Tattoos can be a meaningful and artistic expression of personality, but an unwanted tattoo can be an unpleasant shock. In a recent study of 500 participants between the ages of 18 and 50, 17% had considered getting a tattoo removed (AAD). Removal options range from modern laser tattoo removal (potentially quite successful), to surgery, dermabrasion (sanding), and creams (not successful).
If considering getting a tattoo removed, get a consultation with your dermatologist even if you don’t plan to start right away. Many factors affect who is a possible candidate for which treatment and also affect the timing of treatments. These can include natural skin color, recent sun exposure, size and color of the tattoo, and smoking history, among others. Here’s a guide to help you understand your choices.
Method of Action
Lasers work by the phenomenon of photothermolysis, which means that a light beam (photo) hits a specific pigment target and heats it up (thermo), causing it to break apart into microscopic bits (lysis) that get absorbed into the bloodstream and removed from the body. The faster the pulse of energy is delivered, the less the surrounding tissue absorbs unwanted heat, and the less damage there is to normal skin.
Q-switched Nanosecond Lasers
Laser technology for tattoo removal has seen great advances over the years. Now the gold standard for tattoo removal, initially dermatologists used “continuous wave” CO2 or argon lasers, which heated the surrounding tissue excessively leading to high risk of burning and scarring. Newer Q-switch technology allows the energy wave to target the pigment in the tattoo with less harm to the skin around it by changing the pattern of how the energy is delivered. The most common lasers today use Q-switched wave shapes delivering laser pulses that each last a nanosecond.
Q-switched Picosecond Laser
Until very recently, nanosecond technology was state of the art, but in 2013, the FDA cleared the PicoSure™ Q-switched alexandrite laser, the only laser in the world that uses picosecond pulse durations. This much shorter pulse duration hits the pigment particles even faster and harder so they break into even smaller pieces which allows the body to clear the ink faster, with even less damage risk to the surrounding skin than with nanosecond lasers. The picosecond laser is also more effective at removing difficult colors, and is associated with less discomfort after each session.
For the right candidate, lasers can be used to gradually fade tattoos without leaving a scar, and with little to no downtime at all. The downside is that repeated sessions are always needed, laser removal can cost more than getting the original tattoo in the first place, and some ink colors are extremely resistant to any current lasers. This is the laser I use in my office, and we have seen great success with it.
Cutting out a tattoo surgically and closing the wound with stitches is an option for some tattoos that are not good candidates for laser, either due to the patient’s natural skin color, or the color of the tattoo. Small tattoos can be excised in a single setting, but there is no getting around the area having a linear surgical scar after healing. Larger tattoos may require “serial excision” in which a wedge is cut out from the center of the tattoo and allowed to fully heal, before the process is repeated over and over until the tattoo is gone. Of course this process may take many months, allowing for full healing time between.
Dermabrasion is a process of medically-controlled sanding of the skin. Unlike microdermabrasion that is popular in spas, dermabrasion is a more aggressive, deeper process that literally rubs off the outer layers of skin, eventually removing the cells that contain pigment. Since some of these cells can be quite deep, dermabrasion has a risk of scarring and also leaving skin areas that have lost their own natural pigment after healing.
Who is a good candidate for laser tattoo removal?
Ink depth and tattoo age: Deeper tattoos, or tattoos tattooed over to “fix” them, are harder to remove. Older tattoos tend to have deeper granules, but are also partially absorbed by the body already, so may be easier or harder, depending on the tattoo.
Ink color: Reds, flesh colors, and whites can be difficult to impossible to remove with any existing lasers, while blues and other traditionally difficult colors are handled better with the picosecond laser than ever before. But each tattoo and each patient is different, so you might get lucky.
Dye allergy: Trying to laser a brand new tattoo or one that experienced an allergic reaction when placed can lead to trouble.
Skin color: Lasers work by targeting pigment so be aware that your skin’s natural pigment or recent tan are targets for the laser energy. If the laser is drawn toward your skin while also targeting tattoo pigment, it will damage the skin pigment either temporarily or permanently (scarring). Speak with your physician about selecting the laser that will be safe but also effective.
Cost, Time, and Bottom Line
Most likely, removing your tattoo will cost more than it took to get it. There’s probably no avoiding that fact. Also, whether you got a one-time Tweety Bird that you now regret, or spent months or years working on your full sleeves, the removal will take many more sessions. The best advice is to plan your removal far in advance to gather as much information as possible before committing the time and funds to its careful removal.
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