Q-switched Lasers Used for Tattoo Removal

While many people may think getting a tattoo seemed like a good idea at the time, that can change. Luckily, modern advancements in laser technology have made it possible to safely and effectively remove permanent ink from the skin1.

How Lasers Work to Remove Tattoos

The lasers used in the tattoo removal process break down these artificial pigments, thus removing the tattoo from the person’s skin. However, there are certain requirements that must be met to ensure that only the targeted skin area is treated with the laser so as not to damage surrounding tissue. The requirements are:

  • Penetration of the laser should be sufficient enough to reach the tattoo pigment.
  • The color of the laser must correspond to the absorbability of the pigment. For example, red lasers are used to treat green skin pigments2.
  • Duration of the laser blast must be precisely timed to avoid scarring and burning of surrounding skin tissues. In tattoo removal, laser blasts should only last nanoseconds.
  • Sufficient energy is required for the laser to break down tattoo pigments. If energy is too high, it could damage the skin tissues. If it is too low, no pigment fragmentation will occur3.

Determining Which Laser is Right for You

The gold-standard laser used for laser tattoo removal today is called a Q-switched laser4. In order to target the different color pigments in a tattoo, the selection of the appropriate Q-switched laser must be determined.

Q-switched lasers work by delivering energy at such a rapid speed that it breaks or splits the ink up into tiny particles. The body’s filtration system (or immune system) then comes in to carry off the debris5.

There are various types of Q-switched lasers used to remove tattoos, depending on the color of the skin and the tattoo pigment. Multi-colored tattoos require two or more types of lasers to effectively remove them. The lasers are usually identified by the medium used to create the wavelength, which is determined by measuring its nanometers (nm).

Q-switched Lasers Deliver Energy — FAST!

Most Q-switched—including both Yag and Alexandrite­—lasers deliver laser energy in nanoseconds. However there is new Alexandrite laser on the market that delivers energy in picoseconds. A nanosecond is equal to one billionth of a second. Wikipedia further defines a nanosecond by saying “one nanosecond is to one second as one second is to 31.7 years.”

Conversely, a picosecond is one trillionth of a second. The theory is the faster the energy is delivered, the faster it breaks the tattoo ink up into smaller particles making it easier for the body to filter it away. There is not enough clinical data available to show that a picosecond delivery versus a nanosecond delivery really makes that big of a difference. At best it could save a patient is a couple of sessions, but this too is not clear at this point6.

A medical professional will be able to determine which laser or hand piece combinations are needed to effectively remove a patient’s tattoo. They will take into account several factors including the skin’s natural pigment and the pigments in the ink. Dark blue and black inks respond really well to laser treatments. Lighter pigments like white, reds and pinks can be harder to remove.

About the Q-switched Yag Laser

The Q-switched Yag laser has been the preferred laser of choice and really the “gold standard” in laser tattoo removal since laser tattoo removal came on the scene. It is the only laser suitable for all skin types and dark skin in particular, as the light it creates is not absorbed by the melanin (skin pigment) and therefore less likely to result in hypo or hyper-pigmentation7.

Unlike other lasers, the Yag overcomes the issue of excessive melanin absorption, targeting the ink and not the melanin. It is used to effectively remove all ink colors, but particularly targets darker inks like blue, black or red pigments in all tones. The Yag laser will be used at each of a WIFH patient’s tattoo removal appointments, if they have color in their tattoo a dye hand-piece will also be used at some point during the treatments to target each specific color.

About the Q-switched Alexandrite Laser

The Q-switched Alexandrite laser is also used for tattoo removal, but less frequently8. The Alexandrite or “Alex” laser can only safely treat skin types I-IV so this excludes darker skin types from being treated with this laser without serious risk of burns, hyperpigmentation and even scarring. The Alex laser creates a red light that is absorbed well by green and dark ink pigments. Similarly to the Yag, it will be necessary to use dye hand pieces to treat colors.

Q-switched Lasers Used at WIFH for Tattoo Removal

Q-switched Frequency-doubled Nd:Yag: 532 nm – this type of laser works best for red and orange tattoo pigments9.

Q-switched Ruby: 694 nm – this laser emits red light, which is highly effective in removing green and dark tattoo particles.9 However, this laser can also cause serious changes in the skin’s natural pigmentation structure. Too much use of this laser can cause unwanted spots and blotches on all skin types except white/lighter skin tones.

Q-switched Alexandrite: 755 nm – rated as the weakest of all types of Q-switch lasers, the Alexandrite laser only works best on green tattoo pigments10. It is not effective against, red, orange, and brown. The Alexandrite laser can also be used to remove black and blue ink particles. Since it is a weak laser, it does not cause any unwanted changes in the skin’s natural pigmentation.

Q-switched Nd:YAG: 1064 nm – best for dark skin types since it uses near-infrared light, which is not absorbed by melanin11.

Laser Types Matter & Side Effects May Occur

As with any cosmetic procedure, laser treatment is not without risks and potential side effects12. The potential side effects include hypo or hyper-pigmentation, darkening of the tattoo (caused by changes in the chemical composition of certain inks), blistering, allergic reactions and scarring. The likelihood of experiencing any of these things is a variable. Blistering can be a normal part of the laser tattoo removal process and in most cases should not leave a patient with a scar.

However, it is imperative to seek treatment from an experienced provider that will supply the patient with aftercare instructions and care should they experience a complication. The provider should also thoroughly explain the numerous factors that influence the outcome of treatments, and they will help patients to set realistic goals and avoid unwanted side effects.

Patients don’t have to live with an unwanted tattoo. With a little help from a laser, they may be able to restore their skin to a blank canvas, or at least a minimalist painting. Schedule a free consultation today to discuss treatment options.

 

Citations
1. Naga, LI (2017). Laser Tattoo Removal: An Update. American Journal of Clinical Dermatology. 2017; 18(1): Pages 59-65. https://www.ncbi.nlm.nih.gov/pubmed/27722955
2. Makowska, A. (2015). Long-term evaluation of ink clearance in tattoos with different color intensity using the 1064-nm Q-switched Nd:YAG laser. Journal of Cosmetic Dermatology. 2015; 14(4): Pages 302-309. https://www.ncbi.nlm.nih.gov/pubmed/26133780
3. Leong, Hock. (2006). Treatment of acquired bilateral nevus of ota-like macules (Hori’s Nevus) with combination 532nm Q-switched Nd:YAG laser followed by 1064nm Q-switched Nd:YAG is more effective: Prospective Study. Dermatologic Surgery. 2006; 32: Pages 34-40. https://onlinelibrary.wiley.com/doi/abs/10.1111/1524-4725.2006.32004
4. Hutton, Carlsen. (2017). Tattoo removal by Q-switched yttrium aluminum garnet laser: client satisfaction. Journal of the European Academy of Dermatology and Venereology. 2017; 31(5): Pages 904-909. https://www.ncbi.nlm.nih.gov/pubmed/28107564
5. Gold, M. (2009). Tattoo removal with an electro-optic Q-switched Nd:YAG laser with a unique pulse dispersion. Cosmetic Dermatology. 2009; 33(4). https://www.mdedge.com/dermatology/article/68736/aesthetic-dermatology/tattoo-removal-electro-optic-q-switched-ndyag-laser
6. Torbeck, RL. (2019). Evolution of the Picosecond Laser: A Review of Literature. Dermatologic Surgery. 2019; 45(2): Pages 183-194. https://www.ncbi.nlm.nih.gov/pubmed/30702447
7. El-Domyati, M. (2019). Tattoo removal by Q-switched Nd: YAG laser: an objective evaluation using histometry. Journal of Cosmetic Laser Therapy. 2019; 22: Pages 1-4. https://www.ncbi.nlm.nih.gov/pubmed/31006285
8. Alster, TS. (1995). Q-switched alexandrite laser treatment (755 nm) of professional and amateur tattoos. Journal of the American Academy of Dermatology. 1995; 33(1): Pages 69-73. https://www.ncbi.nlm.nih.gov/pubmed/7601949
9. Hautazrt. (1999). [Tattoo removal Q-switched ruby laser (694 nm) and the Q-switched Nd:YAG laser (532 and 1064 nm). A retrospective study]. 1999; 50(3): Pages 174-180. https://www.ncbi.nlm.nih.gov/pubmed/10231686
10. Dernstein, EF. (2010). Treatment of tattoos with a 755-nm Q-switched alexandrite laser and novel 1064 nm and 532 nmNd:YAG laser handpieces pumped by the alexandrite treatment beam. Journal of Drugs in Dermatology. 2010; 9(11) Pages 1333-1339. https://www.ncbi.nlm.nih.gov/pubmed/21061754
11. Kilmer, SL. (1993). Clinical use of the Q-switched ruby and the Q switched Nd:YAG (1064 nm and 532 nm) lasers for treatment of tattoos. Journal of Dermatology and Dermatologic Surgery. 1993; 19(4): Pages 330-338. https://www.ncbi.nlm.nih.gov/pubmed/8478472
12. Klein, A (2014). An Internet-based survey on characteristics of laser tattoo removal and associated side effects. Lasers in Medical Science. 2014; 29(2): Pages 729-738. https://www.ncbi.nlm.nih.gov/pubmed/23907603
About the Author

Jay M. Kulkin, MD

Dr. Jay M. Kulkin is the Founder and Medical Director of WIFH. Board Certified in Obstetrics and Gynecology, Dr. Kulkin was one of the first physicians in Georgia to use lasers in a surgical setting. He has more than 30 years of experience as a cosmetic laser specialist, and has trained numerous physicians around the United States and abroad on his surgical laser techniques. He has been a featured speaker on the safety and effectiveness of lasers for patients with dark skin types.