Mike Panic

@Stu It is almost always suggested to wait longer between treatments.  I'd personally choose the facility that has proven results, with lots of progress / completion photos.  It's one thing to talk about the machine and the waiting time, ask to see results.  They are what matter. 

For aftercare, I'm sorry but I won't discuss it with anyone but clients treatment in my office, for liability reasons. 

Poorly written article that was barely fact-checked and actually doesn't talk about the real reason the client's tattoo wasn't gone. 

The article simply says the new laser called picosecond, which is the technology, not the laser, but indicates new technology in 2012 which I believe they meant to say PicoSure, as that is a brand name of a laser sold by Cynosure.  At present, there are at least three picosecond capable lasers on the market.

The real reason (I'm assuming) the author was able to continue and get her tattoo removed is not due to the picosecond technology but due to the 755nm wavelength the PicoSure operates at.  That specific wavelength destroys blue, green and blue-based purple pigments.  The only laser on the market that gets close is the Quanta Q+C at 694nm, but it's not a picosecond laser and the picosecond technology doesn't play into why it's not as effective. 

Also, the mention of money is also slightly skewed too. The author started tattoo removal seven years ago, when the technology wasn't being used as much (demand wasn't where it is now) so few clinics bought machines because the ROI was so terrible on them.  The fact she paid $400 / treatment for what appears to be something the size of a quarter seems more of a rip to me. 
 

@pidjones The frosting is normal, and what you explained is very typical in how it appears then fades, usually in 10-20 minutes.  To do a second pass over it is referred to as the R20 method, and it's cloaked in some smoke and mirrors for sure. 

I'd worry less about the methods used and focus on the results, that's what really matter at the end of the day; Be aware though, since you brought up FDA, no tattoo ink on the market is FDA approved and very few cities in America have any health board / health control over what happens inside a tattoo shop, as long as they have a business license and a tax ID. 

I'm really late to this conversation but let me chime in the only time I ever suggest someone getting a tattoo surgically cut out is if the tattoo is smaller than a typical pinky finger nail or smaller than a dime, and it's in a portion of the body where pulling skin together isn't difficult.  I.e., doing this on top of a foot, the side of a wrist, top of shin, etc. are not ideal places.

Aside from that, in an event like a tummy tuck, tattoos are often cut out when the removal of skin happens for that procedure.

The handful of clients I've had come through my office who went and tried the surgical route had horrible results and all wish they didn't do it.

I've had laser treatments, I do it for a living to other people.  It's expensive, slow and painful, I totally get that.  I'm the least pushy "sales" type guy you'll ever meet.  But that the end of the day you have a tattoo you don't love, don't do something else to your skin because you 1. can't wait or 2. can't afford to do it right because in the end, you'll end up a few years down the line not loving the change. 

Most clinics don't make you pay up front for the entire process, in fact it's pretty rare.  The first handful of treatments should be 5-6 weeks apart, at a minimum.  Based on the $1200 you were quoted, that basically means you need to save roughly $20 / week to afford laser (based on the average person needing 10-12 treatments divided by $1200).  And here's the other real truth you should know; Waiting longer between treatments will ultimately get you better results. 

Again @iowagirl it's really tough to say.  QS  Nd:YAG lasers have recently started to be used on toenail fungus, too.  In the most polite way I can, the answer is maybe. 

Up until about 4 years ago the only Pico-second laser on the market was PicoSure (made by Cynosure), which can do both tattoo removal and skin rejuvenation.  Since then, a few other companies have introduced Pico-second technology that I'm aware of only for tattoo removal, as that's the field I'm in.  They include machines made by Quanta, Candella and Zarin. 

@iowagirl I'm going to only make a generalized reply based on the info I know about, and with the lack of info you provided.  There are many types of laser treatments for skin, generally speaking what I do for tattoo removal is with a different laser at a different wave length, unless you're talking about a PicoSure.  The PicoSure has an optional hand piece that can be used for skin rejuvenation, pore reduction, skin tightening and minor acne scar reduction.  

Thank you for the kind words @pidjones, if I knew someone in TN to send you to, I happily would! 

Found this explainer video that really accurately shows what happens during tattoo removal... worth the 85 seconds if you're interested http://www.businessinsider.com/what-happens-during-laser-tattoo-removal-2016-5

What's not covered though is that ink is not regulated, by anyone, and the application of tattoos is violent and can cause scar tissue.  If the pigment becomes encapsulated with scar tissue from the tattooing process, it's very hard to remove it.  Pigment colors, location on the body, lining vs. shading, age of both the tattoo and the person wearing it and overall immune system health are also variables in how successful each tattoo removal appointment are. 

Have questions about anything, leave a comment. 

Please, for the love of everything, do not try tattoo removal at home.

Public service announcement: Just because you saw it on TV doesn't mean it's going to work. This client bought an at-home tattoo removal 'kit' after seeing it on a very popular TV show for entrepreneurs to showcase new products and get financial backing.

The result was 3 small, circular marks being left in their skin, to what initially looked like cigarette burns. This has made a permanent textural change to the skin and will likely impede our ability to remove pigment from the scarred area.

@Blur to answer your questions:

How good is the removing in 2016?

The advancements over the last 4-5 years have been exciting, but they are not perfect. No business should ever offer you 100% without a shadow of a doubt full tattoo removal. Too many variables from getting a tattoo done to your immune system will play a role. It's not just a quality laser and a trained tech.

will leave a shadow?

We call it ghosting but yes, in any full removal situation I always explain on day 1 there may be trace amounts of pigment left.

Will leave a scar

While it's unlikely for this to happen, being treated by a non-FDA approved laser, or by someone who isn't qualified, or by not following the aftercare and picking / poking / prodding it is possible to scar yourself.

different tone skin

Yes, hyper and hypo-pigmentation are a possibility and should be discussed prior to starting treatment after a skin evaluation has been done.

Which one is the best method?

Laser tattoo removal is the most efficient with the least amount side effects when compared to the other more invasive methods of tattoo removal. There is no best laser though. It's the right tool for the job, just like the best tattoo machine can't give you the best tattoo.

is full removal ever actually possible? say in a perfect situation, if a client is dedicated to their treatment course, do you believe complete or close to complete removal is attainable?

Sorry for the late reply @rocketqueen, I stopped getting email notifications from this thread a while ago and can't figure out why. I will never, as a professional, quote 100% tattoo removal. My idea of 100% is different from yours, and it's not a tangible thing to fight over. Even in my "best case" scenarios, I can still find trace amounts of pigment if I look hard enough. A casual stranger who didn't know the history, wouldn't know though.

Also bear in mind, "dedicated to treatment course" isn't always a factor in how successful any given removal will be. How the tattoo was done (scarring, over worked area, dragging or barbed needles, etc.), pigment used, pigment saturation, liner vs. shader, location on the body, immune system, age, age of tattoo and quality of life will all play roles in how much any given tattoo will be functionally able to be removed. There is no black and white answer with tattoo removal.

i do have another question - i have heard that some lasers will turn white ink dark. how common is this and does it disqualify an individual from being a candidate for laser if there are small white highlights in their tattoo?

Not some lasers, all lasers used for tattoo removal have the possibility of white ink turning black. In fact, many colors shift during removal. Black ink will often fade to brown or sometimes if it's got a deep indigo blue, that starts to show after a few sessions. There is no MSDS for tattoo ink, without knowing the ingredients there's always a possibility of color shift. Moreover, even if we do know the ingredients, there likely hasn't been any long term studies done on the effects caused from exposure to lasers.

To directly answer the question, it doesn't disqualify someone but it does cause for a very serious conversation about realistic expectations in my office.

Please understand that my job is to create very realistic expectations about what can and cannot be accomplished. The ol, "well my friend went here and they had the best and it's now gone after X treatments" simply holds no weight. Every tattoo done on every person is unique.

Thank you, as I have a "USMC" tattoo that I feel is not a good candidate for removal for coverup due to the scarring is significant enough that a blind man could read it with his fingers

We do often refer to those as Braille tattoos, and it's very typical in lettering, kanji or other thick black outlines. Also, due to the heavy metals found in many black inks, some people have minor allergic reactions to the pigment. This is most commonly seen after exposure to sunlight for an extended period of time, they become raised, or more raised.

Mike, are you saying that laser removal can reduce scarring?

Professionally speaking, no. If you are interested in having scar reduction please contact a derm or plastic surgeon about having a fraxel laser (fractional laser) treatment done. Have I seen a Q-Switch Nd:YAG laser reduce raised areas that were scarred during the tattooing process? Yes, but I will always do my best to explain that the scar tissue can also encapsulate tattoo pigment making the laser I use ineffective on tattoo removal in that specific area.

I had some good results with the Picosure laser with purple, although I wonder if it's just all marketing. The blisters are pretty...uhm...interesting.

I would love to completely remove the darn thing, but thinking it would be better just to lighten for a cover-up.

I was told usually "4-8 sessions" to lighten for a cover-up. Is there any truth to this? :confused:

Picosure destroys purple, there's no doubt about that, but blisters are not normal. Did you contact your clinic?

Regarding a cover up, I do laser for a living, not tattoo. It's not my place to tell you / your artist when it's faded enough to be covered. Honestly, that's part of the reason I started my business, to work with tattoo artists not against them, and to get clients in the best possible place by working together with everyone for the cover up they want.

Odd they told you 4-8, because most people who own a Picosure, and Cynosure themselves lay claims that the process is 30-50% faster than Q-Switch Nd:YAG, and by 8, according to their marketing, it should be gone. Anyway, I'd say the best thing you could do is 2-3 treatments, wait a month and talk to your tattoo artist about what it is exactly that you will be going over it with. From there the two of you can figure out if you need more laser treatments or if you should start planning out the cover-up.

The point of a blast over, typically speaking, is to put a piece of art over-top what's there and not care about the previous tattoo / use it as "ascent" to the new tattoo. Personally speaking, and not professionally, it's a trend I really hope doesn't stick around long.

Professionally speaking, the dermis can only hold so much pigment. That pigment is of a particle size that is essentially too large for your body to process and dispose of it as the true contaminate that it is. Over years and years though, the immune system will indeed "chip away" at that pigment and that's why tattoos start to look a little faded / blurry / out of focus.

When you do a blast over, you're now cramming more pigment into the dermis, which will ultimately settle and any trauma from the first tattoo will most likely show through, via raised line work is the most common sight. Over time, it will settle down and become muddy. This of course will vary depending on who did the first tattoo, with what colors and how saturated it is.

Since the blast over trend is just now picking up steam, I doubt we'll see any 'long term' photos for another few years. But in the meantime, I'll point you to those who got heavy black work done with the intention of putting white over it. Looks killer when first done but 2-3 years in, it's all muddy.

At the end of the day, it's your skin, you need to decide what you're acceptable living with.

Thanks. I went for several laser consults and all of them said they can´t remove the red ink. Do you know of a method to remove red ink? Thanks for advice

Pretty strange, Black and Red are the most responsive to tattoo removal treatments, the Picosure at 755nm wavelength can't really do much with them but anyone running a quality Q-Switch Nd:YAG laser should be able to treat them for you.

2nd client in, in a week.

Not happy with the cover-up on their chest they sought out tattoo removal. Several months after having a single treatment with the 'non-laser' type of tattoo removal and they are left with these scarred and discolored dots.

Please, ask questions and look at portfolios of work prior to starting tattoo removal with anyone.

For full disclosure, I'd like to request photos of post and healed laser results.

No problem, I'll get you an update in about 6-7 weeks when the client comes back in. My work speaks for itself though, as does most professional laser operators. Because I'm not here to promote myself / business but rather as a resource for the community, I rarely post progress photos on here. Take a look at my website / social media profiles in the meantime though.

Just so I put this out there as a disclaimer, I do laser tattoo removal, in case there was a wonder. This client agreed (and signed) waivers for me to use photographs I took of them. They did not recall the brand name of service that was done on them and even if they did disclose it to me, I wouldn't simply put a business on blast.

It most likely was the aforementioned brand earlier in this thread, but out of courtisey to the brand which I have no first hand experience, I won't (and can't) confirm what 'lactic acid' method was indeed used.

I'm just putting this out there as a public service because the client was sold pretty hard on the service by the tech who bashed laser as being far to painful to actually deal with and that this method would be faster and yield better results. In my clients words, paraphrased: the laser treatment was quick with very little discomfort.

I don't, sorry.

Before you decide to do 'non-laser' tattoo removal, have a look at this. 2 years after a single treatment and the client is left with pinkish-white scarring. They came to see my yesterday so we could start fading this with FDA approved lasers in hopes they will be able to get it covered up.

I don't do 'non-laser' tattoo removal, but if you have questions in general about what I do or how it works, please ask me. This type of scarring is not a fair trade-off in my mind.

I'm just going to leave the arm with my not so perfect tattoo uncovered with no sunscrean this summer. maybe it will fade enough to get it corrected.

That's honestly about the worst thing you could do.

Search this forum - there have been several longer threads on the lactic acid removal process. I personally have never seen a successful removal or fading without some compromise to the texture of skin.

So now that the picoway is here and operates at those wavelengths, will you be purchasing it? I read it just got FDA approved.

I have no intentions of purchasing it, no. As a rule in my life, I rarely ever purchase first gen anything. Cars, phones, computers, etc. With this technology the initial cost is unfathomable for many people, that is to say these things cost a small fortune.

My interests are there, however I know someone who has first hand knowledge of the Picoway and was not overly impressed with its operation or progress compared to the 1064nm wavelength of a Q-Switch Nd:YAG.

I'll be very blunt here. If I buy a Picosure my prices will increase between 25-50% per treatment to offset the new overhead, if I'm only seeing 5-15% better fading, I can't justify that price increase to my clients, nor will my clients pay that.

The Picosure has only been out in the wild for about 3 years now, and we're just finally starting to see people with 7-12 treatments with it. Meanwhile, the procedure protocols are still being established for Picosure lasers, so there's been a lot of inconstant results across the board, world wide, by users. I'm not in a position to gamble with the integrity of my client's skin until I know things work.

From someone who does laser, my advice for cover-up tattoos is almost always start with laser. With something as dark, heavy and scarred as that it will show through the new piece. Maybe not at first, but a year or two down the road it will, and the scarring will still be felt to finger tips and also visually seen through the new tattoo.

In my experience, a good number of people who come to with similar scarring see a significant reduction from the laser tattoo removal process, so it's more than likely worth a shot.

The other thing to keep in mind here is that the dermis has only so much room. In addition to the pigment that was put in here, it's competing for space with scar tissue. Adding more pigment could result into a less than favorable final product a few years down the road.