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Today, the market for tattoo removal is dominated by q-switched lasers. Prior to the 90's there were no good solutions for tattoo removal that were in wide usage. Non-q-switched lasers were sometimes employed but had severe side effects of burns and scarring. Similarly, dermabrasion and acid peels could remove tattoos but also left scars and burns.
Q-switched lasers came into wide utilization in the 90's and quickly became the most common and accepted modality for removal of tattoos. There are only three types of q-switched lasers that are currently available. They include Nd:YAG, ruby and alexandrite. There are subtle but important differences among these. Also, there are multiple laser manufacturers that supply one or more of these types of lasers and sometimes combine two in one platform.
Nd:YAG (shortened: YAG) is a crystal that emits light at the wavelength of 1064 nm. It is absorbed well by certain tattoo pigments, especially black. Using a technique called frequency doubling, most machines that use YAG are also able to emit light at 532 nm, which is useful against red and brown tattoos inks. Blue and green color inks do not absorb the YAG light as well and consequently much higher energies are required for the same effect at 1064 nm. The other problem with YAG is that the 532 nm wavelength also interacts with melanin. This causes loss of skin pigment and blistering (though mild) in treated areas. In dark-skinned individuals this side-effect makes removal of red tattoos prohibitive. Red ink may be less visible than the hypopigmentation that accompanies the removal of red tattoos on dark skin, although this is usually temporary. Hoya Conbio which makes the Revlite and Medlite is the market leader but multiple others are on the market, notably Palomar and Asclepion.
Ruby crystal emits light at 694 nm. This makes it an ideal tool for removal of blue and green tattoos that absorb light closer to this wavelength. There is still some melanin absorption, but not as severe as with 532 nm. Ruby was the first q-switched laser on the market. It is disadvantaged by certain inherent characteristics of the ruby. It cannot fire as quickly as similarly powered YAG lasers. Whereas a YAG can be fired as fast as 10 Hz (10 shots/second), a ruby can only be fired up to 2 Hz. Currently there are only a handful of manufacturers that still make a q-switched ruby laser for tattoo removal. Asclepion is the main manufacturer of ruby lasers today.
Alexandrite laser emits light at 755 nm and is the idea wavelength for green tattoos. As a non-q-switched laser, it is also still commonly used for hair removal. Alexandrite is still the base platform for Candela's tattoo removal machines.
At the present time, YAG laser tattoo removal machines dominate the market in comparison to alexandrite and ruby. This is due to their greater reliability, speed and emssion at two wavelengths instead of one. Additionally, dye handpiece attachments made by Hoya Conbio allow green and blue tattoo inks to be better targeted, although these are slow and limited in laser spot size. A number of manufacturers, including Lumenis, Asclepion and Candela have combined YAG with ruby or alexandrite to create a more versatile laser. Although this creates a laser that is best at both blue/green and black/red tattoos, they are usually more expensive and more prone to breakdown. Frequently power or some other ability has to be sacrificed in the making of these combination machines. Also, if breakdown occurs, the tattoo removal practice is dead in the water until the laser can be fixed. Some lasers have a much better reputation than others in frequency and expense of breakdowns.
Overall, if one has to choose a single laser for their tattoo removal practice, it would have to be the YAG. Adding another laser, such as the ruby or alexandrite to a stand-alone YAG appears to be a good option that increases the spectrum of tattoos that can be treated well and increases the flexibility of the practice.
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