Tattoo Removal

How does tattoo removal work?

To understand the process of tattoo removal, it is necessary to first understand how tattooing works.

Tattoos are created by injecting black or colored inks into the dermis—the layer of skin that lies beneath the skin’s surface.  While your immune and lymphatic systems initially remove some of the injected ink introduced into the skin during your tattooing, some of the ink particles are actually absorbed by cells in the dermis.  Once absorbed, these particles are no longer recognized as foreign bodies; the walls of the dermal cells serve as an insular barrier against further immune response.

Regardless of method, all tattoo removal works in the same basic way.  The goal of each method is to break apart or remove the pigment that resides in the dermis, creating pieces small enough for the body to scavenge and remove.  Once enough of the ink is broken down and swept off by the body, the tattoo fades and disappears. 

Tattoo Removal Methods

The gold standard and treatment of choice for the removal of unwanted tattoos is laser tattoo removal. Other methods present significant risks and laser treatment offers the best outcomes in almost all cases.

Laser Tattoo Removal

Most patients I see are familiar with the idea of using lasers to remove unwanted tattoos, but few are aware of how much the science has advanced in recent years.  In the past, IPLs (Intense Pulse Light) were used to “remove” tattoos, but were less precise and presented unwanted complications. In some cases patients had a scar in the shape of their unwanted tattoo.  While IPLs are still approved for the removal of tattoos, in my opinion there are much more suitable lasers now available for use.

Q-Switched lasers are often used for tattoo removal today.  These lasers use an extremely quick pulse-rate to work directly on the dermis, providing a much lower risk of scarring or damage to the epidermis (the topmost layer of skin).  Lasers also have the advantage of being able to target specific tattoo colors, including colors which are traditionally difficult to remove (greens, yellows, etc.).

It may take anywhere from 6 to 12 laser sessions to fully remove a professional tattoo, though amateur and black tattoos may be completely removed in fewer sessions[1][2][3].  Read more about laser tattoo removal.

Excision and Other Techniques

There are other methods of tattoo removal. One example is excision—cutting into the skin and actually removing the layer of dermis where the tattoo is located.  While excision is extremely effective in removing tattoos, it comes with a 100% chance of scarring.  Patients who want to minimize scarring should not pursue an excision.

There are other methods such as the sanding down and removing the tattoo with dermabrasion or salabrasion. Dermabrasion involves the removal of the surface of skin with a diamond fraise wheel or wire brush. Dermabrasion results in a high incidence of scarring and often leaves much of the tattoo pigment behind. Due to these significant drawbacks, it has been abandoned in favor of better methods[4][5].

Physicians largely disregard other removal techniques in favor of laser treatment. These techniques may include the application of creams, lotions, or other solutions.  Tattoo removal creams often have irritants and caustic ingredients that can burn the skin. Although some of these creams can remove the tattoo, I have not seen any that do it effectively without a very significant risk of scarring.

Tattoo Removal and Pain

Yes. It is painful to have a tattoo removed. But this doesn’t mean that the procedure itself has to be excruciating.  Dermatologists and plastic surgeons may administer a topical or injected anesthetic to numb the skin before any tattoo removal procedure. This will help diminish the pain.

Side Effects of Tattoo Removal

Laser tattoo removal has been in use for a number of years and is safe. There are however some risks associated with laser treatments. Skin discoloration may occur. Infection may also be a risk, though your treating physician will discuss post-treatment care to help minimize this risk. Rare instances of scarring are also possible, though in less than 5% of patients.

A more serious side effect is the development of an allergic reaction following treatment, often from red tattoos[6]. As the treatment breaks up the tattoo inks, the body begins to take the ink away through the lymphatic system. As this happens there is the risk of a life-threatening anaphylactic reaction to the released inks. An experienced dermatologist or plastic surgeon will walk you through the risks and ways to treat any side effects that may arise.