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It is estimated that close to 10% of the U.S. population has some sort of tattoo. Eventually, as many as 50% of them live to regret this decision due to change in their personal or professional life and in fact it becomes a cause of embarrassment. They seek medical advice to have them partially or completely removed.

With the help of evolving laser technology, removal of tattoo is possible safely and effectively, though sometimes not completely. Laser tattoo removal is gaining popularity as it can be done without the adverse risks so commonly encountered with previous treatments.

There are Five types Tattoos:

	Professional Tattoo Usually performed by a tattoo artist using a hand held tattoo gun. This type require the maximum number of treatments while others need less treatments.
	Amateur Tattoo Performed by a friend. Tattoo is not sharp and not well defined as professional ones.
	Cosmetic Tattoo Lipliner, eyeliner, and eyebrow liner are becoming more common.
	Traumatic Tattoo: results from mechanical penetration of the skin by foreign body particles such as metal, glass, dirt, or carbon-containing material.
	Medicinal Tattoo Placed by medical personnel to mark sites for radiation, incisions or catheter placement.

Tattoo Removal Methods

There a number of methods by which a tattoo can be removed. Some of the common methods of tattoo removal are:

Surgical Excision
Best employed for small tattoos on loose skin. In this method, a local anesthetic is injected at the site of tattoo to numb the area, after which the tattoo is removed surgically. This method always leaves a surgical scar which is sometimes worse than the tattoo.

Dermabrasion
Dermabrasion involves sanding the skin with a rotating wire brush. There is bleeding at the site of tattoo and dressing is required for several days. Mostly it leaves a scar or a pale area. Even after several treatments, the tattoo may still be visible.

Laser Tattoo Removal
In the past 10 years, the invention of the Q-switched lasers has permitted the removal of most tattoo ink with very low risk of scarring. The Medlite Q-Switch Nd:YAG laser used at the Vein Laser Center is the newest system in this class of lasers. Q-switched lasers are unique in their ability to produce very short pulses but delivering high power of intense laser light.


Before Laser	After 2 Laser Treatments (Medlite Q- Switch Nd -YAG )


Before	After 5 laser treatments

Nd-YAG Q-Switch Laser is the treatment of choice and the most popular method for removing tattoos. It has replaced other methods as soon as it became available. This is also the safest method as scarring is rare, pain is minimal compared to other methods and chances of infection is very rare with proper precautions.

How does the Midlite laser remove tattoos?

The Midlite laser system removes tattoo ink with the energy of light. Just as natural sunlight is made up of light wavelengths of many colors, a laser is a device which is designed to produce one or more specific wavelengths of light. Tattoo ink is removed by using a specific wavelength which passes through the skin but is absorbed by the ink. The tattoo ink absorbs the light and shatters the ink into tiny fragments small enough to be engulfed by the body’s natural defense cells (Macrophages), which in turn are carried away and removed by the immune system of the body. The real tattoo removal begins after the laser treatment. The laser does not remove anything; it merely disrupts the tattoo pigment. It is the body's own immune system that carries the pigment away, resulting in the fading of the tattoo.

Medical research has taught us which wavelengths of light to use and specifically how to deliver them to best remove tattoo ink. The greater the absorption of the laser light, the greater the energy available to break up the pigment:

√ Black ink absorbs all wavelengths of light.
√ Green and Blue ink absorbs red light best.
√ Red, Orange, and Purple ink absorb green light best.
√ Turquoise responds variably, depending on the pigments in the ink.
√ Yellow tends to reflect light and is difficult to treat.

The actual absorption of a given tattoo ink may vary considerably depending on the particular pigments in the ink, which are usually not known to the patient, tattoo artist, or the treating doctor. Also, the chemical pigments may undergo chemical changes after treatment. These factors often leads to variable and or inconsistent responses of a give color to a given laser wavelength.

Currently there are four different Q-Switched lasers available for tattoo removal:

√	Q-Switched Ruby Lasers -Red light @ 694nm> usually effective for most black, blue, and green pigments.
√	Q-Switched Alexandrite- Deep Red @ 755nm>usually effective for most black, blue, and green pigments.
√	Q-Switched Nd:YAG-Invisible (infrared) @1064nm>usually effective for most black and dark blue pigments.
√	Q-Switched Frequency-Doubled Nd:YAG-Green light@ 532nm>usually effective for red, satisfactory for black, dark blue, and purple pigments.

The Medlite Q-Switch laser is able to deliver four wavelengths: Infrared light @1064nm, Green light @532nm, Red light @650nm, Yellow light @585nm, at very short, high intensity pulses for maximum ink destruction. The use of this specific combination of wavelength and rapidly pulsed light results in minimal damage to the skin while providing maximum tattoo ink removal. The Medlite Q-Switch laser is the most versatile laser in treating the widest range of color tattoos.

Who is a Candidate?

Anyone with an undesired tattoo is a candidate for laser tattoo removal. Most tattoo colors can be eliminated or lightened to a large degree.
Good candidates for tattoo removal without scarring are those with medium to fair skin, dark but not dense ink, and a superficial ink depth. The preferred locations include arms, chest, buttocks, and anywhere else on the body with good circulation. Medium- or fair-skinned patients react well because the light will be able to selectively target the ink instead of the dark skin. Dark ink that is not dense is favorable because the light is more attracted to darker colors so darker ink is fragmented better than yellow ink. Density is also a factor; the more ink, the more there is to fade. Superficial ink is also favorable because it is closest to the surface of the skin so the laser doesn't need to penetrate so many skin layers to get to it. Results are quicker. Areas such as the arm or chest have more blood flow and are a better vehicle for the immune system which is what removes the ink. Areas such as the ankle or fingers have poor circulation and are tougher to treat.

Skin colored tattoos may undergo irreversible ink darkening. This is seen with some white, pink, flesh-toned and light brown tattoo inks. Red ink tattoos may turn black. Tattoos may be improved with subsequent laser treatments.

Patients with previously treated tattoos may also be candidates for laser therapy. Tattoos that have not been effectively removed by other treatments or through home remedies may respond well to laser therapy providing the prior treatments did not result in excessive scarring.

How Many Treatments Are Needed?

Each tattoo has different characteristics that influence the number of treatment sessions necessary. These include: Size, Color, Type of ink used, Whether the tattoo is old or new, and Type of the tattoo.

The color, depth, density of the ink are probably the biggest determining factors involved in successfully removing a tattoo. In addition, professional tattoos require more treatments while amateur and cosmetic tattoos require less. Most tattoos are comprised of different colors. Some tattoos can require between 15 and 20 treatments before they are completely removed. In most cases, laser tattoo removal takes between six and twelve treatments spaced at 6 - 8 weeks apart but can be spread over several months or a few years.

The laser tattoo removal treatment may last anywhere from 10-30 minutes depending on the tattoo size. As a general rule, "modern" (Less than 10-15 years old) tattoos on the trunk tend to clear with fewer treatments than older tattoos or tattoos on the arms and leg.

Do all colors disappear equally as well?

No. Dark (blue/black) inks and red inks fade the best. Oranges and purple usually respond well. Green and yellow inks are the most difficult to remove, although additional treatments can produce significant fading. Turquoise tattoos are some of the most difficult to eliminate because there isn’t a laser that targets the color effectively.


Pre treatment	Post 4 treatment


Before treatment	After 8 treatments

Is the laser tattoo removal safe and will the Tattoo completely disappears?

Thanks to newer technology, treatment of tattoos with laser systems has become much more effective with very little risk of scarring or side effects. Laser treatment is non invasive and only targets the ink used in the tattoo.

In many cases the tattoo disappear completely. Greater than 95% fading of the tattoo may be accomplished. However, it is very important to know that over 100 ink tattoo inks are in use worldwide today, none of which are regulated by the FDA. Not knowing which tattoo ink, how deep or how much was used, makes it impossible for the physician to predict the degree of removal on any given tattoo.

Is the treatment Painful?

The unfortunate thing about tattoos is that both getting them and having them taken off can be uncomfortable. The impact of the energy from the laser's powerful pulse of light has been described as similar to being snapped by a thin rubber band. The application of a prescription anesthetic cream one to two hours before the laser session will markedly reduce the pain. It is wiped off just before laser surgery begins. Others prefer to have a local anesthetic injected into the tattoo prior to laser therapy.

What to expect after the Treatments and what are the side effects?

Recovery time is very short and specific instructions regarding care of the area will be provided. Pinpoint bleeding is sometimes associated with the procedure. Following treatment, an antibacterial ointment and dressing will be applied to the area, which should be kept clean with continued application of ointment as directed. A shower or bath the day after treatment is okay, but the treated area should not be scrubbed. Your skin might feel slightly sunburned for a couple of days and the treated area may remain red for a few weeks. Immediately after a treatment, you can apply an ice pack. The site might also form a scab, which should be handled gently. After healing, the site will gradually and continually fade.

There are no major side effects associated with laser treatment but hyper pigmentation (an abundance of skin color at the treated site) or hypo pigmentation (treated area lacks normal skin color) may occur. There are chances of infection of the site. Occasionally mild changes in skin texture may occur.

In some cases, the tattoo may not be removed completely and the patient may form permanent scars also, though this is rare. Darker tattoos are easier to remove in light skinned people. This is so because, lasers are designed to differentiate between skin pigment and tattoo ink. Also, the best areas from which tattoos can be removed easily are those areas of the body with good circulation, such as arms and chest.

Cosmetic tattoos like lip liner, eyeliner and eyebrows may darken following treatment with tattoo removal lasers. Further treatment of the darkened tattoos usually results in fading.

Recent development:
A recent and exciting development in the laser treatment of tattoos has been the use of topical immunomodulators such as imiqimod (Aldara®) cream. Applied about 10 days after laser treatment, topical immunomodulators activate the white blood cells which carry off the tattoo pigment, significantly reducing the number of treatments needed to clear the pigment completely.

How Much Does it Cost?

Getting a tattoo removed is much more expensive than having one put on. Price depends upon the size, type and location of the tattoo and the number of visits required. Cost range between $200 - $800 per session, as an average. If your tattoo is extensive, expect to pay more.

For specific information about your tattoo(s), a consultation would be required. During the consultation the tattoo(s) can be evaluated, all questions can be answered, risks and benefits covered, as well as establishing a price per treatment & approximate number of treatments needed. Consultations are available on Monday, Tuesday, Thursday and Friday only with appointment. Saturday appointments are occasionally available only. The consultation fee is $50, which may be credited towards the first treatment if done within 30 days of the consult for qualified candidates.

Does Insurance Cover Laser Tattoo Removal?

Since tattoo removal is a personal option in most cases and is considered a cosmetic procedure, insurance carriers will not cover the process. Payment in full on the day of the procedure is required. Remember, the information provided here is designed to provide general information only and is not a replacement for a physician's advice. For details pertaining to your specific case, please arrange a consultation with a physician experienced in the use of tattoo lasers.

If you have a tattoo or other skin blemish that you would like removed,call the Vein & Laser Center to arrange for private laser consultation at 201-795-9007.