It took years to convince the medical community that Laser Tattoo Removal is the principal incr...
Today, the most widely practised tattoo removal technique by far involves the use of lasers. Concentrated beams of light are targeted onto the skin for fractions of a second, breaking the ink into smaller fragments while leaving the tissue unharmed. This happens because the highly energised light (which must be in the absorption spectrum of the targeted area) causes an explosive effect in the pigment. The high energy heats the ink to a temperature of 900 degrees Celsius for an extremely short time, causing it to explode. The resulting tiny fragments are either pushed into deeper layers of the skin and then absorbed and removed by the lymphatic system, or remain in the skin but due to their smaller size become less visible – at least until the next treatment, when they explode again due to the application of the laser and become even smaller.
For several decades, there have been multiple different types of laser devices, each of which has its unique qualities. Many lasers are used for treatment of skin abnormalities such as spider veins, port wine stains, changes in pigmentation, liver spots and hair removal. Not every laser used in the dermatological field is suitable for tattoo removal. Although the wavelength of older devices (such as argon lasers, ruby lasers and CO2 lasers) allowed a small range of colours to be removed, the overwhelming choice for today’s treatment is a Q-switched YAG laser, of which there are several varieties including Erbium, Alexandrite and Pico.
To create a better understanding of these frequently misused concepts, here is a short explanation. “YAG” is an acronym for a neodymium-doped “Yttrium-Aluminium-Garnet” laser. Neodymium is a chemical element with the symbol Nd and is a rare earth element. A YAG laser is a form of solid state laser which uses a neodymium crystal to produce a wavelength of 1064 nanometres. The wavelength is essential to ensure that the tattoo ink will absorb the light and thus explode. At a wavelength of 1064 nm, black ink is targeted; at 534 nm red ink is the target and 694 nm is the wavelength to target green and blue colours. The term “Q-switch” refers to the ability to shorten the wavelength of the laser through technical means in order to target lower-frequency dyes, causing them to oscillate and ultimately to burst. IPL (Intense Pulsed Light) flash lamp technology, which is predominantly used by non-physicians, does not technically involve a laser but is comparable in terms of its effectiveness and the risks and side effects inherent in its use. It is mainly used for hair removal. (1)
Lasers are only partially suitable for tattoo removal and require years of experience and a high level of specialist knowledge. In order to achieve a successful treatment, multiple device parameters must be balanced.
The best results are achieved when black colouration is removed, with the worst (if any) being achieved in respect of yellow ink. Multi-coloured tattoos present the greatest difficulty. Often nobody knows which inks were used and what they are made of. (2)
The number of treatments can vary depending on the amount and quality of the pigments and the depth at which the tattoo ink is located. (3)
“Complete removal of a standard tattoo occurs in approximately half of all treatments. In around 30 percent a remnant, i.e., a shadow of the tattoo remains lightly visible.” (12)
Although there are successful removals with lasers, the ink often does not disappear completely even after multiple treatment sessions. Instead, shadow tattoos remain, which cannot be removed even by the use of other known methods. Nearly all scientific sources recommend that laser treatments are only carried out by highly trained and experienced dermatologists with sufficient experience with laser devices and who have far-reaching clinical experience of laser tattoo removal. (13)
Dr. Erich Kasten of the University of Göttingen sums up the risk-reward ratio of laser treatment as follows: “Firstly, we don’t know what the ink contains and secondly we don’t know what happens to each ingredient in the ink when a laser is applied to it.” Thirdly, no one knows where the broken-down pigments go within the body and what effects they have. “What that means is: we have no idea of the possible side effects or consequential conditions.” (14)
(1) Deutsche Dermatologische Lasergesellschaft e.V., www.ddl.de)
( 2 ) „Vorsicht vor Vielfarbigen Tattoos“ sl Biedersteiner Kolloquium „Haut und Allergie“, München, 2006 zitiert aus ÄP Dermatologie Allergologie 1/2006 S 11-12
( 3 ) Farbverstärker in Tätowiertinte http://www.medizin24.tv/medizin/dermatologie/337-tattoo-entfernung
( 4 ) Australien: „Widened and Hypertrophic Scar Healing Treatment & Management“ Author: Bradon J Wilhelmi, MD; Chief Editor: Joseph A Molnar, MD, PhD, FACS
( 5 ) Skinial Kundendatenbank, 445-2013
( 6 ) miomedi Chirurgie 8.7.2012 http://www.chirurgie-portal.de/haut-dermatologie/taetowierung-laser-entfernung.html
( 7 ) Dr. rer. nat. Wolfgang Bäumler, Laserspezialist der Universitätsklinik Regensburg in ÄP Dermatologie Allergologie 1/2006 S 11-12
(8) Dermatologin Dr. Alder, themenportal myNEWSdesk 2012 www.themenportal.de/gesundheit/Tattoolos-Laserbehandlung-Yael-Adler
(9) Skinial Kundendatenbank 301-2012 / 597-2011 / 89-2012
(10) Kommentar u.a. vom vom Helmholtz Zentrum, München und mehreren Dermatologen via OnMedia.de Link: http://www.onmeda.de/g-rat/tattooentfernung-679.html
(11) Presseerklärung der PARA MEDIC UG in Gütersloh vom 2.4.2012 – Einem Produzent von Lasergeräten
(12) Dermatologe Dr. Heiko Grimme „Hautzentrum am Kurpark“ in Stuttgart 15.09.2012 in WELT ONLINE http://www.welt.de/109032744
(13) Tattoo removal by non-professionals – medical and forensic considerations 12.9.2009 – by S. Karsai, G. Krieger, C. Raulin 2009 published in: Journal compilation of European Academy of Dermatolgoy and Venerology
(14) Dr. Erich Kasten vom Institut für Medizinische Psychologie an der Universität Göttingen, „Risiken der Tattoo-Entfernung: Wenn die Jugendsünde weg soll“ (DPA)
(15) „The fate of Tattoo Pigments in the Skin“, entnommen aus dem Vortrag von Prof. Dr. Wolfgang Bäumler, Regenburg anlässlich des BfR Symposiums „First International Conference on Tattoo Safety“ Juni 2013 in Berlin.