How Does it All Work?

Description of the skin structure, where ink sits & laser interactions with skin

The Skin Structure

Epidermis

The epidermis also called the outer layer, is the thinnest layer, but it’s responsible for protecting you from the harsh environment, with five layers of its own!

The epidermis also hosts different types of cells: keratinocytes, melanocytes and Langerhans cells. Keratinocytes produce the protein known as keratin, the main component of the epidermis. Melanocytes produce your skin pigment, known as MELANIN. Langerhans cells prevent things from getting into your skin!

Dermis

The dermis also called the middle layer, is the layer responsible for wrinkles. It is also WHERE THE INK IN YOUR TATTOO SITS. The dermis is a complex combination of blood vessels, hair follicles, and sebaceous (oil) glands. Here, you’ll find collagen and elastin, two proteins necessary for skin health because they offer support and elasticity. Fibroblasts are the cells you’ll find in this layer, because they synthesize collagen and elastin. This layer also contains PAIN AND TOUCH RECEPTORS.

Hypodermis/Subcutaneous Tissue

The hypodermis is the innermost and thickest layer of the skin, also called the fatty layer. Reduction of tissue in this layer is what contributes to sagging skin. This layer is also known as the subcutis. It hosts sweat glands, fat and collagen cells, and is responsible for CONSERVING your body’s heat and PROTECTING your vital inner organs.

The wavelengths of the most common medical lasers & aesthetic lasers, inc No Regrets lasers, occur in non-ionizing infrared part of the spectrum. Absorption converts light energy into THERMAL and/or MECHANICAL ENERGY.

Types of laser-tissue interactions

Photomechanical

Lasers relying on photo mechanical effects use shorter pulses of power and thermal expansion to create acoustic waves. These waves then break up the target material into smaller particles, such as TATTOO REMOVAL.

Photothermal

Lasers that produce a photo thermal effect use prolonged energy exposure to facilitate an increase in chromophore temperature, which in turn leads to cellular vaporization. This type of laser-tissue interaction is used in HAIR REMOVAL & SURGERY.

Photochemical

Lasers using photo chemical effects do not destroy or break up tissue. Light is absorbed into the chromophores and are used for PAIN RELIEF and INFLAMMATION REDUCTION.

Laser Tissue-Interactions

Once a laser beam is produced it is aimed at tissue to perform a specific task. As the energy reaches the biological interface one of four interactions will occur; scattering, absorption, reflection or transmission.

Scattering:

Once the laser energy enters the target tissue it will scatter in various directions. It is useful in certain bio stimulative treatments such as SKIN REJUVENATION.

Absorption:

Absorption is the most important interaction. Each wavelength has specific chromophores that absorb their energy. This absorbed energy is converted into thermal and/or mechanical energy. Near infrared lasers like Nd:YAG are mostly absorbed by pigments such as HAEMAGLOBIN, MELANIN & TATTOO INKS.

Reflection:

The laser beam bounces off the surface with no penetration or interaction at all. As with SOME LIGHT COLOURED INKS SUCH AS WHITE, YELLOW AND PALE GREEN.

Transmission:

The laser energy can pass through superficial tissues to interact with deeper areas. RETINAL SURGERY is an example; the laser passes through the lens to treat the retina.

Possible Side Effects of Tattoo Removal

See FAQs for further information.

Infection

The risk of infection is very low, especially if you follow the aftercare instructions, but it can occur. Keep the area clean and avoid touching it.

Blistering

The laser pulses heat up the ink particles which, in turn, can break tiny blood vessels around the tattoo. This causes superficial blisters that fill with water and ink. These blisters are only an expansion of the very outermost layer of skin and will not lead to scarring. While the blisters can look intimidating and be tender to touch, do not puncture them. It usually takes between 1-7 days for the blisters to heal completely.

Scabbing

Another sign that treatment is working, scabs often collect fragmented ink particles and usually appear 8-72 hours after treatment. When the scab falls off, a layer of ink can come away with it. Picking at scabs can increase the risk of infection and scarring, so however tempting it might be, DON’T PICK SCABS!

Hyper and Hypopigmentation

Hypopigmentation presents as small white spots or a white halo around the treated area. Hypopigmentation is usually transient and passes naturally. Treatment will usually be suspended until the hypopigmentation recedes. People with darker skin risk hyperpigmentation which presents as a darkening of the skin around the tattoo. The use of 532 wavelength for colour tattoos and darker skin tones have a higher risk of both hypo and hyperpigmentation. Both may be avoided by following aftercare instructions, especially with regard to sun exposure.

In general, the first couple of sessions sees more side effects than subsequent treatments. Once the amount of ink in the tattoo has dissipated, the associated immune response lessens.

Any questions about tattoo removal and/or the process contact No Regrets via the contact form, email info@noregrets.net.au or call 0425 632788.

How Long Does It Take To Remove a Tattoo?

There’s no way to sugar-coat the fact that Tattoo Removal takes time – on average between 10 – 13 months. Many people get to the point in their life where they have a Tattoo they want removed and ask the question ‘How long does it take to remove a tattoo’ only to be surprised by the answer. And the fact of the matter is there isn’t too much you can do to speed up the process – although we’ve got a few tips at the bottom of this article!

But Tattoo Removal is a bit like saving up for a deposit for a house. Because it takes time and there’s no instant results, many people keep putting it off ’till tomorrow’. But guess what? In the blink of an eye it’s a year later and you’ll look back and think ‘If I’d just started my Tattoo Removal Journey last year, I’d be done by now!’ If you are thinking about Tattoo Removal, the time to start is NOW, exactly because it does take time.

So why does Tattoo Removal Take Time?

The biggest factor is the length of time you need to wait between treatments. The minimum time recommended between treatments is 4 weeks, but most clinicians will recommend a gap of 6-8 weeks. So if you consider the average Tattoo may require 9 treatments to completely remove, that adds up to just over one year before the Tattoo is removed.

Some people ask ‘I’m big and tough, I can stand the pain, can’t I just have my treatments every couple of weeks?’ Unfortunately the answer is no, there is no benefit in decreasing the time between treatments. You body needs time to flush out the shattered ink particles, and as Phil Collins would say (if he ever wrote a song about Tattoo Removal instead of love) ‘You can’t hurry treatments, no you’ll just have to wait’

Are you looking to fade or remove the Tattoo completely – If you only want to fade the tattoo (for example so it’s no longer visible under a white business shirt, or if you want to cover it up with a new tattoo) then the treatment time is considerably less

Skin Type – The darker your skin, the less effectively the laser penetrates the dermis and the more session are required

Is there anything I can do to speed up the process?

There are a few things you can do to make the process as fast as possible:

  1. Start Now. As we said at the top of this article, the sooner you start the sooner you’ll be done. A year sounds like a long time, but in 12 months time I promise you’ll look back and say ‘geez where did that year go?’ You can make it the year you got your Tattoo removed.
  2. Agree the optimal time between treatments and keep your appointments. If you need 9 treatments and on average push each appointment back by 1 week, before you know it you’ve added an extra 2+ months to your total treatment time
  3. Don’t smoke. Your overall health has an impact on how well your body flushes out the ink particles and smoking is a known factor in slowing down the process
  4. Don’t tan. As we mentioned above, the darker your skin the less effective the laser is, so the fairer you can keep your skin the more effective your treatments will be
  5. Consider a cover-up tattoo. We’re in 2 minds about this advice. If you LOVE tattoos but just don’t love a particular one, then fading it to the point where you can cover it with a new tattoo makes sense. But if you’re suffering more general tattoo regret then you run the risk of replacing a tattoo you didn’t like with a new tattoo you don’t like – as they say in Poker ‘doubling-down on a bad hand’

What other factors affect the time it takes?

The location of the Tattoo on your body – Tattoos on your extremities (such as fingers and toes) take longer to remove than tattoos on your torso.

The colour of the ink – Black is the easiest colour to remove, colours such as green and red the hardest.

Who did your Tattoo – Professional Tattoo artists use more ink which means longer to remove, but that doesn’t mean we recommend getting your next Tattoo from an amateur!

Does Tattoo Removal Hurt?

Look at any Tattoo Removal Clinics’ web-site under their FAQ’s and you’ll see the question ‘Does Tattoo Removal Hurt?’

And that’s because it’s one of the most popular questions they get asked (along with ‘do you have a time machine so I can go back and scream at myself “Don’t get that Tattoo!!!!!!”)

But not all Clinics want to tell you exactly what it feels like in case you decide not to go ahead, so we’ve put together this independent guide to answer your burning questions about the pain of Tattoo Removal.

Does Tattoo Removal Hurt?

Unfortunately the short answer is ‘Somewhat to Yes’. Tattoo Removal uses a laser to penetrate the skin and break up the ink particles so there will be a level of pain ranging from ‘discomfort’ to ‘pain’. Common descriptions of the feeling are:

  • Someone flicking a rubber band at your skin repeatedly
  • Someone cooking bacon on your arm (only really useful if you’ve actually cooked bacon on your arm before)
  • Rapid pin-pricks
  • Scratching sunburn

 

Though some pain comes much gain
Through (some) pain comes much gain

Well that’s the bad news – any good news?

Of course there is! The first thing to realise is that everyone’s pain threshold is different. For some people it’s not much more than discomfort, and as you’re at least 18 years or older (otherwise you shouldn’t have a Tattoo in the first place) you probably have some idea of your pain threshold. Other things to consider are:

  • A single Tattoo removal session can be over in minutes depending on the size of your Tattoo. So it might be painful, but the actual treatment time is usually short
  • Guess what? You’ve already experienced pain when you got your Tattoo in the first place – unless you were passed out drunk and got a pair of Ray Bans tattooed on your face. The pain level is comparable to getting your Tattoo in the first place and you survived that
  • Tattoo treatments are spaced out over several weeks, so you have time to recover between sessions
  • Not all parts of the body experience the same level of pain. Areas with more fat (such as the arms or buttocks) are less painful. Tattoos in areas with less fat or close to bone are (gulp) more painful

Are there ways to minimise the pain?

Yes there are, and you should discuss these in consultation with your preferred Clinic. The main forms of pain relief are:

  • Local numbing agents. These are topical anaesthetics applied to the skin and help with numbing the area
  • Paracetamol or other over-the-counter pain relievers taken prior to treatment but ALWAYS discuss this with your clinician before taking, as some may have an adverse effect with treatment process
  • Cold air machines. Many clinics will offer this non-invasive option which involves blowing cold air (up to -30 Celsius!) onto the treatment area before, during and after, which produces a numbing effect
  • Local anaesthetic. Not as popular in Australia, but some clinics may offer a local anaesthetic administered by needle to the area

Should the ‘pain factor’ put me off getting my Tattoo Removed?

No, we don’t think it should. You’re not thinking of getting a Tattoo removed on a whim. You didn’t wake up and think “Today I might go and get my Tattoo Removed just for fun”. There’s a sound reason (or reasons) behind your decision. Our favourite quote on the matter says it best “Tattoo Removal Pain is temporary – Tattoo Removal is for a lifetime”

4 Tips for choosing the right Tattoo Removal Clinic

With the recent news about tattoo removal patients receiving burns and scarring from inexperienced Tattoo Removal Clinics, we thought it time to write a ‘buyers guide’ on choosing the right Tattoo Removal Provider. There’s cost, time (and a bit of pain!) involved in Tattoo Removal, so choosing the right clinic is crucial. These are our 4 Top Tips on what to look for.

1. What type of Laser are they using?

There are 2 main types of lasers used for Tattoo removal – Q-switched and picosecond lasers – but they go by various brand names which can make things confusing. These use nano-second and pico-second light pulses respectively to break up the ink pigments and different people will tell you one is superior to the other (usually based on what machine they have!) but in most cases either will be fine. What you want to avoid is IPL lasers, most commonly used for beauty treatments such as hair removal

“What you want to avoid is IPL lasers”

IPL lasers function in milliseconds rather than nano or pico-seconds and the burst of light is too large for the job required, often causing distortion of the tattoo and scarring and burning.

If your provider is recommending an IPL laser it’s time to keep looking. If their using Q-switched or Picosecond then read on.

Scarring from wrong type of laser
The wrong laser can cause scarring, not Tattoo Removal

2. How much experience do they have?

In most states of Australia, tattoo removal is unregulated. That means I can buy a tattoo removal laser, do a laser certification course (which only teaches me how to use the machine safely) and then start offering tattoo removal services. Want to come over and I’ll give it go? Thought not!

Tattoo removal is a skill you gain over time so the longer you do it, and the more frequently you do it – the more experienced you become. So you really want to think about the following:

  • Do they specialise in tattoo removal, or do they have staff that specialise in tattoo removal – and will they be available for all your treatments?
  • How long have they been in operation? The longer they’ve been open, the longer they’ve had to develop their skills. If it’s only a short time, how long have the staff that will be treating you been doing it. e.g were they performing tattoo removal at a previous location?
  • Do they have before and after shots of actual patients they have treated in their clinic not just generic before and after images supplied by the laser manufacturer?

3. Price is important, but not all-important.

The cost of tattoo removal is a function of the cost per treatment x the number of treatments it will require. So if you’re quoted a price of $200 per treatment and expect to need 8 treatments, then the total cost is going to be $1,600

Newer machines with the latest technology will generally cost more per treatment but usually be able to achieve the same result in less treatments.

No-one wants to spend more than they need, but a price that seems too good to be true, probably is. Just like getting your tattoo in the first place, you get what you paid for!

you get what you pay for
Like getting your Tattoo in the first place, you get what you pay for with Tattoo Removal

Think about getting a couple of quotes from reputable clinics before making a decision – to get an estimate – and think about the total price (not the price per treatment) but don’t let it be your sole criteria. Especially look out for a quote that is:

  • Significantly less than the others. There’s quite often a (bad) reason
  • Someone who quotes significantly less treatments required without a sound reason for suggesting it. It might show lack of experience or a lack of ethics – they know once you start, your committed to seeing it through even if it goes beyond the quoted number of treatments

4. The initial consultation

Any reputable tattoo removal clinic will require an initial consultation and so should you. Often these will be free – but price isn’t the issue – it’s the fact that they spend the time to understand your tattoo, your medical condition and what you want to achieve. Things that you should expect to be covered in your consultation include:

  • An assessment of the tattoo(s) to be removed
  • A discussion of your expectations – are you hoping for total removal or just fading?
  • An honest discussion on cost and number of treatments, and any issues that might limit the success of the treatment. Factors such as ink used, skin type, professional vs amateur tattoos are all factors and you should expect an experienced provider to discuss these with you
  • An assessment – usually written – of both your medical history and your skin type.
  • A discussion on pain, pain management and pre and post-procedure care

And just in case you love lists (and who doesn’t) we’ve compiled a checklist below you might consider taking with you to a consultation, adapted from the American Society for Dermatologic Surgery

A 16 point check-list when choosing a Tattoo Removal provider

  1. Which tattoo removal procedure is the correct one for me? (What are the options?)
  2. What is the estimated cost of the procedure?
  3. How long is one appointment?
  4. How often will I need to receive treatment to remove my tattoo?
  5. How far apart are the treatments?
  6. What are the common side effects or complications associated with the procedure?
  7. How can I prepare for the treatment/procedure?
  8. Does tattoo removal hurt?
  9. What are my pain management and anaesthesia options?
  10. How long is the recovery time associated with my procedure?
  11. Do you have before-and-after patient images to help to prepare me for what to expect?
  12. Will someone walk me through the process before going in for treatment?
  13. What are the risks?
  14. What should I expect after the procedure is performed? (i.e., short-term and long-term effects; activity restrictions; expected recovery period)
  15. Was my medical history taken?
  16. Was I given an initial evaluation to determine if the technique or procedure is appropriate for my skin type?
  17. Was I shown before-and-after photos?

The 3 Ingredients of Successful Laser Tattoo Removal

You already know Laser Tattoo Removal is the most effective way to remove or fade tattoos. But unfortunately it’s not as easy as searching for ‘laser tattoo removal’ in your local area and expecting great results. Results can vary from complete removal to burning and scarring (and we’re guessing you’re after complete removal)

Laser Tattoo Removal good results
The results you want
bbb2fe50ee0f9c12026fb449b1228d25
The results you don’t

Below we’ve listed the 3 ingredients that go into successful Tattoo Removal. Follow these tips and you’re well on your way to getting rid of that unloved Tattoo.

1. The Right Laser Tattoo Removal Machine

Guess what? Anyone can say they have a laser that’s capable of removing Tattoos – but it doesn’t mean they do. The efficiency of lasers varies widely and some places may even pass off lasers not designed for Tattoo removal so it’s up to you to have at least some background knowledge.

What you don’t want

IPL lasers. IPL lasers are NOT designed or recommended for Tattoo Removal. If a clinic is suggesting they’ll use an IPL laser you need to run, not walk and find another clinic.

Laser Tattoo Removal Machine
The right machine for the job
cheese grater tattoo removal
The wrong machine for the job (see our Guide: Choosing the right cheese grater for you)

 

 

What you do want

You’re looking for a Class 4 Medical Grade laser that is TGA (Therapeutic Goods Administration) approved in Australia or FDA (Food and Drugs Administration) approved in the US.

The words you’ll hear most often are Q-switched or pico and the laser should operate in the nano or pico second pulse range. Ideally it should operate with single energy pulse technology to deliver the correct power output to the skin.

There are lots of different brand names out there which can make it confusing but if a clinic has the right machine for the job you’ll usually find one of these names on their website to describe their laser

  • Q-Switched Nd: YAG (the newest system in the Q-switched Class)
  • Picosure (operates in the pico second pulse range)
  • Q-Switched Ruby
  • Q-Switched Alexandrite

Different lasers are effective in removing different ink colours and you should discuss this with any clinic before deciding on which machine is going to get the best outcome for you.

2. The Clinician

Not all lasers are created equal, and neither are all technicians. As we like to say, Tattoo Removal is 1 part science and 1 part art – and the art comes from the skills and experience of the Clinician.

The best Clinician (besides using the right lasers in the first place) can also ‘read’ the skin of the client and their reaction to the initial test pulses. Every client is different and every skin reaction is different at every treatment, and being able to judge the ‘end-point’ or the actual reaction to the treatment is where the skill of the clinician comes in.

To get optimal results the Clinician needs to treat at a high enough pulse rate to gain a reaction, but low enough not to damage skin – a fine balancing act.

These skills develop over time with experience and repetition – the more often a clinician has performed Tattoo Removal the more skin types they’ve seen, the more reactions they’ve noted and the more skills they’ve developed.

That’s why we recommend seeking out a Tattoo Removal Clinic that specialises in Tattoo Removal – or at least a clinic that have clinicians that specialise in Tattoo Removal. Repetition and learning are key to developing the skills needed for successful Tattoo Removal.

While the thought of a manicure, pedicure, massage and tattoo removal clinic has its appeal, it’s not what you’re looking for

3. Time

Time between treatments is the 3rd critical ingredient in successful Tattoo Removal. Most people who decide they want their tattoo removed want it done yesterday which is understandable. So they think “the quicker I have treatments, the quicker it will disappear”. Unfortunately the opposite is true.

What the laser is doing is shattering the ink particles into small enough fragments so your body can flush them out through your lymph nodes – and this process takes time.

how laser tattoo removal works

At a bare minimum you should be waiting 4 weeks between treatments, and 6 weeks is becoming the industry standard. Some clinics are even recommending 8 weeks between treatments because they find it produces superior results.

So now you know the 3 (not-so) secret ingredients for successful Tattoo Removal – the right machine in the hands of the right clinician and sufficient time between treatments to let your body do it’s thing.

Got a cover-up tattoo read this to avoid an exploding tattoo

Recently we attended a talk on developments in Laser Tattoo Removal when we were introduced to the fairly unattractive concept of the ‘exploding tattoo’. One moment we’re looking at standard ‘before and after’ shots of successful tattoo removal, the next we’re looking at tattoo removal where the skin has blistered and burned, and the tattoo has ‘exploded’ on the skin.

If you have a cover-up tattoo and are thinking of laser tattoo removal you need to read on, and you need to remember!

As you probably know, laser tattoo removal works by sending very specific wavelengths of pulsed light that pass harmlessly through the top layer of skin to break up the ink particles underneath. The exact wavelengths, frequency and intensity is managed by the technician performing the removal and is based on several factors including ink colour, ink density, age of the tattoo etc.

With double tattoos there’s a lot more density of ink in the area, hence…more heat generated which increases the risk to general tissue in the area

So far so good. A reputable technician will assess your tattoo and choose the correct settings accordingly. In the vast majority of cases there should be no side-effects from your tattoo removal sessions.

But enter the cover-up tattoo. As the name suggests, a cover-up tattoo is where an existing tattoo is covered up with new ink – usually to hide or ‘cover-up’ an unwanted tattoo. The better the cover-up tattoo artist, the better the result and the less obvious it is to anyone that there’s an older tattoo hiding underneath.

But there-in lies the danger of the ‘exploding tattoo.’ A cover-up tattoo doubles the density of ink particles, but isn’t necessarily obvious to the tattoo removal technician that it’s the case. And because it isn’t obvious (and because they probably aren’t going to suddenly ask you ‘hey is there another tattoo hiding under there’) the incorrect settings can inadvertently be used.

In short the more density of colour there is in a target tattoo, the higher the absorption of light and in turn the more heat generated. With double tattoos there’s a lot more density of ink in the area, hence more uptake of light and more heat generated which increases the risk to general tissue in the area – giving rise to the possibility of burning, blistering and excessive scabbing and crusting of the skin – an ‘exploding tattoo’. The solution is for settings to be adjusted down initially to ensure minimal collateral damage in the case of cover-up tattoos.

Example of an exploded Tattoo
You really don’t want one of these
Cover-up tattoos removal
or one of these

And this was a highly trained, respected dermatologist telling us of cases of exploding tattoos he had witnessed just through not being aware that he was working on a cover-up tattoo at the time!

So what should you do?

If you’re thinking about a cover-up tattoo but haven’t yet taken the plunge, consider using tattoo removal to fade the existing tattoo before cover-up. Remember:

  • Fading a tattoo is less expensive and take fewer sessions that full tattoo removal so cost shouldn’t be as much of a factor
  • Your new cover-up tattoo will almost definitely look even better if you’ve faded the original tattoo. You also give yourself more options on what your new tattoo can look like, what colours can be used etc if there’s less emphasis on covering up an old tattoo, and more emphasis on a great new design
  • By fading first, your reducing the final ink density on the skin, ensuring you never have to hear those words ‘exploding tattoo’

If you already have a cover-up tattoo or don’t want to fade first the message is simple – tell your technician if you ever get laser tattoo removal! Remember:

  • Your technician probably won’t be able to tell you have a cover-up tattoo (especially if its good) – so it’s up to you to tell them.
  • Even if they do notice, they may not be aware of the implications. Unless they have experience with cover-up tattoos they may not realise the importance of adjusting down the settings to compensate for the ink density. It’s your skin – make sure you tell them!

So there you have it. Seeing a few images of exploding tattoos is pretty average. Looking down at your arm and seeing one first-hand is a whole lot worse! But if you’re the proud owner of an awesome cover-up tattoo just keep this information filed in the back of your mind and you’re good to go.