First Ever Laser Tattoo Removal Talk Color Tattoos And Lettering Erasing Explained Live

Hello. I am Lee Sang-ju, a dermatologist at Yonsei Star Dermatology Sinchon. Today, I would like to explain tattoos and tattoo treatment methods. I will provide all information regarding the effectiveness, pain, and laser procedures for tattoo removal.

A tattoo refers to the act of pricking the skin with a needle to engrave letters, pictures, or patterns with ink or dye, or the resulting artwork. It is commonly seen around us and is also known as Tattoo in English. It has become a part of our daily lives in various forms such as semi-permanent makeup, contour makeup, and micro-pigmentation.

Dermatology has long utilized tattoos for medical purposes. Skin-colored tattoos are applied to areas where the skin turns white, such as vitiligo, or to scar areas. Recently, scalp tattoos are often used for areas where hair loss makes the head appear sparse, and reconstructive tattoos, such as drawing nipples after breast cancer surgery, are also widely used. Aesthetically, semi-permanent makeup tattoos for eyebrows, eyeliners, and lips are representative. In addition, there are various types such as artistic tattoos, and traumatic tattoos (caused by stone dust or asphalt particles embedded in the skin).

Tattoos are made by injecting tattoo ink into the skin using fine needles. The reason why the ink remains permanently in the skin is due to our body's defense system. When foreign substances enter our body, scavenger cells try to expel or move them. However, tattoo ink particles are too large for scavenger cells to move, so from the cell's perspective, they remain fixed in place like a large rock. These ink particles continue to remain in the skin, displaying the color of the tattoo and maintaining its persistence.

People who visit the hospital for tattoo removal have various reasons.

• Regret: The most common reason is regretting getting a tattoo. Some decide to remove it after getting a tattoo impulsively and then changing their mind, or when it interferes with their social life. Especially if you regret a tattoo, it is more effective to remove it immediately rather than waiting one or two months after the procedure. This is because the ink can seep out again through the wound created by the tattoo procedure.
• Regaining Confidence: If a tattoo feels like a handicap and causes a loss of confidence, people seek removal to regain their self-esteem.
• Social Pressure: Although social perception of tattoos has improved compared to the past, some still decide to remove them due to negative perceptions. Many consider removal during important periods such as employment, marriage, or childbirth.
• Dissatisfaction with Design or Change: Some choose removal because they are dissatisfied with the tattoo design or to get a new tattoo over an existing one.
• Professional Reasons: Many men remove tattoos for professional reasons. There are cases where individuals request removal because they do not want to show their tattoos during corporate training after joining a large company.
• Family Reasons: Women sometimes remove tattoos as they become mothers, fearing it might give their children a negative impression.

Since tattooing involves injecting foreign substances into the skin, secondary side effects such as bacterial infection, allergic reactions, scarring, and skin diseases can occur. Especially if the tattoo contains iron components, heat may be generated in that area during MRI scans, leading to burns. Therefore, it is important to avoid unnecessary tattoos as much as possible and to consider carefully before getting one.

The history of tattoo removal is as old as the history of tattoos themselves. In the past, mechanical, chemical, and surgical methods were used.

• Mechanical Methods: These involved stripping the tattooed skin. Salabrasion, which used coarse salt to create a wound and then applied salt for removal, and Dermabrasion, which used a grindstone-like device to abrade the skin, were used. However, these methods inevitably cause severe scarring, hyperpigmentation, or hypopigmentation, so they are rarely used today.
• Chemical Methods: In the past, methods using car battery fluid or acids (hydrochloric acid, sulfuric acid, nitric acid, etc.) to corrode the skin to remove tattoos were sometimes used. This method also causes severe scarring and side effects, so it should never be attempted.
• Surgical Methods: This involves directly cutting out the tattooed skin and suturing it. It can be considered for small tattoos, but 100% scarring remains, and keloids can occur in individuals prone to keloids. Large tattoos are difficult to remove in one go and require multiple surgeries, and they can leave cosmetically more unsightly scars, so their use is limited.

The safest and most effective tattoo removal method known to date is laser treatment. In the early days, ablative lasers that abraded the skin were also used, but due to the risk of scarring, pigment lasers that selectively destroy only pigment are mainly used today.

The core principle of laser tattoo removal is to break down ink particles in the skin into tiny fragments so that our body's scavenger cells can easily expel them. When laser light is absorbed by the ink, the ink particles break into microscopic pieces, and these fragments are expelled from the body via the lymphatic vessels by our body's phagocytes (scavenger cells). The lymphatic vessels can be thought of as our body's sewage system.

The pulse width of the laser (the duration of light emission) is very important for tattoo removal effectiveness.

• Nanosecond laser (Q-switched laser): Emits laser light in units of 1 billionth of a second (10^-9 seconds).
• Picosecond laser (Picosecond laser): Emits laser light in units of 1 trillionth of a second (10^-12 seconds).

The shorter the pulse width, the more finely the ink particles can be broken down. Just as a nail is driven in better with a short, strong strike, powerful energy delivered in a short time is necessary to effectively destroy the ink. While nanosecond lasers break ink with a thermal effect, picosecond lasers deliver energy in such a short time that they microscopically destroy ink through a photoacoustic effect. Therefore, picosecond lasers break down ink much more finely than nanosecond lasers, helping scavenger cells to move them easily, making them increasingly popular for tattoo removal.

The effective laser wavelength varies depending on the tattoo color. For example, green light (532nm wavelength) is effective for red tattoos. Therefore, when removing color tattoos, various laser wavelengths suitable for the tattoo color must be used to enhance effectiveness. Lasers that can treat multiple wavelengths are more effective for color tattoo removal.

The factors affecting tattoo removal effectiveness are as follows:

• Skin Color: People with darker skin may experience reduced effectiveness because melanin pigment absorbs laser light, reducing the laser energy that reaches the tattoo ink.
• Tattoo Area: Tattoos on the face are relatively well removed, while areas with poor blood circulation, such as the legs, may show reduced effectiveness due to slower ink expulsion.
• Amount and Depth of Ink: Tattoos with a large amount of ink or those deeply etched across multiple layers require more time and effort to remove.
• Skin Damage During Tattooing: If scars have already formed or skin texture has changed during the tattooing procedure, laser light may not penetrate properly, leading to reduced effectiveness.
• Tattoo Color: Monochromatic tattoos tend to be easier to remove than multi-colored tattoos. Multi-colored tattoos require the use of various lasers, and their removal effectiveness may also be somewhat lower.

When it comes to tattoo removal, treatment technique is as important as the laser equipment. Simply treating once with a good laser does not make the tattoo disappear.

• Multi-Pass Treatment Technique: This method involves irradiating the laser multiple times during a single session. It can enhance effectiveness by breaking down ink particles even more finely.
  • R20 Technique: After one laser irradiation, one waits about 20 minutes for the bubbles (generated from ink fragments) to disappear before irradiating again. These bubbles scatter laser light, reducing effectiveness during subsequent irradiations. This can enhance effectiveness by irradiating up to 4 times per visit, but it has the disadvantage of long waiting times, making practical application difficult.
  • R-Zero Technique: This method uses a special medication (patch or topical application) that absorbs the bubbles generated after laser irradiation, allowing immediate subsequent laser irradiation without waiting. Utilizing a substance developed during artificial blood research, it instantly removes bubbles, enabling multiple laser irradiations in a single visit. It is gaining attention as a practical method to enhance effectiveness by compensating for the shortcomings of the R20 Technique.
• Combined Laser Treatment: This method uses multiple types of lasers together to enhance treatment effectiveness. For example, a fractional laser that creates microscopic holes in the skin can be used alongside a pigment laser to aid ink expulsion and enhance the penetration effect of the pigment laser. Methods like PrectaT, where a fractional handpiece is used first before irradiating with the overall laser, also exist.
• Pain Management: Various methods are used to reduce pain during tattoo removal. These include topical anesthetic cream application, sleep anesthesia, conscious sedation, and cryo-anesthesia (cooling the skin to dull pain).

Post-Treatment Precautions

After tattoo removal, wounds are created on the skin, so treatment to reduce pain and inflammation is necessary for 1-2 days post-procedure. Cold compresses can help alleviate pain and inflammation.