Did tattoo laser removal stop working on me? (Photos)

Question

I am on treatment number 7 total. 5 with q-switched laser and 2 with pico sure . I haven't seen any changes since Last 3 treatments. Is not frosting anymore - what does that mean? Should I keep going or do I need to look for something different?

Jason Emer, MD · Answer

It takes a series of treatments with laser tattoo removal and the amount of sessions needed can be variable. Eclipse MicropenTR is an alternative. I recommend getting a formal evaluation with a tattoo removal expert. Best, Dr. Emer

Richard Rosol, MD · Answer

Treatment plateau is a common problem. Often, as already stated in other answers, this occurs as deeper ink goes "out of reach" of the treatment beam, and the highly organized light scatters and weakens as it passes through the tissue on its way to the ink. By the time it gets there, it might no longer be coherent. Another way of saying it's worthless.
In response to this, an important strategy for the operator is to LOWER the treatment energy, where many would expect that the opposite is necessary. Less-intense light undergoes less scatter, in just the same way driving with low-beam headlights allows you to see deeper into a dense fog than using high beams. Erroneously increasing energy works very much against you and increases side effects. Tightly focused, high-energy beams can also elicit frosting on normal, un-tattooed skin, lulling one into believing the treatment is working, when it's not.
With deep ink, it's all about the SNAP, not the frosting.  If an audible snap is heard, however quiet it is, ink shattering is occurring. With lower energy, more passes can (and should) be made. Since there's no frosting, an optical clearing agent, such as a perfluorodecalin patch, would be unnecessary.
Understanding these aspects of the physics and anatomy of stubborn tattoos, I have excellent success getting them over the finish line with my PicoSure laser, and your operator should be able to do the same.
Good luck to you!

Mark Taylor, MD · Answer

When tattoo ink is place deeply in the skin it may not respond completely to Q-Swtiched or Picosecond lasers alone.  A new technique is to use a small spot erbium laser (e.g. Fotona SP Dynamis) and drill small tiny laser holes through the resistant tattoo ink and then use the Q-swtiched or picoseond laser.  This will eject the ink out of the tiny holes and can usually get rid of the rest of the ink.  May take a few more treatments.

Jared Mallalieu, DO · Answer

The Pico may help (but not always) speed things up. You could look for a provider who has a Ruby laser (we use this for resistant black inks) or a provider who offers PFD patch. This allows form multiple treatments in a single setting. Best of luck, Dr. M

Laura Riehm, MD · Answer

Thanks for your question and posting pictures.  You would see much faster results with a picosecond laser.  That being said, your tattoo removal progress is really determined by your metabolism.  Lasers can only break up the ink into smaller particles.  It's up to your body's lymphatic systems ability to carry it away.  We recommend waiting 2-4 months between treatments.  It's going to take several treatments to get rid of the lines and very dark shading on your tattoo.  After doing PicoSure tattoo removal for almost 3 years, you have to constantly change the settings.  Your ink is constantly moving and the technician has to adjust the setting to go deeper or more shallow on each treatment.  After 7 treatments, we would recommend only treating your tattoo every 6 months and let your body break down as much ink as possible.  Best of luck.

Jessica H. Kim, MD, FAAD · Answer

Photos show a black-inked tattoo which would be most responsive with a 1064nm wavelength and with the new picosecond technology.  This would include Enlighten or Picoway.  Consult with a board-certified and experienced physician.

Did tattoo laser removal stop working on me? (Photos)

Answers (6)

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