LASER FOR TATTOOS

NATURE OF THE PROCEDURE

The laser is a beam of light that will selectively target certain tissues based on the wavelength chosen. We know from experience exactly which wavelength to chose for certain colors, and when the laser beam hits the targeted tissue, that particular wavelength is selectively absorbed into the pigment of the tattoo. At that point, the light turns into heat, and the heat "explodes" the pigment itself. Once this happens, the pigment particles have been reduced to fine "dust" and the body scavenger cells (macrophages) carry the pigment away. You might wonder why this didn’t happen originally, but when the tattoo was originally applied, the globs of pigment were too big to be engulfed by these cells. We are simply enabling the body to clear this pigment.

Unfortunately, we cannot control what type of pigment was used, how much, or the depth. Some colors are much more difficult to remove than others (particularly red, yellow, and green) and certain fluorescent pigments are almost impossible to remove. Some tattoos are now made with "laser resistant ink" and this is impossible to treat. Dr. Coverman uses the Erbium:YAG laser at 532 nm or 1064 nm; he also uses the Alexandrite at 755 nm. Depending on the color or your prior tissue response, he will choose what is best.

Once we fragment this pigment, we cannot predict what the body is going to do with it - not how much, nor how quickly. In general, even under the best of circumstances, we have learned from experience that you are going to need at least two sessions, usually a minimum of two months apart. The longer you wait between sessions, the better since there is more natural clearing by the body. Sometimes it can take three, four or five sessions, and sometimes the ink is never fully cleared because the body just isn’t going to do it.

Because of this, Dr. Coverman always tells patients that tattoos will be "faded." This can be 100%. Sometimes however, there may be some residual pigment that will just never come out. No percentage of improvement can be made per session, per area, or overall after all treatment sessions.

Dr. Coverman has extensive photos available for you to see how this procedure progressed in other patients.

FEES

The fee is based strictly on the size of the tattoo and how much time it is going to take. The minimum fee for any tattoo is $500, and a rough guideline is as follows:

Minimum fee - $500 - PER SESSION

3 inches by 3 inches - $500 - PER SESSION

3 inches by 5 inches - $600 - PER SESSION

Other variables that might affect the fee and cause it to be more might be the anatomic location such as a sensitive area on the face, or how much ink there is. Some tattoos are fairly "broken up" with normal skin in between, and other tattoos are solid. If there is solid ink, it will require much more time, and many more passes of the laser beam.

It is stressed that these figures are not firm or guaranteed, and all prices can only be quoted after Dr. Coverman has seen the patient, and made an individual, case-by-case determination.

All fees are subject to change. The fee is always what is current at the time of your actual treatment. Old fee schedules, handouts, or web site fees do not apply. Any quoted fees must be in writing and are only good for six months. No "verbal" quotes are accepted.

These fees are PER TREATMENT SESSION and additional full fees will be charged for EACH treatment session.

SCHEDULING

Dr. Coverman must see you first to determine if you are a candidate. There is a separate fee for this visit. He will examine, measure, and photograph your tattoo. He will discuss risks, benefits, alternatives, and fees. The type of ink will be important, plus history of prior scarring. The actual treatment fee will be IN ADDITION to the consultation fee, and the treatment will be performed on a different date.

Dr. Coverman does not offer "free" consultations.

There is a $150 non-refundable fee for missed appointments without a 24 hour notice. If you need to cancel, please record the date, time, and name of the person you spoke with.

PRETREATMENT

Dr. Coverman or his assistants will inject a local anesthetic, and there is no extra charge for this. It makes the treatment painless at that point.

If you have ever had herpes or think you may have (cold sores or fever blisters in or near the treated areas), inform Dr. Coverman or our staff prior to scheduling your appointment. We will give you a series of anti-herpes pills to take the day before the treatment, the day of, and the day after. This should help or suppress or prevent herpes from flaring, but there are no guarantees. A herpes flare could cause pain, pigment, infection, and scarring.

TREATMENT DAY

You will be wide awake and just wearing goggles. Once the treatment begins you shouldn't feel anything.

POST TREATMENT

Special wound care instructions will be given to you, and often a special gel dressing will be applied (at extra charge) which reduces any discomfort afterward and gives much better healing with less chance of any scar. This product (Vigilon) is available at our office.

POST-TREATMENT PAIN

For normal post-operative pain following most of the procedures that we perform in our office, we do not recommend nor prescribe any of the stronger pain medicines including hydrocodone (Lortab; Darvocet N100; Mepergan Fortis; Ultram). We feel that a combination described below of over-the-counter medicines will be enough. This is what we recommend:

Take one Aleve or Advil pill every 4-6 hours with food. Wash it down well with liquid. Breakfast, lunch, dinner and bedtime snack.
Do not take Aleve or Advil if you are allergic to aspirin, ibuprofen, naproxin, these pills, or have any type of aspirin sensitivity or the syndrome of nasal polyps, allergies, atopic eczema, and aspirin-allergy. Likewise, do not take this if you have any bleeding problems, or have ever had any ulcer disease or similar stomach disease.
We also recommend that you take two Extra Strength (500 mg) Tylenol tablets every 4-6 hours as well at the same time.
Please remember that the side effects of Tylenol have nothing to do with the side effects of Aleve or Advil, thus these may be taken together.

If you have any liver disease or potential liver problems, do not take the Tylenol. Do not take Tylenol if you are allergic to it or acetaminophen. DO NOT DRINK ALCOHOL WITH THIS REGIMEN! Otherwise, follow the schedule below:

8:00 a.m. - Breakfast
One Aleve or Advil with breakfast and plenty of water.
Two 500 mg Tylenol for adults.
12 Noon to 2:00 p.m. - Lunch
One Aleve or Advil with lunch and plenty of water.
Two more 500 mg Tylenol.
6:00 p.m. - Dinner
One Aleve or Advil with dinner and plenty of water.
Two more Tylenol.
10:00 p.m. to midnight - Bedtime
One Aleve or Advil at bedtime and plenty of water.
Two more Tylenol.
Benadryl (diphenhydramine) 25-50 mg for sleep.

The Benadryl is a great idea. It is the main component of most over-the-counter sleeping pills. (Tylenol PM), and is not addicting. Never drink alcohol before or with this, and plan on going right to sleep and sleeping 8 hours. DO NOT take with any other sleeping pill, anti-depressant, MAO inhibitor, or anti-anxiety drug (Xanax, Valium, etc.). Do not drive or operate dangerous equipment.

Thus, in any given day you should never take more than the total of four Advil or Aleve or eight Tylenol total (two every four to six hours).

Normally you should be able to safely do this for one to three days - but never more. If the pain ever worsens or this fails to control it - call our office during normal office hours or the medical exchange (458-1121) after hours.

This combination of Aleve or Advil plus Tylenol is safe, covers you around the clock, and allows you to take two different pain medicines whose side effects don’t cross react with each other assuming you are not allergic to either.

COMPLICATIONS

As with any ablative surgical procedure that can be unwanted pigment (whether lighter or darker) as well as scarring and hair loss in the treated area.

Because the laser beam may be wider than some areas of the tattoo, there could be unwanted gain (or loss) of pigment beyond the actual tattoo borders. This is unavoidable.

There could be infection or scarring.

Certain tattoo inks could actually change to another, possibly unwanted color.

Certain inks may be "laser resistant."

Certain colors (green, red, yellow, purple) are harder to fade, if at all.

There is no guarantee as to what percentage of the tattoo will fade per treatment session or overall after all treatment sessions.

FOLLOW-UP

Usually none is necessary - We normally recommend repeat treatments no sooner than two months.

You may go back to work after your treatment, but use common sense! Physical labor, gym workouts, gardening, etc. are prohibited! There will be an open wound, although bandaged.

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