By Marci Zimmerman, CEO & Owner Delete – Tattoo Removal & Laser Salon
Tattoo removal is at the top of most trending lists these days. According to a recent Bloomberg report, tattoo removals procedures increased by more than 50% in 2013. ‘Patients typically love their tattoo for five years and desire removal after seven to ten years? says Dr. Jennifer Mundt, Medical Director, Delete Tattoo Removal and Laser Salons�. Whatever the reasons behind the desire to get a tattoo removed, consumers seeking tattoo removal services should always be educated about the process. Not all lasers, laser technicians and quality of the tattoo removals are the same. Given the increased demand for tattoo removal, it is no surprise that newer technology is being introduced all the time. But do claims that one technology is superior to another really mean anything? And what does ‘superior technology mean’? Getting past all the hype about the latest technology and faster removal can be daunting.
Tattoo Removal Factors
There are a number of factors that influence the success of laser tattoo removal. The first, and most obvious, is the device. It is critical that your medical practitioner utilizes the right technology. Not all lasers were designed for tattoo removal, and use of the wrong kind of laser can do more harm than good. Q-switched laser technology is a laser tattoo removal technology that replaced other invasive removal techniques, such as salabrasion, dermabrasion, and ablative CO2 laser removal, that removed layers of skin and created a large scar where a tattoo had been. The next set of factors concern the actual laser treatments and the laser settings. It is important that your medical practitioner utilizes an effective wavelength (determined by ink color), spot-size (determined by depth of treatment), and a pulse-rate (speed) that targets the destruction of the ink pigment while minimizing the thermal damage to the surrounding skin. The wrong laser settings can damage the skin, cause wounds that bleed and ooze, or worse, cause permanent scarring. Practitioners who are unfamiliar with the intricacies of laser technology, the tattoo removal process, and the nuances of the human body can turn an unwanted tattoo into a horrific scar.
Before we start our evaluation of the Pico technology, let’s take a moment to more fully understand how certain factors can influence the effectiveness of tattoo removal.
Different wavelengths are used to target different colors of ink and protect different shades of skin. The four available q-switched laser wavelengths are 694 nm Ruby, 755 nm Alexandrite, the 1064 Nd:Yag which converts to a 532 nm wavelength when passed through a KTP crystal. The 532 nm wavelength can be converted by dye laser hand pieces into 585 nm and 650 nm wavelengths. Tattoo ink varies significantly, pigment does not always respond predictably. For example, black inks often contain shadings of blue and therefore will require multiple wavelengths to treat.’
The larger the spot size the deeper the tattoo removal treatment. The spot size is reduced to decrease the depth and increase the fluence i.e. power of the wavelength. According to Dr. Mundt, ‘It is important to treat the deepest layers of ink first and avoid superficial treatments with excessive power because scarring occurs around your ink and actually adds to the number of laser tattoo removal treatments needed.?
The most frustrating aspect for tattoo removal patients is often the length of time it takes for the human body to remove the ink after the laser has broken it up. Pulse rate affects the size of the particles that the ink is broken up into when treated with the laser. In general, the faster the pulse, the smaller the ink particles. The latest tattoo removal technology approved by the U.S. Food and Drug Administration is the picosecond technology. This technology delivers a pulse fired in pico (trillionths) of a second versus Q-switched models which deliver pulses by the nano (billionths) of a second pulses. The faster pulse breaks the ink into smaller particles, and smaller particles have been shown to be easier for the body to remove.
Evaluation: AlexELETE vs. the Picosure
Wavelengths: Ability to Remove Colors
The medical professionals of Delete ? Tattoo Removal and Laser Salons believe in the laser-pumped laser delivery technology found in the AlexELETE by Candela, a q-switched Alexandrite/Nd:Yag laser that delivers three wavelengths to safely treat nearly every tattoo color. Using the AlexELETE laser, our medical providers find red and black to be the easiest colors to remove. Although red is a notoriously difficult ink color to remove, Dr. Mundt and her team have removed it in as few as two treatments. Other tattoo ink colors that have been completely removed by the AlexELETE are blue, green, purple, brown, orange, pink, and yellow. This is unlike most other tattoo removal lasers. The single wavelength Picosure lasers have a difficult time removing red ink and do not treat red, yellow, orange, pink, or browns very well, if at all.
Physicians at Delete’Tattoo Removal and Laser Salons have treated patients that are not happy with the scarring left by Picosure laser. Notice the white thickened scarring in the upper portion of the tattoo on the upper right side. This photo was taken after being treated just once with the Picosure laser.
Spot-Size: Depth of Treatment
Another issue to consider with the faster pico-second laser is the depth of treatment and it’s target ink. When tattoo artists begin an outline of a tattoo they use a deeper needle to allow for a thicker edge to fill ink into. The deeper the ink is set into the skin, the larger spot-size is needed. The AlexELETE is an effective laser for inks of all depths (deep, medium and superficial inks). It can hit the very deep borders of tattoos as well as the lighter, superficial tattoos due to its different spot sizes. A disadvantage of the first pico-second laser to market is that it can only hit superficial ink due to its only having one spot size. Thus, deeper inks are targeted and scar over and because of their depth are left behind, leaving the patient with ink that is now more difficult to remove.
Ink Destruction: Pulse-Rate
The tattoo removal science behind picosecond technology is very promising and laser manufacturers have a number of products in development that promise to deliver the pico-second technology with multiple wavelengths and/or in a safer less invasive manner. The pico-second and nano-second lasers impact the removal process differently in the body. The AlexElete’s laser-pumped laser technology has three wavelengths that allow for the color of ink to be photothermally eradicated without damaging the surrounding tissue. The Picosure photomechanically breaks up the ink and attempts to spare the surrounding tissue. The reported faster removal results with the Picosure are consistent with the results of Delete’s 4-n-1 Tattoo removal treatments, which deliver multiple treatments in a single visit, break up the ink even further. Smaller ink particles equal easier and faster removal by the body. Concerns remain with the pico-second targeting superficial ink and trapping the deeper ink levels.
As the leader in expert and comfortable tattoo removal, Delete–Tattoo Removal & Laser Salon’s board certified medical providers, in Phoenix and Boston, are committed to delivering the safest, fastest and most effective tattoo removal treatment possible. All breakthroughs are continually researched and our conclusions willingly shared. The pico-second technology is the newest tattoo removal technology and is also explored in the May/June 2014 MedEsthetics’s ‘Erasing The Past? article.
One of the most highly marketed lasers in recent years, the Picosure laser by Cynosure is the first picosecond laser commercially available. Reviewing the research presented when introduced, the results that Dr. Mundt has seen Delete has chosen not to jump on the first model available and will invest in the pico-second laser that will address the limitations of a single wave length and the risk of scarring with a limited spot-size’s shallow but intense pico-second pulse-rate. This Delete patient (left side) came to us after just one inch of their tattoo was removed with a Picosure laser.
The AlexELETE has a much more gentle interaction with the skin and does not cause as many blisters, or scarring, as does the Picosure laser. Before and after treatment photos from the Picosure research studies sponsored by Cynosure show aggressive interaction with the skin, and some tissue damage so deep that scarring will be permanent.