Page 76 - An Introduction to Laser Tattoo Removal

Chapter 2 – Fundamentals of Laser Tattoo Removal v1.0
Skin surface
3rd cover-ups 4th 5th
Figure 35 – Each treatment removes a layer of ink. Hence complete removal requires a number of treatment sessions to remove each layer, one at a time.
More commonly these days patients are requesting a ‘fading’ or a ‘cover up’ rather than a complete removal. This is to allow a new tattoo to be positioned above an unwanted, existing one. I recommend that such patients be advised to undergo at least four treatment sessions before returning to a tattoo artist. This number is usually sufficient to remove enough of the tattoo in the upper dermis to allow a fresh tattoo to be placed in that region.
Although the photomechanical reaction is often described as a ‘non-thermal’ process, the reality is that some thermal energy will conduct into the dermis adjacent to ink particles. This is inevitable (unless Heisenberg was wrong!!)
As a direct consequence, some localised fibrosis will occur around the ink sites leading to ‘micro-scarring’. Each subsequent laser treatment will increase the total amount of micro- scarring. This has the negative effect of reducing efficacy due to increased scattering of the incoming laser light. So, each time a patient returns for treatment, not only is the target ink deeper than previous occasions but the increased level of scar tissue makes it a little more difficult to induce the desired reaction in that deeper ink. This may explain why some deep targets are so difficult to remove completely.
Laser Parameters
The important laser parameters which we must consider in tattoo removal are:
Wavelength Fluence Anisotropy Pulsewidth Spot diameter
Let’s look at these individually: ________________________________________________________________________ 76
Chapter 2 LEVEL A Laser Tattoo Removal
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1st treatment
2nd
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