Ask any medical professional for advice on tattoo removal and they’d mention the picosecond laser in a heartbeat. That’s hardly surprising, as this laser technology that operates on picosecond pulse durations is known as the gold standard for removing pigmentation — especially tattoos. 

But are pico lasers the only way to remove tattoos? Absolutely not. Yet, why are they so popular and chosen as the first choice at almost every clinic now? Let’s find out.

Types of tattoo removal options

Before pico lasers came out, Q-switched lasers were the go-to for tattoo removal. However, these days, they’re not the most ideal choice any longer especially if used on their own as they tend to create superheated gas and steam within the skin. This extra layer of “frosting” actually creates a shield and prevents laser beams from reaching deeper-lying pigments. The superheated gas can also cause collateral damage, resulting in scarring. 

In my years of practice, I’ve also found that Q-switched nanosecond lasers bring about these undesirable factors:

Downtime

Patients often experience blistering and painful raw skin after a treatment session. Such an effect is usually minimised with pico lasers.

Scarring

Scarring occurs due to collateral damage from laser energy, and individuals with darker skin or with larger and colourful tattoos are more prone to this side effect. It’s pointless removing a tattoo only to have it replaced with a scar. 

Ghosting or the inability to remove faint leftover tattoos

A tattoo removal treatment plan consists of a few sessions; tattoos are never removed entirely at one go. The goal is to get the tattoo to fade as much as possible and ideally till there’s nothing left. Conventional Q-switched lasers are unable to penetrate deep enough into the skin to break up remnant tattoo particles. This is also due to their pulse durations, which are not long enough to achieve a powerful photomechanical breakdown.

Long process

Ultimately, removing your tattoos can be a long process depending on the complexity of your tattoos. With pico lasers, however, this process can now be shortened by half.

Solutions I offer

At my clinic, I have 3 tattoo removal options.

Discovery Pico Plus

Not to be confused, pico laser is a laser technology, and the different names you see out there like  PicoSure, PicoPlus and PicoWay are different brands made by separate companies. Discovery Pico Plus is one out of the mix. I chose this special machine because it’s a second generation laser that generates the highest peak power in the world! It has a peak power five times more powerful than the Fotona Starwalker and laser pulses that are 10 times shorter — imagine the effect it has on a tattoo. 

Depending on the tattoo type, I usually customise the wavelength settings to cover all colours of the tattoos. For example, I use a 1064nm wavelength to cover black and dark green pigments; 532nm wavelength for red, orange and yellow pigments and 694nm wavelength for green and blue pigments. 

Fractional CO2 laser

I like the Ultrapulse Fractional CO2 laser because of its ability to be absorbed by water in cells. Its short pulse duration produces ablation just a fraction of the skin and allows for deep penetration with minimal damage. I believe the Fractional CO2 laser is favoured by many aesthetic clinics in Singapore as well; however the results from this laser as with other lasers highly depend on the doctor’s skills.

Extracorporeal Shockwave Therapy

This technique is an interesting one. Instead of using laser beams, extracorporeal shockwave therapy works by transmitting focused shockwave energy deep into the tissues to increase lymphatic drainage and metabolic activity. This accelerates the clearance of dermal pigment vacuoles, which enhances tattoo removal.

My approach

For the best results, I use a triple combination technique of pico laser, fractional ablative laser and shockwave therapy. 

The lasers are first used to break up scar tissue and drill micro-channels into skin to directly remove a portion of tattoos. Then, I incorporate shockwave therapy to clean up any leftovers as well as to minimise side effects like bruising and swelling. 

From what I’ve seen, a combination of treatments improve the safety, efficacy and even tolerability of tattoo removal. As far as I know, not many clinics in Singapore adopt this method. If you’re thinking of or looking for an effective solution to remove your tattoos, this might be the one for you!

References

  1. Adatto, M. A., Amir, R., Bhawalkar, J., Sierra, R., Bankowski, R., Rozen, D., Dierickx, C., & Lapidoth, M. (2017). New and Advanced Picosecond Lasers for Tattoo Removal. Current problems in dermatology, 52, 113–123. https://doi.org/10.1159/000450812
  2. Karsai S. (2017). Removal of Tattoos by Q-Switched Nanosecond Lasers. Current problems in dermatology, 52, 105–112. https://doi.org/10.1159/000450811