Best Practices for Laser Tattoo Removal - Laser Service Solutions
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Growing Demand for Laser Tattoo Removal

The tattoo industry is experiencing massive growth, but so is the demand for tattoo removal. Aesthetic laser equipment is an effective way to remove tattoos partially or completely. This article explores the available laser technologies and the risks associated with laser tattoo removal and how to ensure the safety of practitioners and customers.

Laser Technology for Tattoo Removal

This section discusses different laser technologies for tattoo removal, their effectiveness in removing different pigments, and their side effect on different skin tones. The laser technologies discussed are Q-switched laser, picosecond laser, CO2 laser, and Multiple-Pass.

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 Therapy for Tattoo Removal

Experts recommend combination therapies for tattoo removal for better outcomes. This section discusses some of the most effective combination therapies and their effectiveness.

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. 

Related article: Success of Combined Therapy for Scar Treatment.

Safety Measures for Laser Tattoo Removal

This section address the risks associated with laser tattoo removal and how to ensure the safety of practitioners and customers. The section highlights the results of a study conducted by the Centers for Disease Control and Prevention and the guidelines issued to improve safety during the process. Additionally, it offers tips to ensure safety, such as using “Laser in Use” signs, installing smoke evacuators, and monitoring eyewear protection.

In response to these practice staff member concerns, in 2017 the Centers for Disease Control and Prevention (CDC) did a study to pin down the risks of laser tattoo removal. They found: 

  • The air samples showed the concentrations of metal were below occupational exposure limits. 
  • Air samples indicated small levels of acetone, xylene and isopropyl alcohol present during a procedure. 
  • The highest concentration of airborne particles was near the practitioner doing the procedure as opposed to other areas in the room. In addition, no airborne particles move outside the room during the laser operation. 
  • There is no sign of carbon monoxide or hydrogen sulfide in the room. 

They also noted misuse of “Laser in Use” signs and outdated eyewear protection could lead to workplace accidents when using all products including a used cosmetic laser. 

After completing the study, the Health Hazard Evaluation Program of the Centers for Disease Control and Prevention issued guidelines to improve safety during this process. 

Be Informed About Your Laser Equipment

Laser technology manufacturers should provide detailed information on their aesthetic lasers including: 

  • Shelf life 
  • Storage conditions 
  • Cleaning methods for eyewear 

Providing proper information about laser products is a standard instituted by the American National Standards Institute (ANSI) in Z136.3 section 4.6.2. If that information is not available, contact the manufacturer and ask for it.   

“Laser in Use” Signs  

Make “Laser in Use” signs available to staff and ensure they post them only when someone is using the machine. The goal is to prevent accidental eye exposures to the laser when in operation. When the sign is always up or not used, it increases the risk of a staff member walking into a procedure room when the laser is in operation. 

Smoke Evacuators 

Install them in all rooms equipped with lasers. They help remove odors during the procedure. Their use for laser tattoo removal is similar to usage for laser hair removal. 

Eliminate Masks 

Practices can stop using a laser or molded surgical mask during tattoo removal. If staff prefers that kind of protection, use a filtering facepiece respirator with The National Institute for Occupational Safety and Health (NIOSH) approval. NIOSH is the U.S. agency that makes recommendations for preventing workplace injuries and illness. 

Maintain Compliance for Respiratory Protection 

Although there is no evidence that wearing respiratory protection is necessary during tattoo removal procedures, there are some Occupational Safety and Health Administration (OSHA) regulations for voluntary use (standard CFR 1910.134). 

Contact the Department of Environmental Health and Safety for your state to see what the regulations are and that you are in full compliance. 

Use NIOSH Approved Filtering Facepiece Respirators 

When purchasing respirators, establish that they are certified by NIOSH, for example, like the N95 product. The CDC, the governing body of NIOSH, offers a list of N95 products

Monitor Eyewear Protection 

Routinely check all laser protection eyewear to see that they have labels that state the optical density and wavelength specifications for that product as per the ANSI standard Z163.3 section Discard and replace any pieces without labeling or with labels that are unreadable. 

With the right safety guidelines in place, tattoo removal is a revenue-building feature worth adding to your practice.  

Grow Your Skincare Business with Laser Tattoo Removal

Tattoo removal is a growing trend that is worth considering for aesthetic clinics. Investing in laser technology and implementing safety measures is necessary to protect practitioners and customers. Contact Laser Service Solutions to learn about the available aesthetic laser equipment, including pre-owned medical lasers, and the guidelines for laser tattoo removal.

For more information on aesthetic laser equipment and safety measures for tattoo removal, contact Laser Service Solutions today.

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