Tattoo Removal: New Laser Options
The prevalence of tattoos among people younger than 40 years has increased steadily over the past 20 years, and based on current trends, shows no signs of abating. With it comes an increase in interest in tattoo removal. Despite improvements over the years with various lasers, complete removal is not always possible. A new picosecond quality-switched alexandrite
laser offers another tool in the armamentarium for tattoo removal. Based on initial data, it may address lasers in fewer treatment sessions and better address hard-to-treat colors such as greens and blues.
Over the past 20 years, attitudes about tattooing have changed in the United States. Tattoo prevalence is increasing
overall, and significantly in people younger than 40 years.1 Reasons vary, but commonly cited are a desire to be unique, increased sexual attractiveness, and a feeling of rebellion. Tattooing has traditionally been more common in men, but over the past 10 years, the rate in women has “caught up” and is now near equal. Tattoo removal, however, appears to be twice as common in women as in men.2 Body piercing in locations other than ears is more common in women as well.3
As the prevalence of tattoos increases, so too does demand for tattoo removal. While most tattoo owners—up to 83%—are satisfied, surveys suggest that up to 20% of people may be dissatisfied
with their tattoos and 6% seek tattoo removal.3
Who Seeks Tattoo Removal?
In a 2006 survey in 4 states (Arizona, Colorado, Massachusetts, and Texas),2 the average age of tattooing was approximately 20 years for both men and women. Among individuals seeking tattoo removal, common themes emerged. While women make up 45% to 65% of the tattooed population, they were twice as likely as men to seek tattoo removal. The authors speculate that this could be due to less social acceptance of women with tattoos, the challenge of covering tattoos with clothing, or changing life roles. Indeed, women’s biggest complaints were feeling a stigma attached to a tattoo, negative comments, and problems with clothing.
Among individuals seeking tattoo removal, the following features
were more common:
White or Hispanic
Age 24 to 39 years
Self-described risk takers
In stable family relationships
Moderate to strong religious beliefs
Interest in dissociating from the past
Picosecond Laser for Tattoo Removal
Tattoo removal has improved over time but has remained imperfect.
The variation in tattoo dye composition, particularly for reds and greens, makes outcomes variable between individuals
and even between tattoos on a given person. Treatments remain lengthy, taking approximately 6 treatments for amateur tattoos and up to 20 treatments for professional tattoos. Risks include scarring, permanent hypopigmentation, and inadequate tattoo removal. The development of quality-switched lasers—alexandrite, neodymium-doped yttrium aluminum garnet, and ruby—has been a significant improvement over the previous ablative modalities, replacing bulk heating with selective photothermolysis
of nanosecond duration.
Most tattoo inks have a particle size of about 0.1 μm (30-300 nm), corresponding to a thermal relaxation time of under 10 nanoseconds, so a shorter pulse length should be more effective
in addressing tattoo pigment with limited surrounding tissue damage.4 The newer laser technology shortens that time to picoseconds
(1 trillionth of a second, or 10–12 second), which should better address smaller tattoo pigments at lower and safer fluences.
The newly marketed picosecond laser from Cynosure, named the PicoSure, is a 755 mm alexandrite laser with a pulse duration of 750 to 900 picoseconds at a repetition rate of 5 Hz. Spot size is 3 to 3.5 mm, and fluence 2-4 J/cm2. Like other tattoo lasers, pretreatment
anesthesia with local injection or topical anesthesia is recommended. Among one small group,5 pain was minimal after anesthesia at 1/10, and blistering was only rarely reported.
The picosecond laser has been evaluated on black tattoos6 and blue and green pigments.5 The initial studies4 treated carbon or iron oxide tattoos on pig and albino guinea pig models, showing thermal injury and pigment fragmentation without