Laser Tattoo Removal Singapore - My combination approach
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 and wish to get a tattoo removal. There are a variety of tattoo removal lasers around that can be done even without numbing cream and for patients with different skin types. In our experience, the common reasons for laser tattoo removal 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- Feel that the tattoo no longer represents their personality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
Safe and effective Tattoo Removal
with our evidence-based treatments
Discovery Pico Plus
Discovery Pico Plus is a second-generation triple wavelength picosecond q-switched laser that generates the highest peak power in Singapore and the world. With more than 5 times the peak power of the most powerful nanosecond Nd:YAG laser beams (Starwalker) and 450 picosecond laser pulses that are more than 10 times shorter, it results in a more photoacoustic effect with less collateral damage. This means that I can use it to shatter pigments more effectively leading to quicker tattoo removal results, fewer treatment sessions required and lower risk of complications such as scarring.
The tattoo removal process can be customised with three active wavelengths are needed to cover almost all colours of tattoo ink 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
One of the most popular choices in Singapore, the 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. The results of this removal laser technique in Singapore highly depends on the doctor's experience using with the removal laser.
Extracorporeal Shockwave Therapy
Extracorporeal Shockwave Therapy is another choice in Singapore. It uses a hand-held device to transmit focused shockwave energy deep into the tissues, this enhances tattoo removal 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.
1Aesthetics's View on Tattoo Removal
dr wan's perspective
I use Discovery Pico Plus picosecond q-switched laser that has the highest peak power available for tattoo removal. This high peak power is especially crucial for faint remnant tattoos that are hard to clear with traditional nanosecond laser treatment. Furthermore, picosecond lasers’ shorter pulse durations confine the laser energy better, which results in less collateral damage. This higher safety margin and effectiveness allows for more aggressive treatment and better tattoo clearance in fewer sessions.
Another option is to use 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 my 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
My 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. Numbing cream will be applied before the treatment commences. The advantages of :
- 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 in Singapore hence I strongly recommend it over conventional old fashioned single q-switched laser tattoo removal. To my knowledge, it's not common for a triple combination technique to be used in Singapore for tattoo removal.
Is laser tattoo removal safe?
Laser tattoo removal, especially when paired with shockwave therapy, is a safe treatment where permanent damage or side effects are extremely rare.
Is it painful to undergo tattoo removal treatment?
It is a common misconception that tattoo removal treatment is extremely painful. While a certain degree of pain is to be expected (said to feel like a rubber band snapping sensation), most patients say that the experience is similar to getting a tattoo done in the first place. At 1aesthetics, I always ensure that a topical numbing cream is added before any tattoo removal is done in order to make the experience bearable. Combined with shockwave therapy, this will greatly minimize damage and downtime during tattoo removal procedures.
Will tattoo removal leave scars?
Laser tattoo removal procedures by themselves are highly unlikely to leave any form of permanent scarring. However, if the tattoo already triggered some form of scarring, post-removal it is very common for the scarring to remain. Some tattoos, when applied improperly, will naturally form keloid scars and other forms of scarring. This has to be corrected with other forms of anti-scarring treatment and the laser tattoo removal process will not address this.
Improper aftercare will also leave you at the risk of scarring. In Singapore's weather conditions, developing blisters and scabs are common side effects that might arise during the process of healing after a session. It is extremely important for patients to understand that picking or scratching at their scabs or blisters will run a risk of reopening the wound and causing scarring. I always have a proper talk with my patients so that they understand the important role that aftercare plays in these situations.