Tattoo removal on dark tattoo, done within the last year. (photos)

Question

I made 2 mistakes and got tattoos ignoring the fact I've never been a fan, one in April and one in July. Now I'm paying for my mistakes and going through the removal process, they have made me hate my body. I have been done 2 sessions and yes I am seeing results but wanting opinions on Alex trivantage vs picosure, my clinic uses Alex trivantage. My sun is just lines, and on the back of my arm, same arm. Will post more when I get the chance. They are both black. Thank you in advance

Adaeze Okeke, MD · Answer

Actually neither of those lasers is optimal for your tattoo. The AlexTriVantage may remove some of the ink, but you have a higher risk of hypo pigmentation with that laser (removing some of your natural pigment). The Picosure may remove some of the ink without the risk of hypo pigmentation but it is not ideal for dark ink. Between the two I would use the Picosure.

You are not the first and certainly won't be the last person who has gotten a tattoo that they regret. These tattoos don't define you, they are merely marks on your skin. We all tend to see our imperfections first and think that they are emblazoned across our foreheads for all the world to gawk at. In reality we are our own worst critics. These two tattoos are no reasons to hate your body,  please don't beat yourself up over a youthful mistake. Good luck!

Jason Emer, MD · Answer

Based on one of your pictures, you are blistering with treatment. Regardless of which type of laser, blistering sometimes does occur with tattoo removal, it's not the desired outcome. The skin must completely heal prior to future treatments. I usually wait about 6 weeks between treatments. Make sure you consult with your doctor regarding wound care. Each Doctor will have their preferred laser. I use the Medio Star/Tattoo Star Combo. See an expert. Best, Dr. Emer

Jeffrey Gosin, MD, FACS · Answer

There are many different tattoo removal lasers.  The 1064nm, which the Trivantage has, should be effective in lightening the dark ink.  As the ink begins to fade, you might see faster results with a 1064nm pico laser.  An example of that would be Enlighten.  In my opinion, I don't think that Picosure provides any advantage in your tattoo. The ink in your tattoo is very dense.  You should expect that removal will be along process, requiring many treatments.  It is likely that there will still be at least a hint of the ink remaining over time, regardless of the laser used.

Daniel J. Ritacca, MD · Answer

Pico lasers are the most advanced technology. I utilize and prefer the PiQo4 laser which has 4 Pico wavelengths including the 1064 wavelength for black pigment. The amount of treatments can vary based on several factors such as the location of your tattoo, your skin tone, how sharp the ink is, and how quickly your body eliminates the ink. Even with advanced lasers and multiple wavelengths complete removal is not always possible. I believe that tattoos are removed faster and safer with Pico lasers and there is less risk of scarring. I think it is important not only to seek the best technology but an experienced laser tattoo removal provider. Best wishes.

Susan Fox, DO, RPVI · Answer

Alex trivantage uses nano technology and is a Q switch laser which hurts more, causes more scarring and blistering and is slower to remove the ink compared to pico technology. We recommend pico technology as it is quicker at removing the ink, less risk of scarring or burning and faster clearance of the ink. For dark tattoos, I prefer the Pico technology especially the PIcoway 1064 for dark ink on any color skin.

Laura Riehm, MD · Answer

Thanks for your question.  You have 2 routes for laser tattoo removal.  You have a lot of dark ink.  The Alex Trivantage is a Q-Switch laser.  We have been using PicoSure for over 2 years and have completely eliminated dark ink tattoos.Q-Switch or nanosecond lasers came out about 20 years ago.  Picosecond laser came out about 3 years ago.  The majority of former Q-Switch patients we see have significant hypopigmentation (ghosting) around and under their tattoo.  The Q-Switch lasers have trouble differentiating between the melanin in your skin and ink.  The technology uses heat to burn the pigment out of your skin.  In addition, we have seen patients with raised scars as if they have been branded.  Both of these condition are irreversible.  Picosecond lasers (like the Enlighten, PicoWay & PicoSure) fire 1000 times faster, using a pressure wave rather than heat to shear the ink molecules apart.  After using the PicoSure for almost 2 years, we have only seen pinpoint hypopigmentation in a very small number of patients usually of darker skin tones.  We cannot say it is impossible to get burned with a Picosecond laser, but it is highly unlikely.  We tell every PicoSure tattoo patient to expect at least 6 treatments, but don’t be surprised if it takes 10 to 12.  Patience is the key for our patients.  We typically see our tattoo removal patients every 8 to 12 weeks initially.  If they have more time than money, we encourage them to come every 6 months as the tattoos seem to continue to fade while they wait.Treatment prices vary by market.  The cost for picosecond treatments will be higher, but you should need less than half the treatments compared to a nanosecond laser.

Glenn Messina, MD · Answer

I believe your tattoo is all black which is good, however it has a significant ink load. THe tree being solid black vs just empty branches. The trivantage has several different wavelengths 755 and 1064. The 1064 would be better in your circumstance because the 755 will not be as strong for the black inks.

I am fairly sure the 1064 adapter comes standard with that laser so make sure they are using that. If not you can keep going although it will not be as effective or find a practice with a strong Q switched YAG. ( Picosecond lasers do not have the striking force in the early tattoo removal sessions to be very effective) A large thick black ink tattoo like yours will likely require 12 or more sessions.  I hope this was helpful

Steven F. Weiner, MD · Answer

What you are showing is a blistered treated tattoo. Blistering occurs when too much power is done too superficially. When a laser is not powerful enough, it takes small spot sizes to get the desired outcomes. The smaller the spot size, the more superficial the heat. The blisters need attention with specific creams and ointments. Picosure is not the right laser for this tattoo because it is a 755 wavelength. This is great for greens but not black ink. You need a 1064 laser that is more powerful. There are only 2 I recommend, Enlighten and Piqo4. These have both nano and picosecond pulses. The Piqo4 is much more powerful so the treatments will be more effective and safer (larger spot sizes, deeper energy). The Piqo4 also has 4 wavelengths so all colors can be treated. R0 gives faster clearance.

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