Laser treatments to remove tattoos have been used for several decades as an effective and very popular method.
Lasers produce an intense beam of bright light that travels in one direction. This laser beam can cut, seal or vaporize skin tissue and blood vessels. The laser has the unique ability to produce one specific color (wavelength) of light which can be varied in its intensity and pulse duration. Ordinary light from non-laser sources is composed of many different colors and appears white. The wavelength and power output of a particular laser determine its medical application.
When the laser light is directed at skin tissue, its light energy is absorbed by water or pigments found in the skin. Water is found in large amounts in all living cells. Pigments of the skin include hemoglobin, a protein that makes blood red, and melanin, the tan or brown colored pigment. All three absorb laser light of different colors.
The Red Light Lasers
The red light spectrum produced by the ruby laser is emitted in extremely short, high-energy pulses. This type of pulse is possible due to a technique known as Q-switching. The Q-switched ruby laser system was initially used to remove tattoos, particularly amateur tattoos, since it can effectively fade or eliminate the colored pigments with little risk of scarring or damage to the surrounding skin. In addition, this laser is now commonly used to treat many brown pigmented lesions.
Another laser in the red category is the Q-switched alexandrite laser. Like the ruby laser, its energy is selectively absorbed by melanin, making it effective for tattoo removal.
The Q-switched neodymium, YAG (Nd:YAG) laser delivers two different wavelengths of light. One is an invisible infrared light used to remove blue-black tattoos, traumatic tattoos and deep dermal pigmented lesions, such as nevus of Ota. This laser can also be tuned to produce a green light for the treatment of superficial pigmented lesions like brown spots, as well as orange-red tattoos. In both cases, the Q-switching device emits rapid bursts of the laser beam to the treatment site.
Another laser is the KTP which emits a green light and is capable of treating certain vascular and brown pigmented lesions.
The Carbon Dioxide (C02) Laser emits a colorless infrared light which is highly absorbed by water-containing tissue like the skin. This laser system can be used in several ways: “focused” for cutting skin without bleeding, “defocused” for superficially vaporizing skin, and “super-pulsed” for facial resurfacing.
By delivering very powerful, rapid pulsing or scanning of the C02 laser beam, dermatologic surgeons are able to peel and resurface the facial skin for cosmetic improvement while minimizing damage or scarring surrounding skin. This technique removes facial wrinkles, smoothes acne scars and rejuvenates aging and sun-damaged skin as it gently smoothes and precisely contours the skin surface.
If the C02 laser’s energy is defocused and not continuous (pulsed), a larger spot of light is created which makes it less intense. With this modification, the dermatologic surgeon can remove or vaporize thin layers from the skin surface without penetrating deeper layers. This technique is particularly useful for treating warts, shallow tumors, and certain precancerous conditions.
When the C02 laser energy is continuous and focused into a small spot of light, the beam is able to cut the skin. As an alternative to traditional scalpel surgery, the laser helps to limit blood flow during the treatment and reduce post-operative swelling. The carbon dioxide laser is used in this way to remove skin cancers, to treat a variety of non-vascular and pigmented lesions, and for eyelid operations. This technique is also used to remove warts, and also for some surgical incisions.
In dermatology, many different types of lasers are presently being used to treat a variety of skin conditions, growths, and cosmetic complaints. Further, no single laser is currently capable of treating all skin conditions, and some lasers have only limited usefulness in dermatologic applications. In addition, certain lasers can be tuned to a variety of colors of light or coupled to a robotized scanning device to expand their clinical effectiveness.
Laser removal of decorative and traumatic tattooing has been performed for many years by many different researchers. A number of different lasers have been utilized for this purpose, including argon Nd-Yag, Q-switched ruby, and C02 lasers. Since all tattoo pigments selectively absorb laser light regardless of color or composition, all these lasers have had varied success. The pigment is vaporized by the laser light into a plume that exits the skin with minimal damage to the surrounding skin and its appendages. The post-laser inflammatory period is dominated by the introduction of tissue macrophages that continue to remove additional pigmentary residues. Finally, the upper 1 mm of the dermis is replaced by diffuse collagen.
Early attempts at tattoo removal with the ruby, Q-switched ruby, carbon dioxide, and argon lasers had mixed results. Subtotal pigment blanching and hypertrophic scars were common side effects. The argon laser, however, was the most effective for treatment of tattoos.
Dr Adrianna Scheibner has conducted some interesting case studies in which the Q-switched ruby laser was used to treat hypopigmented and atrophic skin. The postlaser fragmentation period was completed with the usual collagen response; however, there was a definite repigmintation of atrophic, hypopigmented skin. These studies seem to indicate that melanocytes and keratinocytes are reactivated when particular collagen restricting occurs. In an effort to reproduce this collagen-melanin reaction with a more assessable procedure, Margot Schweifer, RN, CDT has utilized micro-entomology needles with a modified tattoo machine to perform concentrated systematic trepanation (CST). The initial results have demonstrated a consistent success of repigmentation. The process of repigmentation using laser or needle stimulation has been termed Multitrepannic Collagen Actuation.
TRIC stands for “Tattoo Removal Infrared Coagulator,” and it uses a high-heat infrared beam, explains Dr Tolbert S. Wilkinson, a plastic surgeon and the director of the Institute for Aesthetic Plastic Surgery. The procedure leaves the client with a little more than some second-degree burns and a few blisters, he says. High intensity light from a tungsten-halogen source is reflected from a 24-karat gold surface through a solid quartz column to a special contact tip of sapphire or Teflon. When contacting with tissue, thermal necrosis occurs at 100 degrees centigrade without carbonization or odor with the depth of necrosis controlled by timed exposure.
The TRIC method has been used on inmates to get rid of gang tattoos, says Wilkinson. It takes just a few sessions, and costs a fraction of what laser treatments cost. A TRIC treatment is $10 to 15, while laser treatments can run up to $3,000, he says. But other doctors say the extra money spent on laser removal is well worth it.
In Wilkinson’s initial study, he worked with fifteen people, photographing and following them after the treatment. “This was a quick and efficient way to blur out tattoos,” Wilkinson says. “Both laser light and infrared light shatter the tattoo pigments, like hitting a rock with a hammer, and the body is able to take it away.”
With TRIC, the person is given a local anesthetic, and experiences superficial second-degree burns and blisters. Afterward, the client gets antibiotics and a pressure wrap to use on the burned area. In case of a large tattooed area, the removal should be done in a series of treatments to minimize the scarring.
TRIC “may have value in producing a cheap, effective treatment, and there’s a benefit to that”, says Dr Roy Geronemus, a dermatologist and the director of the Laser and Skin Surgery Center of New York. “Laser treatments are better in some ways, but far more expensive. With Q-switched lasers, a doctor would choose the appropriate laser, according to the tattoo. We can mix and match the laser to the pigment of the tattoo without scarring or changes in pigmentation.”