Page 43 - An Introduction to Laser Tattoo Removal

Chapter 2 – Fundamentals of Laser Tattoo Removal v1.0
This suggests starting at low fluences and increase them slowly until a suitable reaction is observed - either frosting, swelling or reddening of the skin. Frosting is usually observed during the first few treatments, but it becomes less noticeable after around four or five. This is mainly due to scattering effects in the light leaving the skin. Scattering causes the light to 'lose information', and so it becomes much less obvious.
However, some users 'chase' this visual indicator - we feel that this is a mistake. It is better to use the previously-used fluence as a guide, rather than go looking for an effect which may not be readily seen.
If too high a fluence is used, the energy which is not absorbed in the photomechanical reaction will be released as heat into the local tissues, inevitably leading to damage. Quite simply, excess energy will generate scar tissue!
The laser does not remove the tattoo – the body does. The laser merely ‘accelerates’ the removal process. A tattoo might be completely removed naturally by the body in around 300 to 400 years...
One of the features of scarred collagen is that it scatters more readily than 'standard' collagen fibres. This then reduces the overall effect of the treatment, since the fluence is reduced by scattering.
So, it is easy to see that too many treatments combined with excessive fluence is a clear path to a very poor final result. This will, inevitably, make it much more difficult to completely remove all the ink. This is part of the reason why we now advocate fewer treatments spaced out over a longer period of time - fewer treatments results in less scar tissue formation, and, longer intervals between laser sessions appears to allow for more ink removal, by the skin.
Logically, it appears that a more subtle approach to laser tattoo treatments may, in fact, generate better results. (See ‘The Ideal Protocol’). Excess energy will simply result in more scarring!
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Chapter 2 LEVEL A Laser Tattoo Removal
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