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What laser (or machine) do you use? And why this is a loaded question


Mike Panic
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In the nearly 20 years I've been going to, hanging out in and generally being around tattoo shops and artists, I've never heard a patron come in and ask what kind of machine the artist is using. In my profession, I answer it almost daily.

Right behind how much does it hurt? and what is this going to cost me? one of the most frequently asked questions I get asked is what machine I use to treat people. This is mildly important and yet, people really stress about it.

Why it's important? There are China-made machines available on eBay for a few thousand dollars, these are untested, generally not FDA approved in the USA and worse, most don't carry an adequate UL rating. That last one is a biggie, that means there's not been proper testing on the machine to pass fire, smoke and safety regulations.

The 4 main technologies used in tattoo removal:

  • Q-Switched Nd:YAG - the most popular across the board, commonly called the 'gold standard'
  • Ruby - thus named because it emits a red light and is typically used on grenn pigments
  • Alexandrite - essentially a red laser as well, but less powerful than a Ruby, again mostly used on green pigment
  • Pico - the new kid on the block, this laser operates at a 'pico' second, or one trillionth of a second, however isn't as effective on red pgiments

There are many brands, but I'm not going to go into a this is better than that. The Q-Switched Nd:Yag is the most versatile as it operates at two wavelengths and does a great job on the vast majority of pigments, however it's also possible via a swap of hand pieces to operate this laser at the two other wavelengths, making it the technology choice of most facilities. This laser is a 'Nano' laser, pulsing light at one billionth of a second.

Typically speaking, Ruby lasers are much more rare because the scope of treatment is much more narrow and you're likely to only find these in the offices of dermatologists who have a very specific need for them.

Alexandrite lasers are extremely rare to be seen.

Pico laser is the new kid on the block - and the one with the most hype. The claims are 30-60% faster removal, due to the 'trillionth' of a second light bursts. I affectionately call this the Viagra (or Lipitor) of laser machines. Why? Well, they are mass marketed to the general public, so the public learns the name of them fast and since they are only available by prescription, they are knocking down doctor's doors to get their hands on them. Yes, the pico is effective, I've spoken at length with their sales reps and read the clinical trial reports on them. Here's the catch, it costs almost 3x as much as a new Q-Switched Nd:Yag laser, which is also why you typically see prices 2-5x higher when using this laser. The sales rep justifies it as, people don't want to wait 18 months to remove a tattoo, this machine will get it done in 8-12 and we feel people will pay a premium for that. This could be true in LA, NYC, Miami, etc., in my market, it's not.

OK, once we've established the place you're going to isn't using a my first laser beam machine and you now know what 'type' of laser you will most likely be treated with, here's why the machine used really isn't that important.

Lasers are just like Michael Jordan Nikes, they are awesome, are cool to have, but you won't dunk like Mike. Just because you saw someone online who showed you great before & after photos after being treated with Acme Brand Laser doesn't mean you will have the same results. There are 3 main factors that go into any given tattoo removal, provided of course the tech is capable and they are using one of the main lasers available on the market.

  • Immune system does 95% of the work! Yes, you read this right. The laser just facilitates the process. It's medically proven non-smokers heal faster (not just for tattoo removal, in general), but if you're in shape, eat right and generally take care of yourself you'll heal faster and see better progression between each treatment.
  • Pigment varies bottle to bottle sometimes, even from the same manufacture. Aside from the fact there is no FDA regulation in pigment, even if there was it wouldn't stop your artist from mixing it with another ink, or even tap water, which could have contaminates in it. Have two tattoos done by the same artist 6 months apart? They could have switched inks in between sittings.
  • Application. Tattooing is an art, not just in the work they create, but actually getting pigment into your skin. The needle groupings, voltage, angle the machine is held and pressure all make differences in how well your body takes the pigment, as does your ability to follow their aftercare instructions. While this typically is a very small contributing factor, if an artist has a barbed needle (fish hooked, typically from bottoming out in an ink cap while dipping, or from not inspecting needles while assembling the grips), it can cause damage to the skin. Most commonly this is seen in the form of a raised to the touch tattoo, or sometimes known as 'braille tattoos.'

As mentioned earlier, seeing before and after photos is important, I also strongly believe seeing progress photos is equally important so you can see how the tech was able to treat the entire piece, but as it fades focus on the areas containing pigment still and avoiding those without pigment, reducing the chances of hypo-pigmentation.

When you're doing your research, don't get sucked into the hype of 'state of the art ACME brand machine' because one of the leading manufactures that makes one of the most popular machines on the market today hasn't changed the guts of the machine from the two previous models available, they've only made the case prettier. This isn't just from my own research, this is from my tech who services my machine and has 15 years experience in the industry.

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@mikepanic how many treatments do you think to lighten the Virgin Mary tattoo in my profile.

I generally tell clients who want to cover a piece, 2-5 treatments. This will vary wildly based on what you're going to cover it with and the skill of your artist. Typically, after the 2nd or 3rd treatment I'll suggest you call and schedule a 20-30 minute appointment with your artist, stop in and talk with them, show them the progress and discuss what you want covered. The two of you can then come to a decision if you should get more treatments or schedule a sitting with the artist.

Given it's your entire shoulder cap, one of the 2 options in a cover-up is kind of not available to you, the 'go bigger' approach. So you might need 4-6 treatments, especially if you don't want anything overly dark (the 2nd main option in a cover) and / or if you want a lot of shading / light detail work done with a shader.

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@mikepanic wee question always read that green is a bastard to remove , is this true ?

Green can be more difficult to see progress in at the same rate as black, red and other colors. Everyone is different, and treats clients differently, but there is a wavelength that works on a Q-Switched Nd:YAG laser (which I use) that is very effective with green. What I do differently though, and partly because I understand how tattooing works better than most "laser professionals" is that shading involves whipping the color in, typically pulling in some of the black from the outline. When you treat green on it's own, there is a higher risk of problems and side effects if the laser hits other color pigments. This isn't true in every case, but I'd rather be on the safer side.

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Age of tattoo? If the body has already spent the last 25years breaking down the ink do you feel it's easier to fade with laser.

This is a complicated question. If a tattoo is 25 years old, you're not just dealing with that many years of break down - you're dealing with who knows what was used for pigment and lord can only imagine the technique / consistency used to apply it. Top that off with 25 years of sun exposure, wear and tear on the body and everything else. I'm currently working on a client who has tattoos we're removing from the mid / late 70's that is fading at the same rate a younger client with newer tattoos would fade. The downside is this client is now in their late 50's and their skin is more fragile. This also goes for older people getting tattooed.

I'm working on several clients now who have had work done in the late 80's and early 90's though with great success.

Location of tattoo? Immune system works better close to the heart?

This is a general concept across the board, from paper cuts to brush burns, closer to the heart will heal better because the heart works less hard to pump blood. That said, I see great results all the way down to ankles and forearms. Hands, knuckles and feet tend to only really be a little bit different because there isn't as much body mass to help deal with swelling, so there must be a good amount of care given when treating these areas to help lessen discomfort for the rest of the day.

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Can you write anything up about power settings? Im getting zapped with a q-switched:YAG i believe. The first zapping on the black was at a "5" the one I got this weekend was a "10". Last time I got way more bubbleing and seemd to heal worse. Granted I am in far better shape now then I was then. Ive notived some results on the ligther stuff and some of it is ready for a cover up. The thick black lines I have tho seem to fade at a snails pace. The person doing the laser says 4 total season could do it but hes obviously not commiting to that. I always want the tattoo to fade more then it does but often after 6 weeks I notice some fading but with the increased in laser "intensity" should I see more after the second treatment?

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In a word @eisen777, no. It's just something else people fixate over without understanding how the machine operates, what a Fitzpatrick Scale is or without any experience. The word you're looking for is energy, not power is relative to several mitigating factors in any treatment. I also don't want to undermine any other professional laser tech, and you aren't being treated by me so I don't want to make any assumptions on you, anyone else, or give advice that could contradict any other professional. I may start a client at one setting, for arguments sake, an arbitrary number might be 2.2 joules (the measurement of energy, often times referred to as 'intensity'). The very next person that comes in might be started at 1.8j. The first client could come back after 5-6 weeks and their second treatment is at 2.4j while the 2nd client's 2nd treatment is at 2.6j. Too many factors go into determining how each client is treated, and each treatment is unique and different.

To clear up a little of your confusion, and maybe help set your mind at ease, you weren't treated at a setting of '5' - I'm going to assume that was the Hz setting on the machine, aka the speed setting. Most Q-Switched Nd:YAG lasers can operate at a 'speed' of 1,2,5 & 10. This has zero effect on the energy setting of a machine, and typically a slower Hz setting is used when a tech wants more precise control over a treated area, although sometimes slower speeds are needed when operating at specific nanometers.

I will also assume that "bubbling" you mean frosting, and not blisters. Frosting typically is most apparent in the first treatment, but again everyone is different. Frosting is water being vaporized in your skin, converting from a liquid to a gas, and the oxygen (O part of H2o) being trapped under the epidermis. While it's used as a guide for treatment, it bears no significance on the speed at which pigment will be broken down and dispersed through your bloodstream, it's merely a byproduct of the treatment.

Some of your questions you need to ask your tech specifically. I've never heard anyone quote a full removal in 4 treatments, typically speaking it's common in the industry to accept 10-12 as a baseline standard, however some will see faster reactions and need 8 while others will need 14+

It's also fairly typical to not see dramatic fading until 6 weeks after your second treatment. Are you or your tech taking photos prior to each treatment for comparison reasons? If not, then you're tattoo is probably fading more than you think.

Regarding thick black lines. It's my experience that any portion of a tattoo that's done with a liner will take longer than any portion of a tattoo done with a shader. Moreover, when linework is gone over several times to 'even out' or 'thicken' the lines, often a technique used by artists to hide the 'dot' that appears when they stop through a line or at the end of a line, the fading can take even longer.

Take care of yourself, drink plenty of water, eat healthy, get exercise, don't smoke. Those will help put you into a place that will allow the greatest amount of fading per treatment, assuming your tech isn't milking you for more treatments.

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No no....not full removal. Just lighten for a cover up. Really I just wanted you to touch onto subjects like you just did so it worked out. I didn't use science language properly because I never think about it here. My wife is a chemist use used a q switched in her lab but she explain alot but not in the context of tattoo removal so your info helps. My tattoo is getting lighter and I know the machine works and I'm getting a good deal plus he comes recommended by various regional tattooers so I'm trusting he's not milking me. Thanks for the info.

The bubbling I ment was blisters I got wayyyy more the first time and less the next. I always get the frosting.

Pardon the typos phone post and get annoyed editing

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Blisters are more uncommon than common, I'd strongly suggest using ice post treatment to help reduce swelling and extract more heat, faster. 15-20 minutes on, 45 minutes off, repeat as needed.

For fading to facilitate a cover-up, I tell clients 2-5, but again, that depends on location, desired cover, skill and talent of artist and their ability to do what you want, without going overly large or overly dark.

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  • 4 weeks later...

@CercleRouge - I'm not sure I qualify to answer this, as I'm not a scientist or developer of new technologies, but I'll give you my 2 cents based on what I know. There honestly hasn't been a whole lot done in the last 10 years. The gold standard, Q-Switched Nd:YAG lasers that most of us use, have been FDA approved and been in use for 15+ years now.

The first thing to really stir up the industry has been the Pico laser, however it's proving to be inefficient on red pigments, and priced out of most providers budgets / most consumers won't pay the bloated price for treatment. The R20 protocol is still, in my eyes, very early in it's infancy with proven results.

Where are things going? Honestly, I don't know from a technology standpoint. I think the next 5 years will see brutal price wars as more people invest in service based industries, tattoo removal being one of them. I did a phone consult with someone interested in starting a business in Canada earlier this year. He has no tattoos, no interest in tattoos, is not a health care worker but did the research and math and sees this as a growing demographic and industry and is trying to get paid doing it. I anticipate hearing more stories like this. I come from a tattoo community, and work within that community (hate that word but whatever). The other sect of people are the med-spas and plastic surgeon / dermatologist who will continue to add this service onto their existing menu of items.

My only fear is, like tattooing and piercing, there will be people offering super cheap service and people seeking a super cheap service, but getting hurt, harmed or damaged skin because of it. Or worse, not seeing results and get a bad taste in their mouth about tattoo removal. There are new businesses opening all the time with what I call Mickey Mouse Machines, cheap $2500 boxes from China. That's not how to get into this business.

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Scratchers will come full circle coming round to peoples houses to have laser parties :)

That's what myself and many others are very afraid of. I've already spoke to many professionals in the UK who face this problem on a regular, cheap, unregulated lasers and improper technique are scarring people. There's such a violent price-war going on right now in the UK over laser removal that quality is taking a back seat.

Old saying, Pick two of the following 3:

* Cheap

* Fast

* Good

but you can never have all 3

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Yeah I definitely think there needs to be some sort of regulation involved in the laser business over here . They should be classed as medical equipment or something

I'm always skeptical of places like beauty salons and posh skin clinic/spa places that offer laser too , because I feel they don't know enough about tattoos to remove them properly (its probably just predjudice on my part lol ) they often charge a lot more too.

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That's what myself and many others are very afraid of. I've already spoke to many professionals in the UK who face this problem on a regular, cheap, unregulated lasers and improper technique are scarring people. There's such a violent price-war going on right now in the UK over laser removal that quality is taking a back seat.

Old saying, Pick two of the following 3:

* Cheap

* Fast

* Good

but you can never have all 3

great info you have posted in this thread,thanks :)

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  • 2 weeks later...

@john - it's been covered a few times here, most people don't offer or do the R20 method unless there's a serious time crunch, like enlisting in the military.

It causes more trauma to the skin, you'll be in the office for up to 2 hours and the cost is typically 3-5x per treatment. The results vary wildly. The whole R20 method was based off one test study of 12 patients, with mixed results. Somehow, it's become common knowledge and people offer it and ask for it.

There's a few places that show really great results, but it's not the normal.

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Either a Pico or R20 should be explored in that situation, but it will probably still take a minimum of 6-8 months to remove it. I worked with a young gentleman this year who had a tattoo on his neck, and we did shorter time between treatments because he was healing really fast.

That being said, hands / feet always take a little longer to heal, being further away from the heart and all.

I wish your friend good luck, and thank them for wanting to serve for me.

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  • 2 months later...
  • 3 weeks later...
hey, mike. I just saw on your website the way you guys are doing pricing now. that is huge. I wish there were more people like you guys out there.

Thanks, really appreciate it. Ironically someone just tore me a new one on our Instagram account about how we could possibly justify the pricing for a 10 seconds worth of work, they sadly failed to read the person had more then one tattoo and we do scale for very small pieces. Thanks for the support!

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- could you help me to explain: which one is more better between Yag or Tonning laser?( I am gonna to take some laser treatment sessions before cover-up my old tattoo. Atually, i had just tested Yag laser for the skin reaction this morning and will come back after 3 weeks to take the first laser session. It ís actually painful than i thought...(

- what foods need to eat or not to eat? and how long i can do excerise after each laser treatment?

THank you so much for this valuable topic..

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