Tattoo Removal - Q switched Ruby Laser

Lasers have been used for tattoo removal for more than 20 years. For the last 10 years, the Q-switched ruby laser has been the acknowledged laser of choice for all tattoos, excepting some reds, which may be best treated with an ND Yag laser.

The following information is designed to cover the most commonly asked questions.

Why is a tattoo so difficult to remove?
The tattoo pigment injected into the lower layers of skin (the dermis) becomes sealed away by a tough network of collagen fibres. It is very difficult to remove the tattoo pigment without affecting the surrounding tissue. The alternatives to laser treatment are, either to physically remove the pigment and the surrounding skin by surgical excision and skin grafting, or chemically destroy the pigment using salts or acid. In either case the surrounding skin is damaged and will require significant aftercare. Significant scarring would be an expected outcome of non-laser removal methods.

How is the Q -switched Ruby Laser different to other lasers used for tattoo removal? The Ruby laser produces extremely short pulses of high-energy, red light. This light is absorbed strongly by particles of tattoo pigment but not by the surrounding skin. The tattoo pigment particles heat up and break down into smaller particles; these minute particles are targeted by the body's own immune system and removed. Because the energy is selectively absorbed by the tattoo pigment, surrounding tissues are not usually affected and there is usually no lasting damage to the skin.

I have seen other 'light treatments offered for tattoo removal, what are these?
In some cases Intense Pulsed Light (IPL) systems are advertised for tattoo removal. These systems were designed to target melanin in hair follicles for hair removal and differ from lasers in producing a wide range of wavelengths in the red end of the spectrum rather than a single frequency. In addition, these systems are not Q-switched and more energy is absorbed and accumulates in the skin tissue than is the case with the Ruby laser. More energy in the skin equates to skin damage and an increased risk of scarring.

Can a tattoo be removed in just one treatment?
Only very rarely; some amateur (pin and ink) tattoos may disappear after only a small number of treatments; professional tattoos usually take a higher number.

How many treatments will be required to treat the average tattoo?
There is no such thing as an average tattoo; every tattoo is different and every individual responds differently. As a guide, amateur tattoos can take anywhere from 1-10 treatments; professional tattoos from 5-20, although they may take more than this. Without seeing the tattoo it is impossible to be more accurate and even then, we will only be able to give an estimate.

What are the costs likely to be?
The cost of a single treatment will depend solely on the size of the tattoo. The bigger the area, the more time it will take to treat and the higher the charge. Again, until we can see the tattoo, we cannot measure the area or price the treatment. The minimum treatment charge is £60 per session.

Is the treatment cost fixed throughout the course of the treatment?
As the tattoo fades away, the size of the tattoo will normally reduce, although this is not always the case; some tattoos will fade evenly without reducing in size. Consequently, treatment cost is re-assessed on an individual basis as the treatment progresses. If the size of the tattoo reduces significantly during treatment, the price will be reduced accordingly.

Do all tattoos respond to treatment?
Unfortunately not; most pigments, especially blacks and blues, do respond very well to Ruby laser treatment. However, some pigments, usually greens, can be resistant to treatment and some pigments, usually reds, are transparent to ruby laser light and do not respond at all.

How will I know if there are any resistant colours present?
In most cases it will be apparent to the assessor whether there is likely to be a problem. Where there is any doubt, a test patch will be required to determine the likelihood of successful treatment. There is a charge of £50 for a test but, in our experience, it is better to find out about potential problems before the whole tattoo has been treated and a larger sum of money has already been spent.  

How long does the treatment take?
This depends on the size of the tattoo; a small tattoo might take 5 minutes, where a large, or multiple tattoos could take an hour or more of treatment. Again, the assessment will provide this information.

Does it hurt?
The honest answer to this is yes, although the amount of pain felt will depend on the type of tattoo, the amount of treatment required and your own pain threshold. Some clients would describe it as no more than uncomfortable where others will describe it as painful. Clients' descriptions range from an elastic band flicked against the skin to splashes of chip fat and even red-hot needles. The truth is that you will only know how painful you find it until you try it! Advice on pain relief will be given during your assessment.

Does the laser cause scarring?
Although there is a risk of scarring with any laser, in most cases, scarring is not a significant risk for tattoo removal with the ruby laser. Tattoo removal has become associated with scarring because the first lasers used for tattoo removal were very aggressive and carried a high risk of scarring. The ruby laser does not heat the surrounding skin significantly and the risk of scarring is much reduced. The risk of scarring is mainly associated with a genetic pre-disposition to forming scar tissue and the presence of resistant, green pigment. To reduce the risk, we carry out an extensive medical evaluation to identify high-risk clients; we also have an adjunct treatment that can stop scar tissue forming and even improve existing scarring.

Are there any other side effects?
After each treatment, the area may blister; this is quite normal and usually resolves in a few days. Once any blisters or crusts have subsided, the skin around the tattoo will look shiny for a number of weeks. Treatment cannot be repeated until your skin has returned to normal; this will usually take from 4 to 6 weeks.

The highest-risk side effect is skin de-pigmentation . (loss of natural skin colour) Because the laser targets dark pigments, ruby laser energy is also absorbed by the melanin in the skin. The most frequent side effect is for the natural colour in the skin to 'bleach' after a number of treatments. While normal skin pigment will usually recover, it can take months, or even years to do so and, in some, rare cases, the natural colour of the skin may not return at all, or will return in patches. As a general guideline, the darker the skin and the more treatments required, the more risk there is of long term de-pigmentation.

Because of the risk of damage to skin pigment, we will not treat tanned skin and will postpone treatment until any sun-tan has faded.

The risks of permanent de-pigmentation is harder to measure than for scarring as the skin usually recovers to at least some degree.

Is the treatment safe?
The ruby laser has been used around the world for more than 10 years and has treated millions of tattoos safely.

Our clinic alone has delivered more than 30,000 treatments to 2,000 individuals with the only problems encountered being these outlined above; ruby laser energy is really just a strong red light and there is no linkage with any skin disorder or any increased risk of skin cancer.

The major risk to health is to the retina; lasers and other light sources can cause permanent damage. Consequently, the use of lasers and light sources (IPLs) is regulated under the Care Standards Act 2000 by the National Care Standards Commission (NCSC).

All facilities using laser/IPLs must be registered and inspected by the NCSC. If a facility is not registered, it is operating illegally and will not be insured against negligence. The Eden Clinic is registered and fulfils its legal requirements to the very highest standards.

What do I do if I want to find out more?
Just call us on 01753 623753 to arrange your FREE consultation. This will take about 30 minutes and will give you all the information that you need to reach an informed opinion about the suitability of our treatment.