vary up or down according to how the tattoo is reacting. No additional charge is made for an increase in the number of pulses used. However if, in the later stages of treatment, there is a significant reduction in the area requiring treatment, the cost will be reduced accordingly.

All 'Laserase' Centres provide initial consultations which are entirely free of charge and without obligation. Any cost incurred by the patient relates only to the treatment provided.

Do all tattoos respond to treatment?
Yes in the majority of cases, although it is impossible to give an absolute guarantee as some pigments can resist treatment. Dark blues and blacks are generally the first to respond and usually all the pigment will be removed. Bright colours, especially greens, are less predictable, they may take longer to fade, and in some cases may not go entirely. Some centres have the Nd:yag laser which is used to treat bright red tattoos in conjunction with the ruby laser.

Some red, white and flesh coloured inks have been known to turn black in the early stages but this is rare. People who have experienced any allergic reaction to their tattoo(s) in the past should inform the doctor as this may be relevant to their laser treatment.

How long does the treatment take and does it hurt?
A typical treatment session can last anything between five minutes to an hour depending on the size and number of tattoos the patient wishes to have removed. The treatment stings and may cause some minor discomfort which will start to subside when the session is over. This is tolerated very well by most patients but a local anaesthetic cream is available if required.

Are there any after-effects following treatment?
Some patients may blister. This is quite normal and does not indicate potential scarring. Rarely is any specific treatment required and it will usually clear within a few days. A dry dressing may be applied to avoid contact with clothes, etc. When bathing or showering, the area should be patted dry and not rubbed. If blistering occurs, prolonged immersion in water, e.g. swimming, should be avoided.

During the period over which the tattoo is being removed, the treated area should be protected from strong sunlight or sunbeds by means of a reputable sunblocking cream (Factor 20) or by covering the tattoo.

Doesn't the laser treatment scar?
It depends on the type of laser used. In the past, certain types of carbon dioxide and argon lasers have been used to remove tattoos. Many of these induced localised burning of the tissue and so caused unsightly scars which were cosmetically unacceptable and often left the patient more disfigured than with the original tattoo.

However, scientific research initiated in Glasgow in 1980 by Strathclyde University and the Canniesburn Hospital, has led to the development of a new generation of lasers, the most proven of which is the Q-Switched Ruby. This laser, which neither burns nor cuts the skin's surface, has been used extensively in medical practice for a number of years.

Some people are very sensitive to the inks used in their tattoo which can lead to a severe inflammatory response during treatment - this may on rare occasions result in a scar. Since Laserase was set up in 1992, we have treated many thousands of tattoos with the vast majority of people being delighted with the results. Although scarring is a possibility, we have found the chances of this occurring to be very low.

Are there alternatives to the Q-switched Ruby Laser?
Yes, the Q-Switched Nd:YAG laser and the Alexandrite, however neither of these two lasers have been in use long enough to achieve the proven track record of the Q-Switched Ruby Laser which, over the past 19 years, has been extremely well documented in several leading American and British medical journals.

Although the Q-Switched version of the Nd:YAG is effective in the treatment of certain coloured tattoos and of patients with dark skin, its deeper penetration can sometimes cause more surface skin damage. In some patients, this may result in a permanent "frosted" appearance over the treated area.

Will the skin be normal when treatment is finished?
During treatment with the Q-Switched Ruby Laser, it is quite normal for the tattooed area to become paler and any freckles may disappear. This is because the laser is also effective at removing natural skin pigment. Once all the treatments have been completed, the pigment should slowly return, sometimes within six to twelve months, although in other cases several years. However sometimes there may be a permanent loss of natural pigment and the area may remain pale. If this does occur, continued protection from strong sunlight and sunbeds is recommended. A tattooed area which is particularly hairy, should be shaved prior to treatment. The hair should grow back normally but in some cases may be slower than expected.

Is 'Laserase' treatment safe?
Yes. There is no evidence whatsoever to suggest that the treatment can lead to skin disorders or an increased risk of cancer. Furthermore, every precaution has been taken to ensure the safety of the patient. Having met all the necessary conditions, each 'Laserase' Centre is registered with the Local Health Authority. The lasers are also subject to periodic checks by the Regional Radiation Physics & Protection Service.

The 'Laserase' treatment is carried out only by qualified and fully trained doctors and patients are required to wear approved protective goggles at all times.

Does the Ruby Laser have any other uses?
Yes, It can be used to treat certain pigmented lesions under the guidance of a consultant dermatologist. In a completely different mode of operation, the laser can successfully remove hair.