Combination Therapies May Be Best for Tattoo Removal | Laser Service Solutions
Ryan Koenig

With the increase in demand for tattoo removal, practitioners and medspa businesses are looking for the best way to accommodate this need. Once thought to be permanent, today, aesthetic laser equipment makes it possible to eliminate the ink fully or partially. 

There are many different options for tattoo removal but some of the best are non-invasive laser products. As laser technology continues to improve, more and more of these products hit the market. A recent presentation offered by Agneta Troilius Rubin, M.D., indicates that a combination treatment provides the best outcomes for patients. Practices that want to offer tattoo removal have a lot to consider. 

The Industry Standard 

The current standard for tattoo removal is the Q-switched laser, sometimes called giant pulse formation. The Q-switched laser produces lower repetition rates but more energies with each pulse and longer durations. 

During this therapy, various lasers work to remove different pigments in the tattoo based on light absorption rates. Certain colors are more of a challenge to remove this way including yellows and greens. Q-switched lasers fail to reach deep-intradermal pigment, as well. 

Picosecond Lasers 

The picosecond laser emits short pulses, typically less than one nanosecond. The technique is more effective for clearing out green and blue pigments that resist the Q-switched approach to tattoo removal and for multicolored tattoos. However, this methodology may not be the right choice for patients with darker skin tones as they tend to be more likely to suffer side effects from the treatment such as scarring or hyperpigmentation. 

It also tends to be faster and requires fewer sessions. The picosecond laser provides precision that is hard to find in other laser models. 

Approved by the Food and Drug Administration in 2012, the picosecond laser has also shown effective in the removal of acne scarring, photoaging and wrinkles. 

CO2 Lasers 

The CO2 laser in one of the first to use gas. The application of CO2 gas allows the laser to emit a continuous wave effective for tattoos that are in aesthetic places like the face. 

The frequency of light produced by the CO2 laser absorbs well in light, making this an effective option for soft tissue procedures. CO2 vaporization reduces side effects such as swelling, redness and initial drainage. Aesthetic equipment like the CO2 laser can help calm patients who worry about how they will look after the removal. 

Tattoos with white metallic compounds do poorly under pigment-specific therapies since the treatment can color instead of fading it. A CO2 laser is a handy option for tattoos at risk of darkening because they do not target a set color or ink. 


The rapid-heating of tattoo ink seen in other laser methods can cause vacuoles to form in skin cells. Multiple-pass methods offer a way to remove the tattoo through epidermal clearance using the R20 protocol for accelerated removal along with the perfluorodecalin (PFD) patch. 

The PFD patch contains perfluorodecalin-infused silicon gel to reduce laser frost that inhibits additional light energy from hitting the targeted area. The goal is to fade the tattoo faster and safely, reducing the number of visits required for the patient. 

Combination Treatments 

Although studies have yet to confirm that the use of combination treatment is the most effective for tattoo removal, industry experts like Dr. Rubin support it. Dr. Rubin indicates that results from five patients show better clearing using combinations like: 

  • Nonablative fractional laser plus Er: YAG 
  • Er: YAG plus Er: YAG along with CO2 plus Er: YAG 

These treatments saw positive outcomes in just three sessions. 

Dr. Rubin also suggests acoustic shockwave with picosecond laser is effective, according to a recent study. The research indicates an 80 percent clearance with this combination of treatment methods. For dark tattoos using blue and black pigments, the combination of CO2 and the Nd: YAG laser treatment has worked on Indian skin, as well. 

Grow Your Skincare Business with Laser Technology 

The demand for successful tattoo removal treatment is growing and practices who are looking to accommodate that trend may want to explore the benefits of combination therapies via an Alma laser or aesthetic laser rental. Contact us at Laser Service Solutions to ask questions and find out about laser equipment for sale. 

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