Tattoo Removal

Also known as laser tattoo removal and body art removalTattoo ink lives underneath the top layer of skin, which makes it difficult to remove, often requiring multiple laser sessions or in some cases, surgical removal. Laser tattoo removal is a noninvasive procedure that uses a Q-switched laser device to break down the pigment colors of an unwanted tattoo, while causing minimal damage to surrounding tissue. Laser tattoo removal has become more and more popular as the prevalence of tattoos has increased over recent decades.

When to Consider Tattoo Removal

If you have an unwanted tattoo that makes you feel embarrassed, self-conscious, or limits your ability to wear certain clothing
If you feel your tattoo no longer reflects your lifestyle or personal aesthetic
If you are unhappy with changes in your tattoo caused by the natural aging of your skin

Considerations

Pros

Highly effective treatment with minimal side effects
Nonsurgical procedure (no incisions)
Outpatient procedure with little pain and little to no downtime

Cons

Multiple sessions may be required to remove a tattoo
Scarring and changes in skin color or texture can occur
A slightly elevated, white discoloration (sometimes accompanied by pinpoint bleeding) is often observed immediately following treatment

These are the top three pros and cons to weigh when considering tattoo removal. If you wish to focus on what is unique to you, please consult with your aesthetic plastic surgeon.Are you a good candidate for a tattoo removal?The following are some common reasons why you may want to consider laser tattoo removal:

You have an unwanted tattoo that makes you feel embarrassed or self-conscious
You are tired of hiding or covering your unwanted tattoo
You are unhappy with changes in the appearance of your tattoo due to the effects of aging
You have found other methods of tattoo removal ineffective

If you are in good general health, have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.

Detailed Procedural Info

How is a tattoo removal procedure performed?

Eye shields are used to protect your eyes from the laser light.
The skin’s reaction to the laser is tested to determine the most effective energy level for treatment.
A handpiece is placed against the surface of your skin, and the laser light is activated. The laser technology produces an extremely short laser pulse that is absorbed by the tattoo, causing the ink particles to break down while causing very little damage to the surrounding tissue. The resulting by-products will be removed by the body’s immune system as part of the healing process.
Smaller tattoos require fewer pulses while larger ones require more.
Multiple treatment sessions are often required for optimal results. The number of treatments will vary depending on the particular nature of your tattoo. The tattoo should become progressively lighter with each session.
Immediately following treatment, an ice pack is applied to soothe the treated area. A non-occlusive dressing will be used to protect the site, and sunscreen should be used.

Laser tattoo removal requires multiple sessions for optimal results.

What are my options?

Q-switched laser therapy is currently the preferred method of noninvasive tattoo removal. There are a number of Q-switched laser devices available. Different lasers are better for treating different tattoo colors. After evaluating your particular tattoo or tattoos, your plastic surgeon will choose the option that is best suited for your particular situation.Variables affecting laser device tattoo removal

Skin and tattoo color
Tattoo type and the age of the tattoo
Amount and depth of ink
Laser light color, frequency, pulse duration, spot size, and fluence
Skin temperature
Cooling and treatment timing

Surgical excision is more invasive, but might be a good, one-time, guaranteed removal method for a smaller tattoo. This technique is more precise than a laser, but there will be some scarring and higher risk.What are the types of lasers used for tattoo removal?Your surgeon may use one or a combination of the following devices, depending on your skin type, the color of your tattoo, the age and type of your tattoo, the size and location of the area being treated, and the treatment timing:

Q-switched Ruby laser
Q-switched Nd:YAG laser
Q-switched Alexandrite laser

Selecting a Surgeon

Select a surgeon you can trust

It’s important to choose your surgeon based on:

Education, training and certification
Experience with laser tattoo removal
Your comfort level with him or her

After finding a board-certified plastic surgeon in your area who is experienced in performing laser tattoo removal, you will need to make an office appointment to set up your consultation. Generally, because of the in-depth nature of the consultation, there is a cost associated with the initial visit.

Your initial consultation appointment

During your initial consultation, you will have the opportunity to discuss your cosmetic goals. Your surgeon will evaluate you as a laser tattoo removal candidate and clarify what laser removal can do for you. Understanding your goals and medical condition, both alternative and additional treatments may be considered (see related procedures).Certain tattoos are more difficult to remove than others and may require more sessions to achieve a satisfactory result. Darker colored tattoo pigments (red, blue and black) are easier to remove and can usually be removed more completely than lighter ink colors (green and yellow). Amateur tattoos are easily removed and often only require one to two sessions, while many multicolored tattoos require twelve or more sessions spaced several months apart.You should come to the consultation prepared to discuss your complete medical history. This will include information about:

Previous surgeries
Past and present medical conditions
Allergies and current medications

Your treatment plan

Based on your goals, physical characteristics and the surgeon’s training and experience, your surgeon will share recommendations and information with you, including:

An approach to your treatment, including the type of device or combination of devices to be used and the number of treatments anticipated
The outcomes that you can anticipate
Your financial investment for the procedure
Associated risks and complications
Treatment location options
What you need to prepare for your treatment
What you can expect to experience after treatment
Show before and after photos of cases similar to yours and answer any questions

Questions to ask your aesthetic plastic surgeon

For a general list of questions to ask your surgeon about his or her background, find out about plastic surgery safety, and to plan your procedure visit the Planning Toolkit.We developed these questions to help you:

Make the most informed and intelligent decisions about your procedure
Confirm that you have the right surgeon for your procedure
Make your initial consultation as rewarding as possible
Understand your options, potential outcomes, and risks

It is important for you to take an active role in your surgery, so please use this list of questions as a starting point for your initial consultation.

Am I a good candidate for laser tattoo removal?
Are the results I am seeking reasonable and realistic?
Do you have before-and-after photos I can look at for the procedure I am undergoing?
Will there be scarring or discoloration?
Will a local anesthesia be used during the procedure?
What will be the costs associated with my treatment?
What will you expect of me to get the best results?
What kind of recovery period can I expect, and when can I resume normal activities?
What are the risks and complications associated with my procedure?
How are complications handled?
What are my options if the cosmetic outcome of my surgery does not meet the goals we agreed on?

Preparing for Your Procedure

How do I prepare for a tattoo removal procedure?

Your surgeon will provide you with pretreatment instructions and answer any questions that you may have.In advance of your procedure, your surgeon will ask you to:

Wear sunscreen and/or avoid the sun
Avoid pretreatment shaving, waxing, or exfoliating
Avoid tanning and spray tans several weeks prior to your procedure
Stop smoking at least six weeks before undergoing treatment to promote better healing
Avoid taking aspirin, certain anti-inflammatory drugs, and some herbal medications that can cause increased bleeding
Regardless of the type of treatment to be performed, hydration is very important before and after surgery for safe recovery

Laser tattoo removal is usually performed on an outpatient basis and you are usually able to return to your normal activities immediately after the treatment. If necessary, arrange for someone to drive you home after treatment.What can I expect on the day of tattoo removal surgery?Laser tattoo removal is performed on an outpatient basis. Some form of local anesthesia, such as a topical anesthetic cream, may be applied before treatment. The pain experienced during treatment is quite tolerable and is described as feeling like a “grease splatter” or a “slap” from a rubber band. Most laser tattoo removal sessions take only a few minutes to complete; however, a longer time period may be required, depending on the nature of your particular tattoo.

Your surgeon will follow the treatment plan discussed with you.
After your procedure is completed, you will be able to return home and resume your normal activities.

Surgical tattoo removal will require an anesthetic before the procedure begins. Your surgeon will excise the area of the tattoo and either close the wound with stitches or use a skin graft. Once the surgery is complete, you may be prescribed medication to help with healing and pain.

Aftercare and Recovery

In most cases you may return to work and other daily activities immediately following your treatment. After the procedure, you will receive detailed instructions about your post-treatment care, including information about:

Skin care
Normal symptoms you will experience
Potential signs of complication

It is important that you follow all patient care instructions provided by your surgeon. Your surgeon will also provide instructions about the normal symptoms you will experience and any potential signs of complications.Immediately after tattoo removalIt is normal to experience some mild pain or discomfort for up to forty-eight hours following treatment. In most cases, pain can be managed by applying an ice pack to the affected area. You may notice a slightly elevated, white discoloration and possible pinpoint bleeding in the treatment area immediately following the procedure. Minimal edema and erythema of adjacent skin may also occur. These symptoms typically resolve within twenty-four hours. Subsequently, a scab will form over the entire tattoo, which will fall off after about two weeks.If you experience extreme or long-lasting pain or redness and swelling after treatment, contact your surgeon to find out these are symptoms are normal or a sign of a problem.Week two to eightYou will notice your tattoo gradually fading over the eight week healing period following the procedure. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.

How Long Will the Results Last?

Laser tattoo removal is permanent but it may take as many as two to twelve different sessions to obtain satisfactory results.Maintain a relationship with your aesthetic plastic surgeon For safety, as well as the most beautiful and healthy outcome, it’s important to return to your plastic surgeon’s office for follow-up evaluation at prescribed times and whenever you notice any changes in the treatment areas. Do not hesitate to contact your surgeon when you have any questions or concerns.

Associated Costs

The cost of tattoo removal varies from doctor to doctor and from one geographic area to another. Costs are also related to the size and complexity of the tattoo, as well as the number of sessions required for complete removal.These numbers only reflect the physician/surgeon fees last year and do not include fees for the surgical facility, anesthesia, medical tests, prescriptions, surgical garments or other miscellaneous costs related to surgery.Because tattoo removal is an elective procedure, insurance does not cover these costs. Many surgeons offer patient financing plans to make the procedure more affordable.Choose your surgeon based on quality, training, and experience—not cost.See why ASAPS members are widely recognized for upholding the highest standards in the area of aesthetic plastic surgery by viewing their basic credentials, training, and certifications.

Limitations and Risks

Fortunately, significant complications from laser tattoo removal are infrequent. Your specific risks for laser tattoo removal will be discussed during your consultation.All procedures have some degree of risk. Some of the potential complications of all procedures are:

Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
Infection and bleeding
Changes in sensation
Scarring
Allergic reactions
Damage to underlying structures
Unsatisfactory results that may necessitate additional procedures

Other risks specific to laser tattoo removal are outlined below:

Skin discoloration such as hypopigmentation and hyperpigmentation
Temporary changes in skin texture
Rarely, paradoxical darkening of a tattoo may occur

You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your laser tattoo removal treatment.

Recently Asked Questions

How can I get a black ink tattoo removed?

Will it be painful to remove the tattoo? Take several treatments? Does this require surgery or can this be done with a laser?

Black tattoo ink is very amenable to removal with laser treatment. It can take 9 or more treatments to achieve an optimal result depending on how.