Dr. Stephen M: Welcome to Plastic Surgery Talk with Dr. Stephen Mulholland, brought to you by SpaMedica.
Hello and welcome. Dr. Stephen Mulholland back at Toronto, Canada on Plastic Surgery Talk for another installment of our podcast. And this one is on specialized considerations around tattoo removal. Big topic, tattoo removal. I think you’ll find this interesting. In fact, if you find these interesting, entertaining, rewarding, informational, educational, please share, subscribe, and comment.
So what is laser tattoo removal? It’s the use of a specialized laser with special features and technological developments to remove a tattoo without cutting, without surgery. Specialized lasers that are designed to remove the tattoo in as few as many treatments as we can with the fewest number of complications. With the growth and explosion in the popularity of tattoos, there’s also been a reciprocal development of high tech lasers to get the best possible result we’ve ever been able to achieve in laser tattoo removal.
So we talked about what is tattoo removal using a laser. It’s a specialized laser to specifically target the little ink particles in the tattoo. It works beautifully. How common is tattoo removal? It’s quite shocking. There are 45 million people with tattoos in the United States. When you add United States and Canada, there’s about 50 million people with tattoos. That’s a huge part of the population. Up to 20 to 25% across the board. Now if you take millennials, young people, young millennials, there’s 69% of millennials that have a tattoo. In the first time in recorded history, women outnumber men. So tattoos have become very, very common. That’s why you see such a dramatic rise in laser tattoo removal with products like the PicoSure because it’s never been more common. Interesting statistic. There’s up to 30% regret factor within one week of doing a tattoo. So one third of 45 to 50 million people, or 15 million people out there in North America are unhappy with their tattoo. That’s why PicoSure laser tattoo removal is a tremendous growth opportunity if you’re a physician. And a tremendous way to remove your tattoo if you’re a patient. And sometimes, you’re a patient and a physician as well.
So we have a laser and we’ve got a tattoo. Now who’s a good candidate? What kind of patient? What kind of tattoo is a good candidate? Well, first of all, it needs to be a patient that has a reasonable expectation. That is that we can never … Will often never get 100% reduction. We can get significant reduction. How much? 60 to 90% over nine or more treatments. So a realistic patient who’s willing to commit to the number of treatments at the intervals specified to get a nice improvement, almost near total reduction after a series of treatment. So expectation, need to be realistic. A patient who doesn’t have any skin diseases or pathologies in the area are generally medically well. So uncontrolled diabetics are not good candidates. Patients who are not pregnant, who don’t have a pace maker, and whose pigment has been done with professional ink by a reputable tattoo artist. There are certain inks that oxidize on contact and lead to an odd color. So the right ink, the right tattoo, the right expectations, and the right commitment. Because it is a process. It’s a commitment to six to nine treatments minimum to get your 90% reduction. Those are good tattoo removal candidates.
I often get questions from patients who email in or call the clinic. Can I get tattoo removal if I have dark skin? And in the past, we used to say if you have very dark skin and a tattoo, the tattoo is gonna remove some of the pigment of your skin if you have dark melanin. And so you weren’t a candidate. Now, with the newer generation of tattoo removal devices called the picosecond tattoo technologies, the PicoSure, the PicoWay, the Enlighten, these super, short pulse duration tattoo removal devices allow us to treat darker skin types with dark tattoos. So any skin type is a candidate. Generally the lighter the skin type, the more effective the removal. But dark skin types now, Asian, Hispanic, African American, Caribbean skin, Middle Eastern Skin, are also candidates for tattoo removal.
So we hear a lot about different lasers. The most popular laser the last five years by far has been the PicoSure followed by the PicoWay and the Enlighten. What is the unique thing about those devices? They are very, very, uber, short pulse duration. A picosecond is a billion times faster than the blink of an eye. A picosecond is super short pulse duration. The previous generation of lasers were in the nanosecond pulse duration was still very short, but nanosecond is still a factor of a million times slower than a picosecond. So nanosecond pulse duration lasers were things like the RevLite. Devices, like the RevLite, the Medline, the C4, the C6. Generally devices made by ConBio, which is one of the biggest laser manufactures in the world. And the ConBio was bought by Cynosure, that also makes the PicoSure. So Cynosure has a huge array of options.
Now the RevLite, it was the state of the art 10 years ago. Late 2008, nine, 10. The RevLite is nanosecond pulse duration, so it’s short pulse duration, but not super short. Not like the Pico. But it gives you four wavelengths of light. A 1064, a 650, a 590, and a 532. And these four wave lengths, 532, 1064, 650, and 580 allow you to treat almost all color. So the RevLite was really the first four wavelength tattoo with a gated pulse duration through pulse delay that allowed us with a nanosecond pulse duration to treat most tattoos. The problem was, with the RevLite and its brothers and sisters like the MedLite, the C4, the C6, the Trifecta, other devices of that generation was it would take 16 or more treatments to get 50 to 75% reduction of your tattoo. We could treat multi-colors, but it was multiple, multiple treatments. Like two to three years of treatments to get about 50 to 75% reduction. And because it was also heat, it was heating the tattoo as well as shattering the tattoo. The heat would damage some of your natural melanin and you get some hypopigmentation or lightening called ghosting.
So the RL, older generation. Nanosecond, not Pico. Multiple wavelengths, yes, but twice as many treatments as the Pico for a less permanent reduction. 90% versus 50%. And with a higher risk of hypopigmentation. So those are the difference between the Pico and the RevLite. The Pico six to nine treatments, up to 90% reduction, the lowest risk of hypopigmentation, and the best permanent reduction.
So your first big decision, what laser? A PicoSure, a PicoWay, or an Enlighten. Those are the three picosecond pulse durations. And so those two, the PicoSure, PicoWay are the best and by far the most common is the PicoSure. But it’s not just the device. You have to have the right wavelengths in the device. So you want a configuration. And that doctor, that clinic’s PicoSure that has a 1064 if you have darker skin, has 755 Alexandrite PicoSure wavelength for light skin dark ink. So the 755 is great for lighter skin, Asian, Hispanic, Caucasian, who have black, green, purple, blue, tattoo ink. What if you got red or orange? Well, then you need a PicoSure with a 532 wavelength applicator. So you want to make sure you’re using the 532 for your red, orange, and yellow tattoos. You’re using a 755 for your green, dark green, light green, black, and blue, and purple. And then for your dark skin with dark ink, that’s when you need the 1064. So three wavelengths and one PicoSure, that’s what you’re looking for.
So what do you do if you’re a patient with a tattoo and you have olive complected skin, darker complected skin, or black complected skin? You got let’s say a black tattoo on dark brown or very dark brown skin. Well, you’re still gonna seek out a picosecond pulse duration laser. The PicoSure, PicoWay, or the Enlighten. PicoSure, by far the most commonly used. Now it’s not just about the pulse duration, you also need the right wavelength. So you’re gonna pick a 1064 nanometer wavelength, what’s called the 1064. A picosecond pulse duration 1064 is your safest treatment for darker skin type with dark ink tattoo. Now let’s say you live in a town or city with no PicoSure, no PicoWay, no Enlighten. Your next best option is the 1064 in a product called the RevLite. And we talked about the RevLite. It’s an older generation product. It’s still nanosecond. But it still does a good job on black skin or dark skin with dark ink because it’s a 1064 wavelength. You may need up to 16 treatments to get 50 to 75% reduction. But it’s still gonna be a safe option for you.
Is tattoo removal safe? Absolutely. But we’ve been doing laser tattoo removal for 15, over 15 to 20 years and it’s very safe. There’s no systemic risk to your body by breaking up these ink particles. You’re not gonna get the zinc or the oxides traveling through your system and causing dementia or brain problems. There’s a lot of hyperbole online about breaking up the tattoo and causing systemic problems. Never been proven. What has been proven over the last 20 years are there are some risk, but they’re local risk. Local risk to the skin. When you use older generation technology like the RevLite, you’re gonna get some heat and some shockwave effect or photoacoustic effect. So there’s a risk of a burn, of hypopigmentation, of local stalled ink so you get only partial removal. Those are the biggest risks. Lightening of your skin, the risk of a burn and a scar, and only partial removal of the tattoo or stalled ink. Once you get into a picosecond, it’s such a short pulse duration. When the laser hits the skin, the photon, the energy goes through the skin and hits the ink. It shatters it like a shockwave. There’s very little heat.
So a picosecond pulse duration device like the PicoSure acts more like a photoacoustic or shockwave trauma to the ink rather than heat. Without much heat, there’s less risk of a burn. There’s less risk of hypopigmentation or lightening. And it’s safer on darker skin types. So the risk of the laser or local risk, lightening and a scar. And those risks are far less with a picosecond pulse duration because it’s more photoacoustic or shockwave than heat, which is why the PicoSure is still your best bet because the complications and risks are much lower.
No matter what laser you ultimately choose to do your tattoo removal, you’re gonna need to do multiple treatments. Six to nine minimum with a PicoSure, 16 or more with a nanosecond pulse duration like a RevLite. So multiple treatments. Now, what about each treatment? Tattoo removal can be quite uncomfortable. Like any laser, laser hair removal, or a photofacial, or fractional laser wrinkle reduction, any time you’re creating heat or a shockwave in the skin, there’s gonna be stimulation of sensory nerves and it’s gonna be painful. How do we minimize that pain? Well, at SpaMedica, I use a triple approach to pain reduction, which makes it painless tattoo removal if you approached it this way.
First of all, we use some topical anesthetic cream on the tattoo. Something with benzocaine, lidocaine, tetracaine. We put it on top of it for about 15 minutes. That takes a lot of the stinging away. But not all of it. Still about 50% of that pain is still persistent. And so what we do next is we give you a little laughing gas. Some nitrous oxide. And as you’re breathing in this nitrous oxide, it releases an immediate sense of well-being, of giddiness, of happiness. It releases dopamine and serotonin in your brain. And when you’re feeling good like that, that’s when we do the laser treatment if it’s a small tattoo. If it’s a bit bigger, we’ll actually take some very, very dilute lidocaine or freezing. And while you’re feeling good from the nitrous oxide or laughing gas, we do very tiny little microneedle mesotherapy lidocaine in the tattoo. We leave that for eight to 10 minutes and then it is painless. So if you want painless tattoo removal like we offer here at SpaMedica, it’s gonna be topical anesthetic cream, laughing gas, and microneedle delivered lidocaine. And then tattoo removal will not hurt at all.
How long does a treatment take and how long is your recovery? Well, first of all, most tattoos are about the size of a business card. About the size of a business card. And so it takes maybe two minutes to remove that tattoo. So it’s a fairly quick treatment. And when it’s small like that, usually laughing gas and topical is all you need. Once you get into a bit bigger like the size of the palm of your hand, we use topical anesthetic and the laughing gas. Usually that’s enough. But if it smarts a bit, we use some tiny mesotherapy microneedle deliver the lidocaine. And we can do that treatment in about four or five minutes. If you got a larger tattoo like part of a sleeve or something bigger than the palm of your hand, that takes about 20, 25 minutes to do including the topical anesthesia, the laughing gas, and the lidocaine. So it takes between five and 20 minutes. So half an hour.
Once you’ve done the treatment, it creates a little crusting or frosting on the skin. And we put a little topical antibiotic on and a dressing. You want to keep it covered with a bandage for about a week. During that week, it’s kind of crusty and yucky like you fell off your bike when you were young and you got a scape. Do not pick the scab. Just leave the topical antibiotic and the dressing on. Let it heal. After a week, the scab will come off and it’s gonna be healed underneath. And it’s gonna be a bit red and sensitive. So you’re crusty for a week in a dressing, a bandage. Then you are no bandage in the second week. But it’s a little sensitive so you want to avoid the sun, avoid rough activities that could rub or scrape your newly healed over tattoo. And it’s sensitive for about a week. And then usually by about three or four weeks, you can go back out in the sun. You can be more rough and tumble after two to three weeks. We don’t recommend you do another treatment for about six to eight weeks. So it’s six to eight weeks between treatments.
Remember what we said. It’s six to nine treatments to get your final result. So one week of crusting, one week of sensitivity. Generally if you’re in a work sensitive environment where people are gonna be off put by a crusted lesion, you wear a long-sleeve shirt over it. Make sure you cover up your chest. And hopefully you don’t have a head and neck tattoo. For example, eyebrow liner, eyebrow tattooing. We can do that, but it’s a bit crusty and you gotta take some time off work because people can see it.
So how much time should you plan to have your tattoo removal? Well, let’s say you have a wedding coming up and you’ve done a tattoo and you want to get rid of that tattoo. It might only take you two hours to get the tattoo on. But if you’re gonna do six to nine treatments every six to eight weeks, it’s gonna take you a good year to year and a half to remove that tattoo. Now, if you’re gonna come in once a month, once every six weeks and it takes six treatments to get 90% reduction, it might take you as quick as seven or eight months. So plan on some months between starting and finishing. So if you have a big event where you don’t want that tattoo to be seen, like a wedding and you’re gonna have a plunging neckline or open sleeve shirt and you’ve got an arm tattoo, give yourself minimum six months. Better still, one year to get your 90% reduction.
How much does laser tattoo removal, example, with a PicoSure cost? Generally, most clinics will charge by the treatment. You charge by the treatment. Now if you buy a package of three, it might save 10%. Buy a package of six, you might save 20%. But in general, for small tattoos, the size of business card or smaller, it’s gonna cost you anywhere from $99 to $250 per treatment depending on the clinic. If you buy a three pack, you’re gonna save 10 to 15%. You buy a six pack, you’re gonna save upwards of 20%.
What about the size of the palm of your hand? That’s your medium size tattoo. In general, for medium size tattoos, you’re looking at anywhere from $250 a treatment to $500 a treatment. Probably averages four to $500 for treatment for a medium tattoo. Smaller than the palm of your hand, but bigger than a business card.
For larger tattoos, those that are bigger than the size of your hand, upwards even to half a sleeve is gonna be custom pricing depending on size. But in general, larger tattoos the size of your hand are gonna be about 750 to $950 per treatment. Again, you buy a series of treatments, you save the money for a three pack. You might buy a six pack and save up to 20%.
So there’s the rough prices that I see across North America. Individual prices may very depending on the kind of laser a clinic has, the kind of experience they have, and the commitment to the outcome. For example, here at SpaMedica, I have three different picosecond pulse duration lasers. I have a RevLite, I have an [inaudible 00:17:49], I have a Trinity. I have four or five lasers that I can use to make sure you get the best possible result. So we’ll often charge a bit more because within six to nine treatments, we’re gonna give you a better result than anybody. Now you can pay less and see a clinic that’s got a RevLite and do 16 treatments and you pay less per treatment, but it’ll cost you more over time because you’re doing way, way more treatments. So generally, the total global cost to remove these tattoos, it might cost you a couple hundred dollars to get your tattoo and it might cost you 1000 to several thousand dollars to get the tattoo off. So the best way to treat it is just don’t get a tattoo and avoid it in the first place.
So you’ve made that big decision. You got your tattoo. And for whatever reason, you’re disappointed. Welcome to the club. 30% of all tattoo removal patients don’t like their tattoo within one week of doing it. And so be very aware of why you’re doing it, of what is meaningful to you, of what you want to put on your body and your skin for the rest of your life. That’s gonna say something about your life, and what you believe, or what you find attractive, or what you want to project.
So let’s say you get the treatment done. And you’re gonna come in and get a tattoo removal. How to pick the right physician and the right clinic. Well first of all, start doing some work on consultation with Mr. Google. Simply Google laser tattoo removal, your location, your zip code, your city, your town. Or even better, PicoSure laser tattoo removal, your city, your town. Or PicoWay. Or Enlighten. That specific search on the best laser you’re gonna get and find out how many physicians or non-physician clinics have a PicoSure in your city, or your town, or your area of the city, or zip code. And then start going to those websites. Check out those doctors. How long have they been in business, how long they’ve been doing tattoo removal. Then check their before and after photo gallery. Check any video they have on the treatment. Go on their YouTube channel. See if they’re active. Go on their rating sites. Go on Real Self, and Rate MD, and City Search, and Yelp and find out what their tattoo removal patients are saying about them.
And then, of course, do a little consultation screening. Check out two or three places. Find out the pricing. Sometimes cheapest isn’t always the best. You might, again, be getting a less expensive tattoo removal treatment price per treatment, but you’re gonna do it with a non-PicoSure system and end up doing 12, 13, 14, 15 treatments. So the small difference in price is what grossly outbalance by doing way more treatments. So pick the right technology. PicoSure, PicoWay, or RevLite. Pick the right clinic with a lot of experience with different skin types. Make sure that their PicoSure has at least three wavelengths. A 1064, a 532, and of course the 755. If you got white skin or light skin, 755 or 532 for your yellow, orange, red color. Again, or your best option with darker skin as we mentioned, a darker skin’s gonna look for 1064.
So again, thank you for joining me. Dr. Stephen Mulholland here in Toronto, Canada on Plastic Surgery Talk for our latest installment of our podcast this time on a more specialized questions around laser tattoo removal. We talked specifically about the right wavelength, the picosecond pulse duration generations, and some of the factors you need to consider. If you found this podcast and the other podcasts we’ve done interesting, entertaining, informative, please subscribe, share, and comment. See you next time.