Wednesday, May 23, 2012

The Second Pass Method?

Hello everyone! Been a few months...

Well, I called the dermatologist's office the other day to make an appointment, and unlike usual, they said, "we have an appointment tomorrow". So instead of waiting weeks and posting my next treatment date, I just went in and had number 13 done yesterday.

As usual, the assistant takes photos before injecting me with anesthesia, but this time she said she would need to check with the PA if we would even do a treatment due to how little ink is remaining, which is not what I wanted to hear, because I want ALL of the ink gone as best as possible. I still thought at that point we could do more. I'm sure you'll agree, so here are some pics of where the tattoo was at the day before treatment number 13 and morning of this latest treatment as well. At this point, lighting is everything when it comes to accurately documenting the amount of ink left. Bright lights tend to reflect the white of the scar tissue still remaining, but low lights, such as that in shady areas or indoors, will not have as much light to reflect back onto the observing eye, so you get a better view of the tattoo. I took several pics in different lighting, so you can see what I mean.

The photos below are after 12 treatments of laser tattoo removal in full sunlight, and it been almost 4 months since my last treatment. 

Laser Tattoo Removal After 12 Treatments May 2012

Laser Tattoo Removal After 12 Treatments
Laser Tattoo Removal After 12 Treatments

This is when I most enjoy my arm and the tattoo removal. That is when I am outside under the bright light of the desert sun. Viewing the remaining pigments is more difficult, so I feel more comfortable wearing tank tops and exposing the faded tattoo than I do when I am indoors. I guess outside (as some have remarked) it looks more like a scar of some sorts, though I know they are just being nice :). 

Left Side - Laser Tattoo Removal

Right Side - Laser Tattoo Removal

This is also outdoors, but it is under the lower light of a shaded porch, so the darker inks are more visible. One thing I love best about this process so far, including not just the laser tattoo removal but the tanning project to even out my skin tone as well, is the way the far left side of the tattoo has blended with the rest of my skin pigment. In months and years prior, this side looked the most scarred, but it has turned out to be a well blended and healed area with minimal black ink remaining. I don't think I am recommending tanning (that's dangerous), but I am not saying to avoid the sun all together, especially when you get to the point where you want to see what the tattoo will look like if this were the end of the removal process. It may also signify that the process is not over, as has been my experience.

This was taken indoors and shows how the tattoo would look today if you were standing next to me. The tattoo is clearly (at least to me) still there and obviously was what it was. Not quite done!

Laser Tattoo Removal After 12 Treatments May 2012

The dermatologists office is with me on removing this thing entirely, but I knew that when the PA came in to analyze the progress, she might come recommending something other than lasers (dermabrasion...maybe). I was sitting there waiting and thinking, "am I ready for this and is this the direction I want to go?". 

When the PA came in to the room, her thought was that the ink was deep and that the lasers we had been using were exhausted to their capacity as far as this tattoo is concerned. She thought that the doctor might want cut my tattoo open and then do a laser tattoo removal treatment while that bit of flesh was open.....what?! OMG! Ouch! She said that we had talked previously of this method, but I did not remember that. How invasive and scary is that? Now thinking back on it, what I remember was us talking about doing 3 to 4 treatments of dermabrasion on it, not open-skin-laser-removal method, ouch! Talk about a deep burn. This is good information for those considering all of their options and wanting to see where these paths could lead, as this may be an option if going to a medical clinic. Not sure anyone would want to try this, but it is apparently an option for some.

The doctor came into the room and thoroughly looked it over. His professional opinion was that the newer (research supported - as I was told) and less invasive method of "multiple passes" or "second pass" and "third passes" might be beneficial. In the second pass method, that I did receive, the specialist does one laser (Q-plus or "Ruby Laser") that breaks up the pigments and then have me wait in a lounge area for 15 minutes.
This is me waiting and patiently amusing myself. 

 After waiting for a period of time, my wait ended up being a 30 minutes, I am brought back and a second laser (trivantage) that works by further breaking up the pigments that have already broken-up during the wait. Normally, I get both lasers (...I think), but usually there is just no wait period.My thought also was that they target different inks, but the second laser may be a more catch all type.

In the end, it ended up seeming to hurt more that first day, but so far, that was the only difference. I could be wrong about the increased pain. After all, it has been nearly 4 months since my last treatment.

So I am curious, does anyone else get second pass treatments? Is this new to you too? What do you think given your understanding of the technology?

Also, for the next time, I will be getting "third pass treatments", but the third laser will be entirely new to my skin!! I've never received a treatment by the future number 3.For a sneak peak, the third laser is more cosmetic, and it is not intended to remove any of the tattoo.

I'll keep you posted on all that. I also think this blog is long over due for side-by-sides, and I have paintshop again, so I'll finally be able to get that done. 


  1. hey sarah,
    it is friday evening and I have my seventh appointment tomorrow morning first thing. find that I cannot relax for the weekend until the last smack of the laser. taking my punishment like a man!
    cutting open the tattoo and then lasering it??? that sounds totally mental, I cannot believe that is an option. the pain would be unbearable. even if it was a swastika on my forehead I would have serious concerns about going down that path. do people really go through that? jesus wept.
    with my limited knowledge I have never heard of second pass treatments. again I think it would be too painful. one session then recovery for two months suits me just fine (well, not fine but I can cope). after 700 or so hits with a laser I could not face a break and then another go, the skin would just be too bloody sore.
    looking at your photos it looks as though there really is sod all ink left and it just needs to recover now. I am sure the scarring will calm down given time and gradually blend in with the rest of your skin.
    besides nobody will be looking at your arm when they have that beautiful face to look at.
    great blog.

    1. I hope your treatment went well! I do not know if that clinic has really ever done it before or if they were just suggesting it to me... eeek! Thanks for your kind comments, and let me know how it all progresses.

  2. Hi Sarah! I'm reading you from all the way here in Singapore :) Firstly, you're beautiful. Thank you for sharing your tattoo-removal process in such detail with all of us. I have a butterfly tattoo on my shoulder and I'm thinking of getting it lasered off, too. I'm just not sure if it would end up looking like a discolored patch of scar, considering how deep the ink seems (I can literally feel its shape whenever I touch it) I'll keep checking back here for updates!! Hopefully then I'll come to a conclusion. God bless :)

    1. Thank you! Good to hear from the international readers as well. I too have seen many tattoo removals that look like scared patches with remnants of ink in them, and that is definitely not desirable. I always wonder myself, "how bad was that tattoo?". I definitely do not want that as the end result either. My personal opinion: I tend to think that if I had a tattoo on my back that I did not like (or even loathed) I would just leave it, but it is definitely a personal choice. Good luck with the decision process, and thanks again!

  3. Whoa I think I'm in love.

  4. Hey Sarah,

    I heard of that second pass procedure. It's called R20 method. I just started my tattoo removal journey. I just got my third laser done yesterday. While I was researching, I came across a doctor in NY that had trials for the R20 method. However, he did 4x passed over, not 2. I'm thinking about doing it to expedite the removal process. Did it hurt the on the second passing? Did they charge you extra? Also, I think your tattoo (or lack there of) looks good. I would rather that than the ratchetness that I have inked on me -__-

  5. Anonymous,

    That's interesting and thank you for the link! I had only two passes, not four, but next time I will have three passes, but each of the three passes will be from different lasers not just the Q-switched. I was not charged any extra though next time I will be, but not by much. My fee now is $250, down from $350 as I'm well over the number of treatments that I was originally quoted (8), and next time, the treatment price will go up to $295. I was told the extra $45 was for the new laser and due to the fact that the MD in the office will do it, but not simply for the additional passes. BTW, that third laser is not meant to remove any of the tattoo.

    Also, I get lidocain injected into my arm before removal, so I rarely feel anything (unless I get a stingy tech). The second pass did not hurt any worse than the first, but it was a harder healing process. My body noticed the difference that's for sure. I recommend going as comfortable as possible, because you're paying a lot for this and have already suffered enough, why make it anymore painful?

    Good luck with your treatments and keep me updated if you do go in for the R20 method!

  6. Hi, I just wanted to say I enjoy your blog. I have been having a tattoo removed over the last year, and have followed your progress with great interest.

    My tattoo was similar to yours, a rose with lots of dark ink, but on my ankle. I am a lot older than you, turned 50 this January, so my progress seems to be somewhat slower than yours.
    I guess the location and my age.

    I would say mine is half gone after 6 treatments. Mostly the green and red are hanging on.

    I suppose I will be left with a rose shaped scar when done, but better than a bright tattoo at 50 years old!
    Thanks for sharing your experiences!

  7. this blog is very nice.Thanks for our sharing.we also provide PicoSure Laser is the biggest advancement in tattoo removal technology in the past fifteen years. The PicoSure literally blasts tattoo ink into dust-like particles that are washed away by the bloodstream.