There are many reasons why people are attending laser tattoo removal clinics for tattoo removal, whether it is for a fade for a new special art work, the removal of an ex-lover (and we’ve seen plenty of these!), a drunken night mistake, dodgy artwork, or have simply outgrown a design. According to recent statistics, one in four people in the U.S A have tattoos and one in five in Australia. As it is has become so prevalent, so too has the demand for tattoo removal and without a doubt, laser technology is the safest and most effective way of going about this. It is therefore only natural to have a few questions about the side effects of removal.
Painthresholds do vary from one person to another and as it is completely subjective, what “really hurts” to one person might not be a big deal at all to another. A large tattoo might be treated on two or more separate occasions. A good experienced laser clinician can operate the laser machine with a fast speed of response, literally completing smaller tattoos in seconds, making tattoo removal relatively easy. Tattoo location is also another determining factor to discomfort. Areas such as the inside of the arm, the rib cage, the wrist, feet and face can be a little tenderer. There are various methods to reduce tattoo removal discomfort. Cooling machines, numbing creams andlow level laser therapycan make a big difference. It is important to note that due to the white pigments in numbing creams, acting like a filter, the number of total treatments for total removal can be increased by approximately two for full removal.
The white response to tattoo removal is a side effect we actually want to see in the first couple of treatments. This reaction indicates that the laser has penetrated the ink effectively. The frosting only lasts temporarily, often visible for the first 5-10 minutes.
What is frosting?
The laser causes the rapid local heating of the ink pigment forcing the water particles to the upper layers of the skin giving the white colour. This is not a blister. Once more ink is removed in further treatments; it is less likely to see this frosting.
Technically, our laser machine has a photoacoustic (light and sound) response. The acoustic effect is a creation of a shock wave that propagates throughout the dermis of the target area causing the tattoo pigments to shatter (the energy profile of that shock wave prevents the generation of heat). The vibrational effect causes a rapid heating of melanosomes converting the cells water into steam, the frosting response. This frosting prevents further penetration of laser into the skin due to it scattering the laser light.
Blisters can be common place in properly executed tattoo removal, particularly with red ink tattoos or other coloured tattoos. Fresh heavily inked black ink tattoos do also occasionally blister. It is relatively uncommon with older black ink tattoos. The laser used for red ink is a more superficial laser (acting higher in the dermis) causing the cells to absorb more light energy. As it is not deep within the skin, scarring does not occur. Clinicians will often treat large red ink areas over a few sessions to minimize blisters. Good clinician practice and technique can reduce the formation drastically. During the course of treatment, the chance of blistering is greatly reduced due to the reduction of ink available for the laser to react with.
Most blistering is gone in one week. Covering with bandages to prevent from rubbing on clothes or opposing skin surfaces (for example, inside of the arm) can be helpful.
Blistering has a bubble appearance on the top layer of skin either within or around the tattoo. Small blisters are best left alone. It is your body’s way of protecting your skin by stopping bacteria from coming in contact with it. If not cared for correctly, infection can therefore result. Precise instructions should be provided for care if large blisters result. Blistering from laser tattoo removal lasts for about 3-5 days. Discomfort is generally minimal to non-existent.
Scabbing tends to happen with coloured tattoos after blistering. We find it is not that common with black ink tattoos. Scabs tend to develop within 6 hours to 3 days, followed by crusting which can last from 1-3 weeks. Healing is usually complete within 3 weeks. Again, good clinical practice should keep this time at a minimum. Never pick or remove the scab or crust as it is the body’s way of healing the skin beneath. Unnecessary scarring can result if the skin is disturbed.
The area can become very dry after the tattoo removal process. Whether, there has been blisters or not, dryness can be a common feature. Never pick or remove the skin from a scab as this could cause unnecessary scarring. Crusting will last for as long as your skin needs to protect the area, so be patient with this step. We recommend a chemical free thick moisturising balm with some Vitamin E to be used twice daily on the area.
The laser treatment will often dehydrate the skin causing the skin to become dry and itchy. The healing process itself can also cause itchiness. It is a good sign that your immune system is doing the right thing. If you are prone to hives, other measures may need to be addressed. In most cases, the itching can be relieved by a good moisturising balm, particularly with the addition of Vitamin E as previously mentioned. . Extreme weather or fluctuations in temperature can aggravate the skin and it can be advisable to place your healing balm in the fridge during hot conditions. It is best to avoid chemical creams or lotions and those containing artificial fragrances. Lightly tapping around the treated area can be helpful. It is important to remember not to scratch the skin as we do not want you to disturb or damage the healing process. Areas of reduced blood flow (hands and feet) can suffer a little more due to slower circulation in these areas. We have had a great reduction in itchiness with the use of the low-level laser procedure.
Proper clinical practices using a Q-switched laser should not create scarring at all. If the skin is disturbed during the healing process then scarring can result. A good technician/clinician will often feel your tattoo before commencing treatment. If there are areas of “bumpiness” throughout your tattoo, then it is likely that scarring has occurred during the actual tattooing itself. Sometimes scarring from the tattoo artist can be deeper within the dermis and is undetectable until a few removal processes have left behind some “stubborn” ink. It does take longer to release this ink as it is bound within the scar tissue but any of the scarring from the original tattoo will likely still remain.
A Q-switched laser is not the best device to use for scar revision. Referral to a dermatologist is usually recommended. CO2 Fractional or Erbium lasers are utilized here and cortisone treatment can be recommended. What many people don’t realize is that any scarring that remains after a tattoo removal procedure is often left over from the pre-existing tattoo application.
Hyperpigmentation and Hypopigmentation occur when the body’s production of melanin is affected after a laser treatment. Hyperpigmentation is when the body overproduces melanin in reaction to the laser treatment, so skin in the treated area becomes darker. Hyperpigmentation tends to result if the tattoo following laser removal treatment has been exposed to sun without the application of high block out sunscreen. Good sunscreen and sun protection practices with tattoo removal are therefore very important Hypopigmentation occurs when the melanin is depleted by the laser treatment causing the skin to appear lighter. Hypopigmentation is more common with darker skin types, however, with good laser protocols, this can be prevented or reduced. Gentle sun exposure after time following complete removal will generally re-pigment the skin. Hypopigmentation and hyperpigmentation are generally temporary and resolve naturally with time. Some clients with darker skin are best treated with greater time in between each visit. It is better to treat these skin types conservatively, using lower machine settings over a slightly longer period to minimise any possible change to pigmentation.
Swelling can be normal after laser tattoo removal treatment. There are a few measures that can be taken to manage the swelling. It is best procedure to break up a large tattoo and treat over a couple of visits, particularly those in an extremity (arm or leg) and those that circumnavigate the limb. In those that circumnavigate the limb, we want to not limit lymphatic flow. Swelling will normally subside the day after the treatment .Recent studies have found that usinglow level laser procedures can help limit swelling. As lymph and blood flow is towards the heart, elevation of the limb, where possible is a good procedure to follow to minimise swelling.
The skin, the largest organ of the body, is an incredible barrier against infection if the epidermis, the outer layer of skin is well taken care of following tattoo removal.
With the advancement of technology, infection is an extremely unlikely outcome. Previously, longer pulse duration lasers were used which created significant heat production resulting in large wound formation. It was a very destructive process with slow healing time. This all lead to the greater likelihood of infection occurring. Ultra-short pulse lasers do not create the same degree of heat. It was far more likely to see scarring before these new technology lasers came into being.
An Important Conclusion
Adequate, not excessive delivery of energy to the tattoo is only required to cause fracturing and therefore release of tattoo ink particles. Using conservative and safe clinical practices with proper protocols based on your skin tone, these above mentioned side effects will be temporary or not existant. The goal should be that the skin returns to normal within a few days post laser treatment. It is important to be aware that the laser machine does not remove the ink, it is your immune system that does the work, all of which takes time. The tattoo ink will be removed from your body gradually over 6 weeks to 8 weeks after targeting the ink. Destroying the skins surface with aggressive treatments will not improve the time the ink takes to be removed from the body but can jeopardize the long term results of this process. Preserving the integrity of the epidermis should be a priority! All permanent side effects are completely avoidable if proper procedures and after care are followed. Redness, tenderness, and swelling typically subside within a day or two following treatment. Blisters usually appear within 12-24 hours of treatment; sometimes the blisters are large and may look alarming – please note that this is completely normal. Scabs, bruising, and blistering may take up to a week or longer to heal.
As every tattoo is different, individual experiences are different. It is important to not rush the treatment. A well trained laser technician/clinician should not use skin destruction as an endpoint to determine they have adequately treated the tattoo as infections and scarring could result and it does not speed up the ink removal process.
We work very hard to educate our clients why we prefer to not damage their skin so that we have the best chance of returning the skin back to its pre-tattoo health.
Our advanced healing technology and trained staff means great skin and great results.