The most popular technique currently being used to remove skin tattoos is laser, whose therapeutic and aesthetic results surpass those of the chemical and surgical solutions of before. But tattoo removal is no trivial matter, as it requires both patience and money. Today I interview Dr. José Manuel Miralles, a dermatologist and expert in laser medicine.
How does laser remove tattoos? Nowadays we use Q-switched technology, which is laser that emits high-energy but extremely short-duration pulses. It photoacoustically or mechanically breaks up the pigment particles, and any pigment that remains is then removed by immune system cells. Previous lasers destroyed the pigment thermally and were not as effective.
What is the first step in carrying out a treatment of this type? After assessing the characteristics of the tattoo – how long ago it was done, if it was done by an amateur or professional, the colour, the ink load, where it’s located and other factors – we explain to the patient how the process will be gradual and will need several sessions. At the moment tattoos cannot be removed in a single session; that only happens in very exceptional circumstances.
How many sessions are needed on average? It is very difficult to say in advance how many sessions will be needed. Small tattoos with low ink loads disappear in four or six sessions, whereas complex tattoos may take two or three years and may easily require 20 sessions. Sometimes Q-switched lasers have to be combined with other lasers. Removing tattoos is a lengthy process.
Why is so much time left between sessions? A session every two month is the norm. If sessions are more frequent side effects result and the procedure is not effective. And effectiveness is also reduced for longer intervals. The patient and the dermatologist have to come to an agreement to see the treatment through to the end.
Let's talk money ... A small tattoo in blue or black costs around 100 euros per session, and after that, prices go up depending on the size of the tattoo and its colours. Quality laser technology is expensive, especially Q-switched laser. Our equipment, for instance, has four wavelengths that work on the different colours. These are sophisticated devices with high maintenance costs.
Is it painful? Is anaesthesia used? Tattoo removal is relatively painful, especially in the initial sessions when the ink load is higher. To keep discomfort to a minimum we often use topical anaesthetic creams.
What about side effects? Normally they are minimal. For example, in the initial sessions, if there is a high ink load, blisters may develop, even affecting entire areas of the tattoo. But that does not imply burning. With proper care there will be no scarring. Another risk arises from not knowing the composition of the inks, which are, in fact, implanted foreign bodies. Reactions are sometimes toxic, especially with the red pigments. But there’s nothing major to worry about.
Can tattoos be fully removed? Tattoos can indeed be fully removed, but the process can be lengthy. Colours like green and yellow, for instance, are more difficult to remove than blues and blacks, and white is especially problematic. Technological research is likely to soon lead to further advances, for example, with picosecond lasers or combined lasers. But I can assure patients that, with patience, their tattoos will be removed.
It can be assumed, then, that larger tattoos pose greater problems. Obviously, but in such cases we work bit by bit to reduce discomfort and risks. We never remove a tattoo that envelops a limb – whether an arm or a leg – all at once, because post-treatment inflammation could compress vessels and cause severe compartment syndrome.
However, people with large tattoos usually just want to remove a specific area or detail, rarely do they want to delete the tattoo entirely. Sometimes it’s to tattoo something different in the same place, or change a name or a small detail they do not like.
Is laser dangerous? The world of light physics is fascinating and complex, but only those who properly understand laser achieve satisfactory results. Laser is safe in expert hands. Laser specialists achieve the best therapeutic and aesthetic results and ensure that any side effects or incidents are correctly managed.
I would also like to remind readers that laser is simply light loaded with energy, so it has none of the risks associated with the radiation used for x-ray examinations.