Top Tips To Avoid and Minimize Scaring That Can Happen From Laser Tattoo Removal

When considering laser tattoo removal clients often ask “Will I scar?”

Laser tattoo removal with a Q-switched laser is safe, but complications can occur, including scars. The occurrence of scars after laser tattoo removal was of great concern 10 years ago, lasers were more primitive. Q-switched lasers used today do not go that deep into the skin, and the laser’s pulse is fast, this means the ink is the target not the surrounding skin. Complications such as scarring often start with the tattooing. A common finding in clients seeking removal is scars caused by the artist, using a heavy hand. When an artist is not properly trained they do not distribute ink evenly and often time over saturate an area of the design with the placement of deep ink and the improper use of the needles. The result for the client is a new tattoo and a permanent scar.

Certified laser operators, specializing in tattoo removal know how to identify this. At a consultation when a tattoo is examined for possible removal a client should be told if they have existing scars before making the decision to proceed with laser tattoo removal. Tattoo removal can be a slow and costly process so an existing scar potentially leaving behind a ghost image of a tattoo should be identified and discussed in a consult.

Skin Types Most At Risk For Scarring:

Scarring is more common in dark or tanned skin, because the epidural melanin absorbs most of the laser radiation. In a large prospective study of laser tattoo removal there were 6.2% of clients that suffered a complication, 0.28% of those were observed to have scars after five treatments. That’s roughly three in a thousand. Hyper pigmentation, darkening of the skin, was the most common complication. Clients that had scar formation prior to Q-switched laser removal had attempted tattoo removal with intense pulse light beams, continuous wave and argon lasers.  Intense pulsed light (IPL) devices allow for the delivery of light to the skin in a controlled manner, much like a laser does. But, these devices are useful for a variety of dermatologic conditions; they emit light with a mix of wave lengths. Lasers emit light with a single wave length, the wave length is chosen by the practitioner to target a certain color of ink. Argon-ion lasers are used as medical lasers, usually by ophthalmologists to treat retinal phototherapy; they emit a continuous-wave of light energy but are not intended for skin. The study also looked at the old hypothesis that clients seeking to remove “cover ups” had a greater risk of scars. According to the author 97 clients studied had layers of ink/cover ups and suffered no adverse effects. 

Choosing the best tattoo artist for inking, having a Q-switched laser used for removal in a protocol based setting, avoiding aggressive treatments, and examining  the site before the next treatment is started will help clients avoid scars.

When considering laser tattoo removal clients ask “What can I do to prevent scars?”

Follow the advice of your practitioner. Many clients experience redness, swelling, minor wounds or blisters after a laser treatment. These skin effects are normal, and your skin will heal. Do not pick at scabs. Blisters are best left untouched, if blisters are large they can be pricked and allowed to drain, but less is more, just let your skin heal. Normally, 3-10 days after laser tattoo removal the skin has healed.

Immediately after a treatment session we coat the site with Carrasyn Hydrogel and cover the treatment area with a dressing. This provides a moist wound healing environment; maintaining this environment facilities healing. The beneficial effects of a moist versus a dry wound environment include: prevention of tissue dehydration and cell death, along with accelerated angiogenesis. Angiogenesis is a feature of wound healing. As wounds heal they develop new capillaries. The capillary content in healing wounds or tissue may reach three or more times that of normal uninjured tissue. This new vasculature is required to restore oxygenation, allow the growth of new tissue and thus promote adequate healing. In addition, pain is significantly reduced when wounds are covered with an occlusive dressing. The use of Carrasyn and a dressing in maintaining a moist wound environment has proven to be useful in facilitating skin preservation after a laser session. Carrasyn has been called a “healing gel”, it serves as a barrier to pathogens and the moisture reduces the sensation of itching. We suggest that clients leave the dressing in place till they shower and let the shower remove the dressing, this will prevent the dressing from sticking and it makes tape removal non-painful.  Once the dressing is wet it will remove from the skin much easier. 

Aloe Vera, Acquaphor, and Scarrid To Reduce Scarring 

Aloe-Vera Gel (alcohol free), or Acquaphor can be massaged into the site up to four times each day to promote healing and help disperse the ink. Application of Aloe-Vera Gel or Acquaphor can begin as soon as the dressing is removed or the skin has healed. Do not use antibiotic ointments, for example Neosporin, Bacitracin, or Triple Antibiotic Ointment. These products have actually been shown to promote the formation of blisters.

Do your own research and choose the product that is right for you. Products such as “Scarrid” are expensive but appealing to those seeking a natural product.  Do you own an aloe plant? Try the following recipe to create your own gel.  Others chose a silicone gel such as “Scarfade” to fade scars, prevent scars and prevent hyperpigmentation. Practitioners also recommend doing nothing; “less is more” we often say to clients that want to “overly care for the site”. Clients often want to purchase expensive creams and potions, they want to keep dressings over the treated area.  We receive emails from client’s asking us questions about products they have found on the internet. The bottom line is to moisturize the area between sessions, and take care of yourself to promote healing and prevent scarring. 

Strengthen Your Immune System To See Faster Results 

Your immune system is a critical component to good laser tattoo removal.  It would not be inaccurate to say your immune system does ALL of the work, after a laser session.  A strong and healthy immune system will remove destroyed ink much more effectively using Macrophages. Macrophages eat and destroy alien bodies, including ink. For further reading you can see the Harvard Medical Schools ideas on it and here is a more natural approach about boosting your immune system.  Reducing alcohol intake and promoting clean living where your immune system is strong will considerably help your body heal and speed up the removal process.    

Avoiding Sun Exposure

Clients should also avoid sun exposure to the treatment site; UV ray exposure can slow the tattoo removal process by competing with melanin and can cause scarring. One suggestion I often make is to cover the site with maximum strength Desitin. This product contains zinc and other ingredients that soothe and completely protect the skin, even from sunlight. A thick layer, like icing on a cake, applied before going outdoors will protect the site for many hours, even if you go swimming. Always remember to re-apply additional product to maintain a nice layer of protection. Again, you choose. But always choose a sunblock, not a sunscreen. Sunscreens do not give you the protection that you need, they usually contain chemicals that can irritate the treated area and delay healing. Sunblock’s contain zinc oxide as the main ingredient. Zinc oxide will physically block the UV rays from the treated site.

Further information about studies referenced and the incidence of Hypertrophic Scarring can be found in the May 1, 2016 JCAD here.