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The Current ‘State of the Art’ in Tattoo Removal

Seattle Skin and Laser has been performing laser tattoo removal in conjunction with Blink Tattoo Removal for the last 7 years.  We have successfully removed hundreds of tattoos using multiple different laser systems.

However, tattoo removal has been performed for hundreds of years.  Early techniques were crude by modern standards and involved physical removal of tattoo pigments by physical methods, such as injection of foreign material, salabrasion (salt rubbing), dermabrasion (using a wire brush attached to a hand engine), excision (cutting out), trichloroacetic acid application, and carbon dioxide laser ablation.  While these methods were somewhat effective, they were painful and often left unsightly scarring, resembling third degree burn scars.

Removed using the Q-Switched Nd: Yag from Hoya Conbio

Removed using the Q-Switched Nd: Yag from Hoya Conbio

The evolution of laser technology in the early 1990’s involving the development and commercialization of ‘q switched’ (nanosecond pulse duration) systems revolutionized the medical removal of tattoos. The early systems had serious limitations on what types of pigments could be removed.  Older systems such as the q switched Nd:YAG, and q switched Ruby lasers also frequently caused superficial scarring and pigment loss due to beam profile, relative lack of power, and relatively longer pulse duration which generates a thermal (heat) effect on tissue.  Use of these systems produced significant aerosolization of tissue during treatment which posed some risk of transmitting infectious diseases to the operator.

Removed using the Q-Switched Nd: Yag from Hoya Conbio & the Q-Switched Alexandrite from Cynosure

Removed using the Q-Switched Nd: Yag from Hoya Conbio & the Q-Switched Alexandrite from Cynosure. Some hypopigmentation visible.

Q switched technology evolved significantly in the late 90’s and early 2000’s.  Devices became more powerful allowing treatment of deeply situated tattoo ink, beam profiles improved resulting in less superficial tissue destruction.  Different systems such as the qs Alexandrite which allowed treatment of blue and green pigment became commercially available.  In the mid 2000’s there were numerous options for laser removal of tattoos.  Although the technology had evolved rather quickly, there were still significant limitations including the inability to remove very deep pigment and significant thermal effect of the lasers on tissue resulting in superficial scarring and dyspigmentation.  Our experience also demonstrated that some tattoos were simply refractory to complete removal despite multiple treatments with multiple laser systems (qs Nd:YAG, qs Alexandrite, Fractional carbon dioxide, Fractional erbium.)

This stubborn tattoo was treated 14 times using the Q-Switched Nd: Yag from Hoya Conbio. The final 3 treatments were completed using the Picosure from Cynosure.

The development of the picosecond 755nm laser (Picosure, Cynosure) represented the first novel technological advance in laser tattoo removal in many years.  This laser was approved in 2013. Picosecond refers to the pulse duration (width) of the laser energy delivered to the skin.  The Picosure laser pulse duration is approximately 6 fold shorter than older q switched lasers.  Shorter pulse widths are beneficial when removing tattoos as less thermal (heat) energy is dissipated to the surrounding normal skin structures resulting in less discoloration and scarring of skin in the treatment field.  In terms of laser energy/ pigment interaction, picosecond energy delivery is fundamentally different than nanosecond (q switched) energy.  Picosecond energy produces a more complete shattering of the pigment (photoacoustic effect) as opposed to the photothermal effect imparted by older systems.  Research demonstrates that picosecond energy delivery shatters tattoo pigment more completely resulting in fewer treatments needed to completely remove a tattoo.  In addition to this, picosecond laser removal results in fewer undesirable effects such as, post treatment blistering, dyschromia and scarring.  The limitations of the Picosure device include inability to treat red, orange, and pink tattoo pigment.  Darker skin type patients may also develop pigment alteration.  This often resolves with time but could potentially be permanent.  Cynosure has developed a picosecond 532nm device which will address the colors that the current unit cannot treat.  The newest picosecond device which has been approved and released is the Enlighten (Cutera).  This is a 1064nm/532nm picosecond device.  This laser may potentially be beneficial for treating darker skin types and may penetrate deeper into the skin.  It is unlikely to be as effective as the Picosure for blue, purple and green tattoo pigment.  Unfortunately some tattoo pigments continue to defy non-invasive laser removal.  These include white (titanium), pastels such as pinks, some yellows, and florescent pigments.

Seattle Skin and Laser was an early adopter of the Picosure device.  We have operated this tattoo removal laser since 2013 and have been thoroughly satisfied with the results our patients have experienced.  We have observed that this laser removes tattoos with 40-50% fewer treatments than the q switched systems.  Many tattoos which were previously refractory to our older systems have been effectively treated as well.  As the Picosure does not treat red/orange pigment, we still utilize our Nd:YAG system (Revlite/HoyaConbio) for these colors as it is very effective and produces almost no adverse effects.  We have found this combination to be effective for the vast majority of tattoos.  We are committed to upgrading our technology as it evolves, with the goal of providing the region with the combination of the most experienced laser tattoo removal staff and the most efficacious laser tattoo removal technology available.



Posted in Picosure, Tattoo Removal Tagged with: ,