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laser tattoo removal, Laser Tattoo Removal: 5 Proven Strategies to Help You Avoid Botching It Terribly, Ask Dr Wan
Tattoo Regret – More common than you think

Up to 78% of people experience tattoo regret.

Do you have an unwanted tattoo that you no longer identify with?

Although you can’t wait to get rid of it, you might be secretly afraid of taking the next step to remove it.

Do you fear a botched job leaving a sad, ugly mess or perhaps a lengthy blister-filled recovery process?

These are common concerns that I’ve heard from patients during consultations for laser tattoo removal in Singapore.

Today, I am going to give you a comprehensive overview of the common pitfalls with laser tattoo removal and reveal 5 indispensable tips that will help you remove your tattoo more safely and effectively.

In the process, I will share secret new cutting edge techniques based on the latest research.

The One Thing You Must Avoid in Tattoo Removal

I have encountered many cases of botched tattoo removals leaving patients worse off than before.

I’ve frequently seen raised scarring in the shape of the tattoo due to attempted removal with tattoo removal solutions or creams marketed online (or in beauty salons).

One of my patients actually came to me for steroid injections to treat upper arm keloids with persistent pain and itching. Her beautician had recklessly attempted to remove her tattoos with acid.

Imagine being stuck with scars for life!

laser tattoo removal, Laser Tattoo Removal: 5 Proven Strategies to Help You Avoid Botching It Terribly, Ask Dr Wan
Scarring can result from botched tattoo removals

Where Should You Get Your Tattoo Removed?

In Singapore, only certified medical doctors can legally perform laser tattoo removals.

Horrific scarring can result from attempted removal by unaccredited spa therapists or tattoo artists that use illegally imported, sub-par laser equipment. These people simply don’t have the requisite training, comprehensive understanding of laser-tattoo interactions and medical knowledge to perform tattoo removals safely and effectively.

Even worse, amateurish attempts at tattoo removal can result in a thick layer of scar tissue over the tattoo. The scar tissue blocks laser penetration, rendering the tattoo 10X more difficult to remove!

laser tattoo removal, Laser Tattoo Removal: 5 Proven Strategies to Help You Avoid Botching It Terribly, Ask Dr Wan

NEVER trust a non-medical professional to remove your tattoo! It may be cheaper, but you may end up as one of the many poor patients with disastrous results that I’ve had to fix over the years.

No point trying to remove your tattoo only to replace it with an even more permanent and 100X uglier scar.

Can Laser Tattoo Removal Cause Scarring?

Having said that, even laser tattoo removal by medical aesthetics doctors using nanosecond or even the latest picosecond lasers is not perfect.

Doctors who lack the appropriate experience may use the wrong settings leading to excessive blistering and scarring.

How Do Lasers Remove Tattoos?

Tattoo pigments remain in the skin because they are too large to be removed by immune cells.

Laser tattoo removal uses ultrashort high energy laser pulses to break pigment grains into smaller fragments. The immune cells then remove these smaller, disrupted particles via the lymphatic system.

laser tattoo removal, Laser Tattoo Removal: 5 Proven Strategies to Help You Avoid Botching It Terribly, Ask Dr Wan
A summary of how the laser tattoo process goes

What Is Frosting & Why Is It Bad?

The high-energy laser disruption of tattoo pigment forms superheated plasma, steam and other gases beneath the skin under high pressure, producing a loud snapping sound. As a result, a white residue or ‘frost’ appears.

laser tattoo removal, Laser Tattoo Removal: 5 Proven Strategies to Help You Avoid Botching It Terribly, Ask Dr Wan

This ‘frost’ acts as an optical shield, preventing subsequent laser pulses from reaching the deeper pigments. The trapped superheated gas damages the skin, causing blistering and scarring.

laser tattoo removal, Laser Tattoo Removal: 5 Proven Strategies to Help You Avoid Botching It Terribly, Ask Dr Wan

How Your Doctor Can Help

Practitioners who are unfamiliar with the intricacies of laser technology, the tattoo removal process, and the nuances of skin healing can turn an unwanted tattoo into a terrible scar.

It is important that your doctor utilizes an effective wavelength, adequate power, spot-size, and a pulse-duration that targets the destruction of the ink pigment while minimizing the thermal damage to the surrounding skin.

laser tattoo removal, Laser Tattoo Removal: 5 Proven Strategies to Help You Avoid Botching It Terribly, Ask Dr Wan
Laser tattoo removal can also produce collateral damage and scarring

How to Overcome Critical Drawbacks of Laser Tattoo Removal

Just using old school nanosecond q-switched lasers like Revlite, Spectra, Starwalker to blast tattoos used to be the gold standard.

In fact, many aesthetics doctors in Singapore are still relying solely on these older, less powerful machines to perform tattoo removals and charging good money for it.

laser tattoo removal, Laser Tattoo Removal: 5 Proven Strategies to Help You Avoid Botching It Terribly, Ask Dr Wan
Tattoo removal technology has progressed a lot

Having done many tattoo removals back in the days when nanosecond q-switched lasers were the only viable option, I can safely say that in my opinion, such treatment is no longer best practice.

Over the years, I realized that there are critical issues with traditional laser tattoo removal methods:

  • Downtime: patients often have blistering and painful raw skin for many days
  • Scarring due to collateral damage from laser energy
  • Ghosting or faint remnant tattoos that are difficult to remove with nanosecond lasers or lower powered picosecond lasers. These occur when:
    • there is remnant tattoo pigment deep in the skin (inadequately powered lasers cannot penetrate deep enough to break up the remnant tattoo pigment)
    • remnant small tattoo particles (the pulse duration of the laser is not short enough resulting in an inadequate photomechanical breakdown of the pigment)
    • scar tissue shielding the tattoo pigments
  • Long process with many sessions required

Can you completely remove your tattoo with minimal fuss and risk of scarring? Imagine the tattoo gone as though it never existed – How can you harness the latest technology to achieve the best tattoo removal in Singapore?

Let me share 5 pro tips with you on how you can get your tattoo removed safely and efficiently. These valuable insights have been gleaned from my practical clinical experience with many patients and the latest research evidence.

5 Proven Ways To Supercharge Your Laser Tattoo Removal

  1. Avoid nanosecond lasers and go for picosecond lasers instead
  2. Choose the highest powered picosecond laser you can find
  3. Shockwave treatment improves tattoo clearance by up to 100%
  4. Opt for a full powered triple wavelength laser, especially if you have a coloured tattoo
  5. Combine picosecond lasers with fractional laser

Avoid nanosecond lasers and go for picosecond lasers instead

Older q-switched lasers have pulse durations of several nanoseconds (one billionth of a second) pulse duration, which is too long to completely break the tattoo ink into smaller particles.

The longer pulse duration produces mainly photothermal effects which cause more tissue damage. The pulse duration is long enough that some of the laser energy spills over to the surrounding tissues causing collateral damage.

Picosecond lasers have much shorter pulse lengths (>10 times shorter) that better confine the energy to tattoo pigment molecules. With peak powers many times higher than nanosecond lasers, picosecond lasers produce photoacoustic fragmentation rather than photothermal destruction.

The combination of greater photoacoustic shattering and better laser energy confinement accelerates pigment disruption and reduces heat damage to the surrounding tissues.

laser tattoo removal, Laser Tattoo Removal: 5 Proven Strategies to Help You Avoid Botching It Terribly, Ask Dr Wan
Picosecond laser has much shorter pulse duration, there is less leakage of energy and the pigments are broken down more thoroughly.

Studies have shown that picosecond lasers break down tattoo pigment into smaller particles, producing better tattoo clearance. They were particularly effective for tattoos that had not responded to nanosecond lasers.

Patients reported less pain with picosecond laser tattoo removal and were less likely to develop scarring.

laser tattoo removal, Laser Tattoo Removal: 5 Proven Strategies to Help You Avoid Botching It Terribly, Ask Dr Wan
Picosecond lasers break up pigments into smaller particles

Choose the highest powered laser you can find

Picosecond lasers have peak powers ranging from 0.3GW (Cynosure Picosure) to 0.8-0.9GW (Cutera Enlighten, Syneron-Candela Picoway), up to 1.8GW (Quanta Discovery Pico Plus). Nanosecond lasers typically have much lower peak powers ranging from 0.2GW (Revlite) to 0.32GW (Fotona QX Max).

As the laser beam penetrates the skin, some of the energy is spread to the sides instead of penetrating into the skin. This scattering loss is more pronounced for small spot sizes, hence laser penetration decreases as the laser spot size decreases.

laser tattoo removal, Laser Tattoo Removal: 5 Proven Strategies to Help You Avoid Botching It Terribly, Ask Dr Wan
Smaller spot sizes have more scattering losses and less skin penetration

Sufficient laser power delivered over a large spot size is required to penetrate deep within the skin and shatter tattoo pigments. Low powered lasers are unable to produce enough concentrated energy at large spot sizes to adequately break up the deepest pigment particles within a tattoo.

laser tattoo removal, Laser Tattoo Removal: 5 Proven Strategies to Help You Avoid Botching It Terribly, Ask Dr Wan
Low powered lasers may not be able to produce adequate power at large enough spot sizes to break up deep pigmen

This results in a faint remnant shadow, or a ghost tattoo. Ghost tattoos are quite common, especially with older nanosecond lasers. I have treated many patients who have gone for many (>10) sessions of nanosecond laser tattoo removal trying to get rid of the tattoo ghost, to no avail.

laser tattoo removal, Laser Tattoo Removal: 5 Proven Strategies to Help You Avoid Botching It Terribly, Ask Dr Wan
Example of ghost tattoos

Persisting with even more sessions of these lower powered lasers will not yield much improvement. These lasers simply do not have adequate power to penetrate far enough to break up the remaining pigment deep in the skin.

To avoid this problem, choose the highest powered picosecond laser you can find for laser tattoo removal.

Shockwave treatment improves tattoo clearance by up to 100%

A 2018 USA split tattoo study showed that adding shockwave therapy after picosecond laser tattoo removal improved tattoo clearance by 100% after 1 laser session. In addition, a 2017 US study showed 94% of tattoos receiving combination treatment with shockwave therapy had 3 times greater fading (average 48%) compared to Q-switched laser alone (average 15%).

laser tattoo removal, Laser Tattoo Removal: 5 Proven Strategies to Help You Avoid Botching It Terribly, Ask Dr Wan
Shockwave therapy visibly improved tattoo clearance on the right half of this tattoo

Shockwave therapy enhances tattoo clearance by increasing microcirculation, lymphatic drainage and metabolic activity. This accelerates tattoo pigment clearance and decreases redness, swelling, and crusting after laser tattoo removal.

Opt for a full powered triple wavelength laser, especially if you have a coloured tattoo

Different colours of tattoo pigments absorb different wavelengths of light. At least three wavelengths of light are required to clear all colours of tattoo ink.

laser tattoo removal, Laser Tattoo Removal: 5 Proven Strategies to Help You Avoid Botching It Terribly, Ask Dr Wan
1064nm laser clears black or blue pigments, 532nm clears red or yellow pigments. A third wavelength (such as 694nm) is required for green and light blue pigments.

Most q-switched lasers including picosecond lasers such as Picoway, Enlighten have only 2 wavelengths such as 1064nm and 532nm, making it difficult for them to clear coloured tattoos. Some tattoos that appear to contain only black pigments may, in fact, contain green or blue pigments for shading or layering.

Hence, many lasers on the market that are used for tattoo removal may carry a risk of being unable to completely clear your tattoo, leaving a ghost tattoo.

Other tattoo removal lasers may produce a third or fourth wavelength (such as 585nm, 595nm, 660nm or 670nm) using dye convertor handpieces. While these converted wavelengths are better at clearing coloured tattoos than just relying on 2 wavelengths, they suffer from a severe deficiency in energy. This is because the laser has to undergo 2 wavelength conversions and each step results in significant energy losses.

laser tattoo removal, Laser Tattoo Removal: 5 Proven Strategies to Help You Avoid Botching It Terribly, Ask Dr Wan
Dye convertor handpieces result in high energy losses

High conversion losses and resultant low energy mean that only small spot sizes can be used. Such small spot sizes have high scattering loss resulting in low skin penetration, making it difficult for the laser to adequately break up tattoo pigments deeper in the skin. Small spot sizes also mean that treatment of larger tattoos becomes very slow and coverage may be uneven.

laser tattoo removal, Laser Tattoo Removal: 5 Proven Strategies to Help You Avoid Botching It Terribly, Ask Dr Wan
Low energy means only small spot sizes with poor penetration can be used

Full-powered triple wavelength lasers like the Quanta Discovery Pico Plus are able to produce more than 12x higher energy than dye handpieces. This enables the usage of high spot sizes for fast, even coverage and removal of coloured tattoo pigments deep in the skin.

Combine picosecond lasers with fractional laser

How Does Fractional Laser Help Blistering And Scarring?

Fractional laser pre-treatment, sometimes known as FracTAT, laser drills microscopic holes into the tattoo prior to treating the skin with a q-switched laser. These tiny exit ports act as ‘chimneys’ or pressure relief ducts that allow the gases to escape without building up excessive pressure. This reduces the risk of scarring and blistering.

laser tattoo removal, Laser Tattoo Removal: 5 Proven Strategies to Help You Avoid Botching It Terribly, Ask Dr Wan
Fractional laser reduces frosting

In a Californian study, a third of patients treated with picosecond laser tattoo removal alone (without fractional laser) developed bulla (large blisters). None of the patients pre-treated with a fractional laser before picosecond laser tattoo removal developed blisters.

laser tattoo removal, Laser Tattoo Removal: 5 Proven Strategies to Help You Avoid Botching It Terribly, Ask Dr Wan
Fractional laser reduces downtime and blistering

How Does Fractional Laser Impact Tattoo Clearance?

The fractional laser-ablated channels allow better penetration of picosecond laser energy with enhanced generation of photoacoustic shockwaves. They allow the ink to be expelled during treatment and some of the tattoo ink is also directly vaporized.

As a result, more ink clearance is delivered with each treatment producing faster overall clearance in fewer sessions.

This is particularly relevant in tattoos that are very stubborn and difficult to remove due to the usage of particular coloured tattoo pigments, or in cases where the tattoo artist put the ink in a little bit too deep.

Studies have shown that fractional laser can remove tattoo pigments in a colour blind manner even without using q-switched lasers.

Can Fractional Laser Help Scarred Tattoos?

In addition, the fractional skin resurfacing improves skin texture and tone, reduces any scarring resulting from when the tattoo was created and breaks up any scar tissue that has formed from previous laser tattoo removals.

What You Should Do Next

laser tattoo removal, Laser Tattoo Removal: 5 Proven Strategies to Help You Avoid Botching It Terribly, Ask Dr Wan

In my opinion, high powered picosecond laser combined with fractional laser and shockwave is currently the best tattoo removal method available.

Mindlessly blasting nanosecond lasers without thinking very much may work some times but often creates problems such as tattoo ghosts or scarring.

Technical factors are just one of the cornerstones of safe and effective laser tattoo removal. The doctor’s skill, experience and understanding of the machines, tattoo removal process and skin recovery is equally, if not more important.

Going for laser tattoo removal is a big decision and with the wide variety of lasers available in Singapore, deciding on how to proceed can be very confusing.

After reading this article, you should have a better understanding of the latest secrets to achieving a flawless tattoo removal. In fact, you might actually know more about technical factors affecting laser tattoo removal than some medical aesthetics doctors in Singapore.

In my experience, these new techniques make it much safer and more effective.

You don’t have to hold back anymore for fear of botching your laser tattoo removal.

If you have any doubts, please feel free to drop me a line and I’ll be glad to help!


References

  1. Lorgeou, A., Perrillat, Y., Gral, N., Lagrange, S., Lacour, J.-P., & Passeron, T. (2017). Comparison of two picosecond lasers to a nanosecond laser for treating tattoos: a prospective randomized study on 49 patients. Journal of the European Academy of Dermatology and Venereology, 32(2), 265–270.
  2. Choi, M. S., Seo, H. S., Kim, J. G., Choe, S. J., Park, B. C., Kim, M. H., & Hong, S. P. (2018). Effects of picosecond laser on the multi-colored tattoo removal using Hartley guinea pig: A preliminary study. PLOS ONE, 13(9), e0203370.
  3. Ahn, K. J., Zheng, Z., Kwon, T. R., Kim, B. J., Lee, H. S., & Cho, S. B. (2017). Pattern analysis of laser-tattoo interactions for picosecond- and nanosecond-domain 1,064-nm neodymium-doped yttrium-aluminum-garnet lasers in tissue-mimicking phantom. Scientific Reports, 7(1).
  4. Ho, D. D.-M., London, R., Zimmerman, G. B., & Young, D. A. (2002). Laser-tattoo removal? A study of the mechanism and the optimal treatment strategy via computer simulations. Lasers in Surgery and Medicine, 30(5), 389–397.
  5. Ash, C., Dubec, M., Donne, K., & Bashford, T. (2017). Effect of wavelength and beam width on penetration in light-tissue interaction using computational methods. Lasers in Medical Science, 32(8), 1909–1918.
  6. Weiss, E. T., & Geronemus, R. G. (2011). Combining Fractional Resurfacing and Q-Switched Ruby Laser for Tattoo Removal. Dermatologic Surgery, 37(1), 97–99.
  7. Au, S., Liolios, A. M., & Goldman, M. P. (2015). Analysis of Incidence of Bulla Formation After Tattoo Treatment Using the Combination of the Picosecond Alexandrite Laser and Fractionated CO2 Ablation. Dermatologic Surgery, 41(2), 242–245.
  8. Ibrahimi, O. A., Syed, Z., Sakamoto, F. H., Avram, M. M., & Anderson, R. R. (2011). Treatment of tattoo allergy with ablative fractional resurfacing: A novel paradigm for tattoo removal. Journal of the American Academy of Dermatology, 64(6), 1111–1114.
  9. Ramya Vangipuram, MD, Selina S. Hamill, MD, and Paul M. Friedman, MD. Accelerated Tattoo Removal With Acoustic Shock Wave Therapy in Conjunction With A Picosecond Laser. Lasers in Surgery and Medicine 9999:1-3 (2018)
  10. Ibrahim O, Kaminer M. Accelerated tattoo removal facilitated with acoustic wave device: Delivering up to 90% fading in a single office visit. Lasers Surg Med 2017;49:411.