why do it?
Tattoos can be
- traumatic tattoos such as asphalt or pencil lead injuries
- amateur tattoos
- professional tattoos, both via traditional methods and modern tattoo machines
- cosmetic tattoos or “permanent makeup”
- medical tattoos such as for nipple reconstruction
Tattoos have always had a certain degree of popularity among various subcultures, but in recent years have become more socially accepted as the self-expression of identity.
While tattoos are permanent, patients’ perspectives aren’t, and they sometimes fall out of love with their tattoos and wish to get them removed. In our experience, the common reasons that patients want to remove their tattoos are:
- For employment reasons
- Demise of relationship
- Feel that the tattoo no longer represents their personality
- Badly done or ugly tattoo
- Regret getting a tattoo
- Need more space for new tattoos
to remove tattoos safely and effectively
Discovery Pico Plus
Discovery Pico Plus is a second-generation triple wavelength picosecond q-switched laser that generates the highest peak power in the world. With more than 5 times the peak power of the most powerful nanosecond Nd:YAG laser (Starwalker) and 450 picosecond laser pulses that are more than 10 times shorter, it is able to produce more photoacoustic effect with less collateral damage. This means that it can shatter tattoo pigments more effectively leading to quicker results, fewer sessions required and lower risk of complications such as scarring.
Three active wavelengths are needed to cover almost all colours of tattoo pigments. 1064 nm wavelength targets dark green and black pigment, 532 nm wavelength targets red, orange and yellow ink, and the 694 nm wavelength targets notoriously hard to treat green and blue ink. Most picosecond lasers are limited to two (532/1064nm) wavelengths with the third wavelength deriving from inefficient dye conversion. Discovery Pico Plus is the first picosecond laser to include a full power Ruby 694nm wavelength able to deliver up to 1200 mJ of energy and not just few hundred mJ such as other “red” lasers.
Fractional CO2 Laser
Ultrapulse fractional CO2 laser is absorbed by water in cells. It produces ablation of a fraction of the skin vaporizing many tiny channels. Due to the short pulse duration, there is deep penetration of the skin with minimal collateral damage, reducing downtime and risk of complications like post-inflammatory pigmentation. It is used to pretreat the skin before shattering the tattoo pigments with q switched laser.
Extracorporeal Shockwave Therapy
Extracorporeal Shockwave Therapy uses a hand-held device to transmit focused shockwave energy deep into the tissues, this enhances tattoo clearance by increasing lymphatic drainage and metabolic activity, thereby accelerating the clearance of dermal pigment vacuoles produced by the picosecond laser and minimizing side effects such as redness, swelling, crusting.
dr wan's perspective
Dr Wan uses Discovery Pico Plus picosecond q-switched laser that has the highest peak power available. The high peak power is especially crucial for faint remnant tattoos that are hard to clear with nanosecond lasers. Furthermore, picosecond lasers’ shorter pulse durations confine the laser energy better, resulting in less collateral damage. This higher safety margin and effectiveness allows for more aggressive treatment and better tattoo clearance in fewer sessions.
In q switched laser tattoo removal, the photoacoustic breakdown of tattoo pigment creates superheated gas and steam trapped within the skin. This optical shielding or "frosting" prevents subsequent laser pulses from reaching deeper-lying pigments. The superheated gas bubbles cause collateral damage resulting in scarring and blistering. In Dr Wan’s opinion, the critical things that need to be managed in laser tattoo removal are:
- Downtime: patients often have blistering and painful raw skin after traditional laser tattoo removal with q-switched nanosecond lasers
- Scarring due to collateral damage from laser energy - there's no point removing a tattoo only to have it replaced by scarring
- Ghosting or faint remnant tattoos that are difficult to remove with nanosecond lasers or lower powered picosecond lasers. These occur when:
- there is remnant tattoo pigment deep in the skin (inadequately powered lasers cannot penetrate deep enough to break up the remnant tattoo pigment)
- remnant small tattoo particles (the pulse duration of the laser is not short enough resulting in the inadequate photomechanical breakdown of the pigment)
- scar tissue shielding the tattoo pigments
- Long process and many sessions required
Dr Wan’s approach is to use a combination of fractional ablative laser, q-switched laser (sometimes referred to as FracTAT) and shockwaves to address these pain points. The fractional laser drills micro-channels in the skin that act as pressure relief ducts through which the superheated gases can escape without building up excessive pressure. The advantages:
- Reduced collateral damage, less chance of scarring
- Improved healing, shorter downtime with less blistering
- Better laser penetration into the tattoo via the channels
- Breaks up scar tissue, improving skin texture and tone
- Directly removes a portion of stubborn tattoos ablated by the fractional laser
Shockwave therapy further enhances tattoo clearance by increasing lymphatic drainage and metabolic activity, thereby accelerating the clearance of dermal pigment vacuoles produced by the picosecond laser and minimizing side effects such as redness, swelling, crusting.
Overall, combination treatment improves the efficacy, safety and tolerability of laser tattoo removal hence Dr Wan strongly recommends it over conventional old fashioned single q-switched laser tattoo removal. To Dr Wan's knowledge, there are few doctors in Singapore able to offer this triple combination technique.