Expertise Is Essential for Effective Laser Tattoo Removal

NAPLES, Fla. — Patients present with different reasons for tattoo removal—such as regret following a crazy night or a change in relationship status. The number of options for laser tattoo removal, however, is more limited, Dr. Albert J. Nemeth said.

Photos courtesy Albert J. Nemeth

Specific Q-switched Nd:YAG laser wavelengths are good at shattering tattoo ink but must be applied specific to the ink color. Also, do not use non-Q-switched Nd:YAG lasers or other lasers designed for different dermatologic indications, Dr. Nemeth said at the annual meeting of the Florida Society of Dermatology and Dermatologic Surgery.  

In general, 95% of amateur tattoos take one to three laser treatment sessions for removal. In contrast, six or more sessions are often required to remove most professional tattoos. Variables include the depth at which pigment was placed and type of ink. "Tattoo depth can vary. That is important to conceptualize when treating these tattoos," Dr. Nemeth said.

Tattoos applied by a friend or family member and those inked professionally share a common challenge for dermatologists—a lack of regulation on what can be used for pigment. "It's really quite interesting in terms of the secret concoctions that I've heard … cigarette ash; for some reason Crest toothpaste seems to be a magic ingredient; and—I don't understand why—but urine seems to be important in there also," Dr. Nemeth said in an interview.

An important caveat: If the patient reports or displays any symptoms of allergic dermatitis to the ink (constant oozing or crusting), lasers can worsen those symptoms. Physical removal of the tattoo is the only option for these patients, said Dr. Nemeth, a private-practice dermatologist in Clearwater, Fla., and FSDDS president. Dermabrasion, for example, is an option "if you are extraordinarily proficient at that."

An estimated 14% of all adults in the United States have at least one tattoo, according to a Harris Poll by Harris Interactive in 2008. A predominance of tattooing among a younger segment of the population means dermatologists are likely to see more and more patients with tattoos.

Removal of tattoos via laser can be life changing and/or life saving for some patients. For example, former gang members might feel safer after removal of an identifying tattoo, said Dr. Nemeth, also of the department of dermatology and cutaneous surgery at the University of South Florida, Tampa.

For removal of green tattoo inks, Dr. Nemeth uses a 694-nm Q-switched ruby or 755-nm Q-switched alexandrite laser. To shatter black, blue, sky blue, or darker inks, he employs a 1064-nm Q switched Nd:YAG laser. If a patient's tattoo features red, orange, or purple inks, these can be effectively treated with a 532-nm Q-switched Nd:YAG laser, he said. Also be aware that laser therapy can darken tattoo inks if they contain iron oxide or titanium oxide.

Avoid the temptation to use lasers for other indications. "An EpiTouch ruby laser made for hair removal should not be used for tattoo removal," Dr. Nemeth said. "This is an important take-home message: Just because the wavelength is close, it does not mean the indications are the same."

Also, intense pulsed light systems are not appropriate for this indication, Dr. Nemeth said. "If your salesperson told you IPL can be used to remove tattoos, [he] lied to you. IPL cannot be used to remove a tattoo, in my humble opinion."

The Q-switched lasers have afforded patients a much better aesthetic outcome following tattoo removal. "It used to be every patient knew they were switching their tattoo for a scar, "Dr. Nemeth said. "Now you can get some very, very nice results."

Dr. Nemeth had no relevant financial disclosures.

NAPLES, Fla. — Patients present with different reasons for tattoo removal—such as regret following a crazy night or a change in relationship status. The number of options for laser tattoo removal, however, is more limited, Dr. Albert J. Nemeth said.

Photos courtesy Albert J. Nemeth

Specific Q-switched Nd:YAG laser wavelengths are good at shattering tattoo ink but must be applied specific to the ink color. Also, do not use non-Q-switched Nd:YAG lasers or other lasers designed for different dermatologic indications, Dr. Nemeth said at the annual meeting of the Florida Society of Dermatology and Dermatologic Surgery.  

In general, 95% of amateur tattoos take one to three laser treatment sessions for removal. In contrast, six or more sessions are often required to remove most professional tattoos. Variables include the depth at which pigment was placed and type of ink. "Tattoo depth can vary. That is important to conceptualize when treating these tattoos," Dr. Nemeth said.

Tattoos applied by a friend or family member and those inked professionally share a common challenge for dermatologists—a lack of regulation on what can be used for pigment. "It's really quite interesting in terms of the secret concoctions that I've heard … cigarette ash; for some reason Crest toothpaste seems to be a magic ingredient; and—I don't understand why—but urine seems to be important in there also," Dr. Nemeth said in an interview.

An important caveat: If the patient reports or displays any symptoms of allergic dermatitis to the ink (constant oozing or crusting), lasers can worsen those symptoms. Physical removal of the tattoo is the only option for these patients, said Dr. Nemeth, a private-practice dermatologist in Clearwater, Fla., and FSDDS president. Dermabrasion, for example, is an option "if you are extraordinarily proficient at that."

An estimated 14% of all adults in the United States have at least one tattoo, according to a Harris Poll by Harris Interactive in 2008. A predominance of tattooing among a younger segment of the population means dermatologists are likely to see more and more patients with tattoos.

Removal of tattoos via laser can be life changing and/or life saving for some patients. For example, former gang members might feel safer after removal of an identifying tattoo, said Dr. Nemeth, also of the department of dermatology and cutaneous surgery at the University of South Florida, Tampa.

For removal of green tattoo inks, Dr. Nemeth uses a 694-nm Q-switched ruby or 755-nm Q-switched alexandrite laser. To shatter black, blue, sky blue, or darker inks, he employs a 1064-nm Q switched Nd:YAG laser. If a patient's tattoo features red, orange, or purple inks, these can be effectively treated with a 532-nm Q-switched Nd:YAG laser, he said. Also be aware that laser therapy can darken tattoo inks if they contain iron oxide or titanium oxide.

Avoid the temptation to use lasers for other indications. "An EpiTouch ruby laser made for hair removal should not be used for tattoo removal," Dr. Nemeth said. "This is an important take-home message: Just because the wavelength is close, it does not mean the indications are the same."

Also, intense pulsed light systems are not appropriate for this indication, Dr. Nemeth said. "If your salesperson told you IPL can be used to remove tattoos, [he] lied to you. IPL cannot be used to remove a tattoo, in my humble opinion."

The Q-switched lasers have afforded patients a much better aesthetic outcome following tattoo removal. "It used to be every patient knew they were switching their tattoo for a scar, "Dr. Nemeth said. "Now you can get some very, very nice results."

Dr. Nemeth had no relevant financial disclosures.

NAPLES, Fla. — Patients present with different reasons for tattoo removal—such as regret following a crazy night or a change in relationship status. The number of options for laser tattoo removal, however, is more limited, Dr. Albert J. Nemeth said.

Photos courtesy Albert J. Nemeth

Specific Q-switched Nd:YAG laser wavelengths are good at shattering tattoo ink but must be applied specific to the ink color. Also, do not use non-Q-switched Nd:YAG lasers or other lasers designed for different dermatologic indications, Dr. Nemeth said at the annual meeting of the Florida Society of Dermatology and Dermatologic Surgery.  

In general, 95% of amateur tattoos take one to three laser treatment sessions for removal. In contrast, six or more sessions are often required to remove most professional tattoos. Variables include the depth at which pigment was placed and type of ink. "Tattoo depth can vary. That is important to conceptualize when treating these tattoos," Dr. Nemeth said.

Tattoos applied by a friend or family member and those inked professionally share a common challenge for dermatologists—a lack of regulation on what can be used for pigment. "It's really quite interesting in terms of the secret concoctions that I've heard … cigarette ash; for some reason Crest toothpaste seems to be a magic ingredient; and—I don't understand why—but urine seems to be important in there also," Dr. Nemeth said in an interview.

An important caveat: If the patient reports or displays any symptoms of allergic dermatitis to the ink (constant oozing or crusting), lasers can worsen those symptoms. Physical removal of the tattoo is the only option for these patients, said Dr. Nemeth, a private-practice dermatologist in Clearwater, Fla., and FSDDS president. Dermabrasion, for example, is an option "if you are extraordinarily proficient at that."

An estimated 14% of all adults in the United States have at least one tattoo, according to a Harris Poll by Harris Interactive in 2008. A predominance of tattooing among a younger segment of the population means dermatologists are likely to see more and more patients with tattoos.

Removal of tattoos via laser can be life changing and/or life saving for some patients. For example, former gang members might feel safer after removal of an identifying tattoo, said Dr. Nemeth, also of the department of dermatology and cutaneous surgery at the University of South Florida, Tampa.

For removal of green tattoo inks, Dr. Nemeth uses a 694-nm Q-switched ruby or 755-nm Q-switched alexandrite laser. To shatter black, blue, sky blue, or darker inks, he employs a 1064-nm Q switched Nd:YAG laser. If a patient's tattoo features red, orange, or purple inks, these can be effectively treated with a 532-nm Q-switched Nd:YAG laser, he said. Also be aware that laser therapy can darken tattoo inks if they contain iron oxide or titanium oxide.

Avoid the temptation to use lasers for other indications. "An EpiTouch ruby laser made for hair removal should not be used for tattoo removal," Dr. Nemeth said. "This is an important take-home message: Just because the wavelength is close, it does not mean the indications are the same."

Also, intense pulsed light systems are not appropriate for this indication, Dr. Nemeth said. "If your salesperson told you IPL can be used to remove tattoos, [he] lied to you. IPL cannot be used to remove a tattoo, in my humble opinion."

The Q-switched lasers have afforded patients a much better aesthetic outcome following tattoo removal. "It used to be every patient knew they were switching their tattoo for a scar, "Dr. Nemeth said. "Now you can get some very, very nice results."

Dr. Nemeth had no relevant financial disclosures.