Brief info Fact sheet Photo gallery

Tattoo Removal by Ruby Laser

Patient Information:Question and Answer Sheet

Lasers have been used very successfully for tattoo removal for more than 20 years. For the last 10 years the Q Switched Ruby Laser has been the medically acknowledged laser of choice for all tattoos, except some reds which may be best treated with an ND-Yag Laser. The following information is designed to cover the most commonly asked questions.

Why is a tattoo so difficult to remove?

A tattoo results when pigment is injected into the lower layers of the skin (the dermis) and the pigment becomes sealed away by a tough network of collagen fibres. It is difficult to remove the pigment without affecting the surrounding tissue. Before the development of laser therapy the only alternatives were to physically remove the pigment and the surrounding skin by surgical excision and skin grafting or to chemically destroy the pigment using salts or acid. Such techniques cause considerable discomfort, damage to the surrounding skin and require significant after care. Typically they replace the original tattoo with a scar.

How does the Q Switched Ruby Laser work?

The laser produces extremely short pulses of high energy red light. This light is absorbed strongly by the particles of tattoo pigment but not by the surrounding skin. The tattoo pigment heats up and breaks down into tiny particles. These minute particles are then targeted by the body's own immune system and removed gradually over time. Since each laser pulse is so short (eg 25 billionths of a second) and the energy is selectively absorbed by the tattoo pigment, surrounding tissue is not usually affected and there is normally no lasting damage to the skin. Successive treatments are needed, usually at 4-6 week intervals, so that this whole procedure is repeated and the body can remove as much pigment as possible.

Can a tattoo be removed in just one treatment?

Only very rarely- some amateur (self-inflicted Indian ink) tattoos may disappear after only a small number of treatments. Professional tattoos always take a higher number of treatments.

How many treatments are required to remove the average tattoo?

Due to the many variations in size, colour and type there is no such thing as an average tattoo. The number of treatments required will also depend on the body's own defence mechanism and how effective it is - each individual responds differently. As a guide Indian ink amateur tattoos can take anywhere between 1-10 treatments; professional tattoos anywhere between 8-20. Without seeing the tattoo it is impossible to be more accurate, a free consultation is provided where a better estimate can be given.

What are the costs likely to be?

The cost of a single treatment will depend solely on the size and density of the tattoo. The bigger and more densely shaded the area the more time it will take to treat and therefore the higher the charge. Until we see the tattoo we cannot price the treatment. The minimum charge is £60 per treatment session.

Is the treatment cost fixed throughout the course of treatment?

As the tattoo fades away, the size of the tattoo will normally reduce, although this is not always the case, some tattoos will fade evenly without reducing in size. Consequently, treatment cost is re-assessed on an individual basis as the treatment progresses. If the size of the tattoo reduces significantly during treatment, the price will be reduced accordingly.

Do all tattoos respond to treatment?

Unfortunately not; most pigments, especially blacks and blues, do respond very well to Ruby Laser treatment. However, some pigments, usually greens, are resistant to treatment with any laser. In theory red pigment will reflect the ruby light and not respond to treatment although in practise some red tattoos fade very well. Very bright modern inks are less predictable, they may take longer to fade and in some cases may not go entirely. Some red, white and flesh coloured inks have been known to turn black in the early stages but this is rare.

How will I know if there are any resistant colours present?

In most cases it will be apparent to the assessor whether there is likely to be a problem. Where there is any doubt, a test patch will be required to determine the likelihood of successful treatment. There is a charge of £50 for a test but, in our experience, it is better to find out about potential problems before the whole tattoo has been treated and a large sum of money has already been spent.

How long does a treatment take?

This depends on the size of the tattoo; a small tattoo might take 5 minutes, where a large, or multiple tattoos could take an hour or more of treatment. Again, the assessor will provide this treatment.

Does it hurt?

Yes, but the amount of pain felt will depend on the type of tattoo, where on the body it is, the amount of treatment required and your own pain threshold. Some patients hardly feel a thing where others will describe it as painful. Patients' descriptions range from an elastic band flicked against the skin to splashes of chip fat and even red-hot needles. The vast majority of people tolerate the treatment well.

Does the laser cause scarring?

Although there is a risk of scarring with any laser, in most cases scarring is not a significant risk for tattoo removal with the Ruby Laser. The first lasers used for tattoo removal were high powered, very aggressive and carried a much higher risk of scarring. The Ruby Laser does not heat the surrounding skin and the risk of scarring is very much reduced. The risk of scarring is mainly associated with a genetic pre-disposition to forming scar tissue and the presence of resistant green pigment. If you experienced an allergic reaction when your tattoo was first put on you must inform the doctor or nurse as this can lead to an inflammatory response during treatment and a slightly increased risk of scarring. To reduce the risk of scarring we carry out an extensive medical evaluation to identify high risk patients. We also have an adjunct treatment that can stop scar tissue forming and even improve existing scarring; consequently our scarring record is very low.

Are there any other side effects?

Some patients may blister after a treatment. This is quite normal and will usually resolve in a week or so (you will be given an aftercare information advice sheet on what to do). Once any blisters have subsided, the skin around the tattoo may look and feel shiny for a number of weeks. Treatment cannot be repeated until the skin condition has returned to normal - usually 4-6 weeks.
The highest risk side effect is skin de-pigmentation (loss of natural skin colour). Because the laser targets dark pigments, ruby laser energy is also absorbed by the melanin in the skin. The most frequent side effect is for the natural colour in the skin to 'bleach' after a number of treatments. While normal skin pigment will usually recover, it can take months to do so and, in some rare cases, the natural colour of the skin may not return at all. As a general guideline, the darker the skin and the more treatments required, the more risk there is of long term de-pigmentation. Freckles often disappear at the site of the treatment. Because of the risk of damage to skin pigment, we will not treat tanned skin and will postpone treatment until any suntan has faded. We recommend that patients do not allow their skin to tan before or during treatment, thereby reducing the risk of long-term de-pigmentation. During the period of treatment a sunblocking cream (factor 20) should be used daily or the treatment area kept covered.
A tattooed area which is particularly hairy, may need to be shaved prior to treatment. The hair should grow back normally but the

Is the treatment safe?

The ruby laser has been used around the world for more than 10 years and has probably treated millions of tattoos with absolute safety; our clinic alone has treated more than 10,000 tattoos. Ruby laser energy is really just a strong red light and there is no linkage with any skin disorder or any increased risk of skin cancer. Obviously relevant precautions are taken to ensure the safety of the patient. Until April 2002 our clinic was regulated and registered by Wigan and Bolton Health Authority and we were subject to regular inspection. In April 2002 the responsibility for inspecting our clinic falls to the National Care Standards Commission. Treatments are carried out by our own trained and qualified doctors and nurses. All practitioners regularly update their knowledge and skills.

© 2004 Laserase