Tattoo Removal

What devices are used to remove tattoos? 

The most effective methods of tattoo removal are Q-switched or picosecond lasers. They are designed to put all of the laser’s energy into a short, powerful burst, and work by targeting the ink with pulses of highly concentrated laser energy, breaking the ink into tiny pigment particles, which are then cleared away by your own immune system.

Picosecond lasers, a relatively recent technology, are better at shattering ink particles and require fewer sessions to remove the tattoo than other technologies. That said, no tattoo can be fully removed in a single session. 

Description of treatment

Topical anesthetic creams are usually applied approximately an hour before the treatment. Some patients prefer to have a local anesthetic injected into the tattoo prior to laser therapy. Pinpoint bleeding, crusting, redness, and blistering are commonly associated with the procedure. Pulses of laser energy are directed onto the tattoo, breaking up the pigment. Over the next few weeks, the body's scavenger cells remove pigment residues.

The number of treatments needed depends on the ink that was used to create the tattoo. There are no standardized inks. And different inks may require different tools. It is important to understand that the depth of pigment and color ink of the tattoo play a big role in the removal process. Tattoos that include ink or dye consisting of white, pink, red, tan, or light brown pigments can permanently darken with traditional laser tattoo removal, so these pigments are typically removed instead with ablative lasers, such as the carbon dioxide or erbium:YAG laser.

The type of ink isn’t the only variable potential patients should be aware of. Patients with darker skin should be treated with lasers that have longer wavelength, which penetrate deeper into the skin and interact with skin pigment less. 

What outcome should patients expect?

More than one treatment (each treatment actually only takes minutes) is usually needed to remove an entire tattoo. The number of sessions depends upon the laser and the settings used, the amount and type of ink used and how deeply it was injected, and the effectiveness of the patient’s white blood cells. Six to eight week intervals between sessions are required to allow pigment residue to be absorbed by the body. Anywhere from six to more than 10 treatments may be necessary to achieve maximum lightening, and full resolution of the tattoo may never be achieved for some individuals.

Post procedure recommendations

Just as aftercare is an important component of getting a tattoo, caring for the skin after getting a tattoo removed is vital. Keep the treated area clean and moist with Aquaphor, which helps aid the healing process, and avoid direct sunlight. Once healed, use safe sun practices, which includes applying a broad-spectrum SPF 30 or higher sunscreen daily.

Success rates/potential complications

• Some colors of tattoos are more difficult to remove than others. Because black pigment absorbs all laser wavelengths, it's the easiest to remove. Other colors, such as green, selectively absorb laser light and can only be treated by selected lasers based on the pigment color. White tattoos are the most difficult to treat with laser, as some of them could even turn black with treatment. The Picosecond laser tattoo removal offers an innovative treatment for these colors.
• Professional tattoos are usually harder to remove than amateur tattoos, as they are often placed deeper and use a greater density of ink.
• It is much easier to have a small tattoo removed than a large one
• The risk of scarring is always present, and as discussed may already be present but hidden by the ink.
• Both getting a tattoo and having it removed can be uncomfortable. The impact of the energy from the laser's powerful pulse of light has been described as similar to getting hot specks of bacon grease on your skin or being snapped by a thin rubber band.
• Because it is actually a person’s own white blood cells that remove the ink, results can vary not only by the tattoo or the laser, but also from person to person based upon how well their own immune system works to clear the damaged pigment. Smoking will negatively affect this process.
  

Recommendations for patients considering tattoo removal

Anyone who wants to get a tattoo removed should “do your homework” ahead of time. It is imperative to seek an experienced physician for tattoo removal. Seek a board-certified dermatologist or plastic surgeon with considerable expertise in tattoo removal, and experience treating your skin type.

Ask potential providers how many times they have performed the procedure, and for before and after photos of their work. It is also advisable to ask about possible complications and what percent of their patients have experienced them. The right answer is not necessarily "none.” Any provider who does a lot of procedures will encounter complications. That’s why it’s important to ask what professional societies the provider is a member of.

Tip:  Use the ASLMS Physician Locator to find a board-certified member physician in your area who performs tattoo removal. 

Updated july 18, 2022