Pros and Cons of Laser Tattoo Removal

Pros and Cons of Laser Tattoo Removal

As tattoos have become increasingly popular, the requests for tattoo removal has also increased.  Laser tattoo removal is the most popular method for tattoo removal; however, it may not be the best treatment option.

Lasers have been used to remove tattoos since the late 1970s.  In 1979 an argon laser was used for tattoo removal in 28 patients, with limited success.

In the 1980s, a new clinical study in Scotland into the effects of Q-switched ruby laser energy on blue/black tattoos. Further studies into other tattoo colors were then carried out with various degrees of success.

When ink is injected into the dermis of the skin, thousands of particles of tattoo pigment remain in the dermis. Laser therapy causes these particles to heat up and fragment into smaller pieces, known as the photomechanical effect.  In most cases, macrophages carry the ink particles to the lymph nodes closest to the site of the tattoo. Macrophages are specialized immune cells, whose job it is to surround foreign particles and clear them from the tissue. But this process is only partially successful when it comes to tattoo ink. Because the cells cannot break down the particles, they become lodged there. The side effect is that the lymph nodes take on the same color as your tattoo. There is also evidence that tattoo ink particles can travel through the blood and become lodged in the liver.

During the photomechanical effect, the energy is absorbed by the ink particles in a very short time, called nanoseconds.  For laser tattoo removal, the destruction of tattoo pigments depends on four factors:

  1. The colour of the light must penetrate deep into the skin to reach the tattoo pigment.
  2. The colour of the laser light must be more highly absorbed by the tattoo pigment than the surrounding skin. Therefore, different tattoo pigments require different laser colours. (eg. red light is absorbed by green tattoo pigments, while yellow tends not to absorb light).
  3. The pulse (time) duration of the laser energy must be very short.
  4. Enough energy must be delivered during each laser pulse to heat the pigment to fragmentation.

Different lasers remove different tattoo colours.

  1. Q-switched Frequency-double Nd:LYAG: 532 nm. This laser creates a green light which is absorbed by red, yellow, and orange pigment.
  2. Q-switched Ruby: 694 nm. This laser creates a red light which is absorbed by green and dark tattoo pigments.
  3. Q-switched Alexandrite: 755 nm. This laser absorbs green pigment, does not work well with red, orange, yellow, brown etc. Available in picosecond speed with claims it can remove ink faster.
  4. Q-switched Nd: YAG: 1064 nm. Works better on darker skin as the light isn’t absorbed by melanin like the ruby.
  5. Picosecond Laser: Picosecond pulses are more efficient than nanosecond pulses in clearing black tattoos. However in polychromic tattoos the difference is minimal compared to Q-swtiched.


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How Many Laser Sessions are Required to Remove a Tattoo?

The Kirby-Desai scale is often used to assess the potential success and number of treatments necessary for laser tattoo removal. Patients often receive a poorly defined assessment of the number of treatments and often engage in the process without full awareness of the potential success. In the Kirby-Desai scale, numerical values are assigned to six parameters: skin type, location, color, amount of ink, scarring or tissue change, and layering.

The average number of tattoo removal treatments required using laser was 10 treatments, with a range of 3 to 20 treatments.  Treatments must be spaced out 6 weeks apart. So, on average, the total procedure will take 1 to 2 years to complete.

Skin type: Patients higher on the Fitzpatrick scale, (darker skin) are not ideal for laser tattoo removal.  They often require longer wait times between treatments due to using the laser on lower settings to try to avoid unwanted side effects such as hypopigmentation.

Location:  Blood and lymphatic supply vary anatomic regions.  After the laser treatment, the micro-particles are taken by the macrophages travelling to the lymph node, where filtering occurs. The head and neck area maintain the largest amount of regional lymph nodes and have a large vascular supply; thus, they are able to mount an increased immune response to phagocytose the ink particles.

Colour: Tattoo artists use a variety of coloured ink.  Colours most often used are black, red, blue, green, yellow, and orange.  Colours other than black have been noted to be up to twice the size of the black pigment. These differences in pigment size and composition lead to the difference in amount of treatments needed. Black colour is the easiest to remove with green, yellow, and orange being more difficult to remove.

The amount of ink: In the Kirby-Desai scale, amount of ink is divided into four categories: amateur (letters, words, or small symbols), minimal (one colour, simple design), moderate (one color, complex design), and significant (multicoloured, complex design).  Amateur tattoos tend to respond quicker to laser treatment. Professional tattoos on the other hand tend to lie deeper in the dermis and have a greater density of pigment.


  1. Good success rate for most clients, not all.
  2. Non-invasive. Does not require anesthesia or surgery.


Q-switched lasers have now become the standard for removal of tattoos. However, complications can occur, with an incidence of about 5%.

  1. Painful. Many patients believe tattoo removal is more painful than actually getting the tattoo. Besides pain, blistering, crusting, pinpoint hemorrhage, and urticarial reaction can occur. Blistering is a natural part of the healing process of laser tattoo removal.  As the laser breaks up the ink in your skin, it can also break tiny blood vessels around the tattoo resulting in blisters, which usually take up to two weeks to heal.
  2. Risk of Infection. After the procedure, the skin becomes inflamed which increases the chance of infection.
  3. Uneven Skin Colour. Laser tattoo removal can cause hypopigmentation where the treated skin can become lighter than the surrounding skin or can also cause hyperpigmentation where the treated skin becomes darker than the surrounding skin. Dark skinned patients are more prone to uneven skin colour from laser tattoo removal.
  1. Many treatments required. On average 10 treatments are required to remove a tattoo.  With a 6 week between treatments, it would take 1 to 2 years to complete the tattoo removal process. Complete disappearance is not always achieved even after performing numerous laser sessions.  Unfortunately, the number of sessions isn’t something that can be easily predetermined during an initial consultation.
  2. Expensive.  Laser tattoo removal is expensive because the machine is expensive which needs to be factored into the price per treatment.  Plus, due to the number of treatments required, a complete removal can cost thousands of dollars.
  3. Tattoo ink breaks down into the body. Some tattoo pigments containing metals could theoretically break down into toxic chemicals in the body when exposed to light. This has not yet been reported in vivo but has been shown in laboratory tests. It has also been shown that carcinogenic amines are generated by a laser-induced cleavage of azo dyes. (  Recently, German scientists reported that concentrations of toxic molecules from red and yellow pigments increased up to 70-fold after laser irradiation. And the bigger the tattoo, the greater the toxic release.” – Bernadine Healy, M.D.
  4. Scarring. While scarring is rare with today’s advanced laser tattoo removal techniques, it does happen. In some cases, laser tattoo removal results in keloid scars, which are thick, raised scars that can appear between three and six months after the treatment.




Although laser tattoo removal is the most popular method of tattoo removal,  there are newer, faster, safer, less painful alternatives to laser tattoo removal that people are not aware of and are increasing in popularity vs laser tattoo removal.  If you are looking for either laser tattoo removal or an alternative to laser tattoo removal which is all natural, why not give TattooRemoval.Clinic a call at 647-559-3662 or fill out our ONLINE ASSESSMENT FORM.  The Premier Laser & Non-Laser Tattoo Removal Clinic in the Toronto GTA.


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