Surgical removal of a tattoo has the advantage of immediate removal, but the disadvantage is that there will be a scar where the tattoo was. How bad the scar will be depends a lot on where the tattoo is and how big it is. Unfortunately, tattoos frequently exist where we tend to scar the worst, such as the upper arm, back and shoulder areas. Most tattoos are removed by taking out an ellipse of skin where the length of the incision is about four times the width. Therefore, a tattoo that is two inches in greatest diameter will leave a scar at least eight inches long if it is surgically removed. There is no way to tell exactly how good or bad that the scar will be. Certain areas of the body scar better than others. In general, the thicker the skin is, the worse the scar will be. Therefore, scars on the back, shoulder and upper arm where the skin is very thick will scar worse than areas such as the neck or wrist.
Only small tattoos are amenable to surgical removal.
2. Will I have a scar if my tattoo is removed with a laser?
The potential advantage of having a tattoo removed with a laser is that there is the possibility that it can be removed with no scar or any evidence that the tattoo was ever present. This depends a lot on where the tattoo is, what kind of ink was used, the color of the ink, what type your skin is and how fast it is removed with the laser.
3. What laser is used for Tattoo Removal?
There are hundreds of lasers available to treat various medical conditions; only a few of them are effectively used for Tattoo Removal. The standard laser is the Nd: YAG laser which has the advantage of having two different wavelengths of light (532 and 1064 nanometers) to treat many different ink colors.
The PicoSure laser is the latest innovation in technology for tattoo removal. Rather than firing in billionths of a second (nanoseconds) like the Nd:YAG lasers, it fires in trillionths of a second (picoseconds). By firing in a more rapid pulse, the PicoSure laser creates not only a thermal effect on the ink particles, but also a mechanical effect to break up the ink particles into smaller fragments.
Beware of anyone claiming that they can get rid of your tattoo with their laser that is not designed for Tattoo Removal. I have seen many bad scars from the wrong laser being used.
4. Is laser Tattoo Removal painful?
The laser spot that hits your skin is anywhere from two to six millimeters in size and feels like a rubber band snapping on your skin. Since you are hit several hundred or several thousand times with the laser with each treatment, it can be anywhere from just uncomfortable to very painful. This also has a lot to do with where the tattoo is. Those on the feet and ankles tend to be the most tender. To make the treatment more comfortable or almost painless, we have our patients put on a topical local anesthetic for about three hours before coming in for their treatment. You are given a prescription for the topical local anesthetic at the time of your consultation. There is generally no pain after the treatment.
There is generally no pain after the treatment. For those who do have pain after a treatment, we recommend using Neosporin® with pain reliever in it.
5. How long does each treatment take?
The length of each treatment depends of how big the tattoo is, how many colors it has and how intricate it is. Small tattoos that just have one or two colors and have a simple design generally only take a minute or so per treatment. This is because the laser fires ten times per second. Large tattoos with many colors and with a complex design may take up to an hour for treatment. In order to increase the intensity of the laser beam, the spot size is decreased; therefore, laser tattoo treatments take longer with each successive session until the smallest spot size is reached.
6. How much time is there between laser tattoo treatments?
Most tattoos can be treated with the laser every three to four weeks. This depends on how quickly it takes to heal from the last treatment. It usually takes about 7-10 days for the area to heal after a laser treatment and it is best to wait at least another one to two weeks before the next treatment. However, the longer you wait between treatments, in general, the fewer treatments you will need. This is because it takes time for your immune system to remove the fragmented ink particles. If you come in for another session before all of those ink fragments that were damaged with the last treatment are cleared, they will absorb the laser again and reduce the penetration of the laser to deeper ink particles.
No one knows that the best amount of time is to wait before getting another laser treatment on your tattoo. We recommend at least six weeks, but you are certainly welcome to wait longer.
7. What kind of care is required after laser treatments?
Immediately after the laser treatment, a topical antibiotic (Neosporin®, Polysporin® or Triple Antibiotic®) is applied along with a light dressing. This can be removed the following day at which time it is OK to wash over the area with soap and water. It can then be left open to the air or ointment and a light dressing can be applied again. Dressings are recommended if there is any bleeding from the area after the treatment. If there is any blistering after a laser treatment, we recommend that you leave the blister intact until it ruptures on its own. Then you should apply one of the above ointments and cover with a new dressing twice per day. Be sure to let us know if you had blistering with the last session before getting another treatment.
8. What does the area look like after a laser treatment?
Initially after the laser treatment,the tattoo looks significantly faded due to evaporation of water in the skin. This initial whitening effect disappears in just a few minutes. Next the area becomes swollen and may look somewhat pink. With deeper treatments, there may be some pinpoint bleeding and scabbing.
9. How does laser Tattoo Removal work?
The laser creates and intense light of a single wavelength which is absorbed by the pigment in the tattoo. The instant that the laser light is absorbed, the light energy is converted to heat energy and a portion of the tattoo is destroyed. Your body then repairs the area like any other injury or burn; a laser treatment for tattoo removal is equivalent to a second degree burn. As the area heals, the smaller ink fragments are removed by your immune system while the larger fragments may be re-encapsulated by local cells (fibroblasts). Since the laser emits a pattern of light which is very specific, it is absorbed better by certain pigment colors. This is why some colors disappear faster than others.
Once the laser light is absorbed, it stops penetrating. Therefore, it is the more superficial ink particles that are treated with the laser. So, we are basically knocking off a percentage of the top of the tattoo with each session; gradually going deeper each time until we get to the deepest ink particles.
10. What colors are the easiest to treat with the laser?
Although there are many types of tattoo ink, certain colors usually disappear faster than others. In general, black and red inks tend to respond best to laser treatments. Grey tones, which have very little black ink, can disappear in one or two treatments.
11. What colors are the hardest to treat with the laser?
In the past, greens and blues were the hardest to treat because they do not absorb the wavelengths on the laser emitted by an Nd:YAG laser (532nm and 1064nm). Now with the PicoSure laser, which is an alexandrite laser emitting a light of 755nm in wavelength, most greens and blues are easier to treat. Tan and yellow colors do not absorb hardly any laser light and are very hard to get rid of. Fortunately since they are generally very close to skin color, they are usually not very obvious once the remaining tattoo colors are removed.
12. Is the entire tattoo lasered with each laser treatment?
Except for very large tattoos, in general the entire tattoo is treated with each treatment.
13. What areas of the body respond best to laser Tattoo Removal?
In general, the upper arms, thighs and truck respond best to laser Tattoo Removal treatments. The hardest areas tend to be the hands, feet, wrists and ankles. The lower back can also be a tough area to treat and tattoos in that area are slower to respond that those of the upper back for some reason.
14. Can you remove cosmetic tattoos on the face with a laser?
Cosmetic tattoos around the eyes and mouth can be very difficult to treat and my not respond to laser Tattoo Removal. Often, rather than fading or disappearing with laser treatments, they change color and become even less attractive. We generally perform a small test area of a cosmetic tattoo to see how the ink will respond rather than treating the entire area at the first session.
15. Why does the tattoo fade with laser treatments rather than just disappear?
Only a thin layer of tattoo ink can be removed with each laser treatment because the upper level of ink absorbs all of the laser light energy. Gradually, with each successive treatment, deeper and deeper ink is eliminated which is why the tattoo gradually fades and thin (lighter) tattoos are eliminated with fewer treatments than thicker (darker) tattoos.
16. Can I get a guarantee that all of my tattoo will go away?
Unfortunately, there is no way to guarantee that all of your tattoo will disappear with laser treatments. Some inks can be very resistant to laser Tattoo Removal. However, most tattoos can be completely eliminated. Stubborn tattoos simply take more treatments.
17. Are professional of amateur tattoos easier to get rid of with a laser?
It is traditionally taught that professional tattoos are easier to remove with a laser because the ink is placed in a more uniform layer. In my experience, however, amateur tattoos and much less ink and also have colors that are easier to remove with a laser than professional tattoos. Tattoos that are made from pencil shavings or cigarette ash usually disappear quickly.
18. How many laser treatments will I need to remove my tattoo?
This is probably the hardest question to answer. I have had many amateur tattoos and some professional tattoos with black, red or dark blue in favorable areas of the body (see question #13) disappear in only three treatments. On the other hand, some with bright colors in difficult areas may take more than fifteen or twenty treatments. Some people will have a number of treatments until the tattoo has faded to the point that it is not very noticeable and not continue until it is completely gone.
Remember, the longer you wait between treatments, the fewer you will usually need.
19. Once I get started with laser Tattoo Removal, do I have to keep coming back on a regular basis or can I take some time off?
Taking extra time off between laser treatments does not diminish the effectiveness of laser Tattoo Removal.
20. Does skin color affect on the success or risk of laser Tattoo Removal?
Because laser light is absorbed by pigment, skin color does affect both the success and risk of laser Tattoo Removal. The laser can also destroy natural skin pigment causing the skin to become a lighter color which can be permanent. On the other hand, laser treatments can stimulate the skin in the area treated to form more pigment and, therefore, become darker. For this reason, patients with darker skin generally need to be treated with lower laser energies in an effort to reduce pigment changes. For this reason, it tends to take more treatments to remove the tattoo. This is also why we recommend that you not tan the area to be treated with the laser. Darker skin also has a higher risk of scarring with laser treatments; which is another reason why lower laser energies are used. The wavelength of light used to treat red tattoos has the highest risk of removing natural skin pigment in patients with darker skin.
21. I have a lot of hair where my tattoo is, will the laser remove it?
If the hair is dark, the pigment in the hair can absorb the laser light energy and potentially destroy the hair follicle causing the hair to be permanently removed. The Nd:YAG laser nor the PicoSure are not particularly effective for hair removal, so, although some hair could be lost temporarily, the hair typically grows back over time. White, blonde and grey hairs are not usually affected by laser Tattoo Removal.
22. I just got a tattoo and I really don’t like it. How soon can I have it removed?
Tattoos generally fade over time because your body naturally tries to get rid of some of the ink. A fresh tattoo is loaded with ink so it will not fade much with laser treatments and there seems to be a higher risk of scarring or pigmentation changes. Therefore, I recommend that you wait for several months before starting to have it removed with a laser.
23. How much does laser Tattoo Removal cost?
The cost of laser Tattoo Removal depends on how big the tattoo is and how intricate it is. The cost can be as little as $80 per treatment for very small tattoos and over $1000 per treatment for very large tattoos. The cost for a consultation is $40, which is subtracted from the first treatment if it is done on the same day as your consultation.
24. Can the ink change color after a laser treatment?
It is possible for the ink in a tattoo to permanently change color after a treatment. I have seen white tattoos turn grey or black and pink tattoos turn purple. Usually this is instantaneous and, if I see it happening, I will stop the treatment and we will discuss whether or not to proceed with the treatment. Fortunately, white and pink tattoos are relatively rare. Change in color is especially a problem with cosmetic tattoos on the face, which is why we proceed with caution with these.
25. Will I get a blister with laser tattoo removal?
Since laser tattoo treatments generally create a second degree burn, it is possible to get blistering. We like to use laser setting that are just below the blistering level in an effort to get rid of as much ink as possible but hopefully not leave a scar or cause permanent changes in pigmentation to the skin that is treated. While getting a blister does not mean you are going to scar or lose pigment, the risk is higher so you should inform us any time you get a blister. If you get one, leave it intact until it ruptures on its own and then start using a topical antibiotic ointment twice per day.
Do you have a question that has not been answered? Please email me at firstname.lastname@example.org or fill out the Contact Us portion at the bottom of the page and I will respond as soon as I can and may add it to my list of FAQ's.
The answers to the above questions are my personal opinions based on years of legitimate general surgery and plastic surgery training and extensive experience in plastic surgery private practice. They are intended to give you, the patient, as much knowledge as possible in making your decision about plastic surgery and who performs that surgery. They are not intended to be derogatory or demeaning towards any individual physician or group of physicians. I firmly believe that physicians should only practice within their field of training and expertise, except in life-saving, emergency situation.
James D. McMahan, M.D., F.A.C.S.