Here’s Exactly How the Tattoo Removal Process Works

How is Tattoo Removal Done
Credit: Kheila Cruz

Life and time changes us all, and while we loved that tattoo on our shoulder when we first got inked, circumstances have changed. Maybe you no longer want your ex-boyfriends initials immortalized for the world to see. He is an ex, after all.

There’s many reasons we may consider tattoo removal includes new jobs, new social circles, or just new feelings towards old tattoos. Of course, just as you would research where to get your tattoo, the same should be true for the removal.

So, if the time has come to consider removing your tattoo, what are your next steps?

The types of tattoo removal

“Historically, the removal of undesired tattoos included destructive techniques such as dermabrasion, chemical destruction, cryosurgery, electrosurgery, and surgical excision. Such non-selective destructive modalities often result in incomplete removal, and varying degrees of scarring and dyspigmentation,” says Dr. Ryan Neinstein, a plastic surgeon with tattoo removal experience.

But laser is a very popular method: “Advances in laser and light-based technology have revolutionized tattoo removal, using various wavelengths to target different colored pigments with relative ease and fewer complications than before,” says Neinstein.

The patient’s treatment objective and expectation should be counseled, and treatment options, expected outcome, potential risks, downtime, and postoperative care should be discussed. “There should be adequate opportunity for patients to have all their questions answered. Obtaining informed consent with a clear outline of risks and benefits prior to tattoo removal is essential, and protects both the clinician and patient. Establishing realistic patient expectations through good rapport is helpful in achieving a satisfactory outcome,” says Neinstein.

There are various ways to remove tattoos , but right now, the most popular as well as the safest way is with a certified laser removal specialist or a dermatologist. The laser breaks up the tattoo pigment into much smaller pieces that the body can then absorb and remove.

It is important to have realistic expectations when making the decision to have your tattoo treated/removed.  “The treatments may require the use of local anesthesia, as well as other methods to expedite clearance and enhance the patient experience,” says Jeremy A. Brauer, M.D., a dermatologist with board certification and fellowship training in Mohs micrographic, laser, and cosmetic surgery. The idea of “erasing” a tattoo is less likely than reducing the pigment to the point where it may not be as noticeable as it once was.

But there are other options as well. “For very small tattoos, excision of the involved skin is sometimes an option,” says Brauer, though it’s not nearly as commonly used.

The tattoo removal timeline

It starts, of course, with studying that tattoo itself.  What sort of tattoo you have, the technique and type of machine that was involved in how was it done, and how intricate and detailed was the design?  This will all play a part in the removal. But it’s hard to predict exactly how many treatments or months it may take to remove a tattoo.

“Multiple laser treatments are usually required to remove a tattoo via laser therapy with an average number of seven to ten treatments are often needed,” says Neinstein. “Patients should be counseled that tattoo clearance is often incomplete and a residual tattoo outline and textural changes may be seen,” says Neinstein, who explains that usually black and blue tattoos due better and bright color tattoos tend to have less of a complete removal with lasers.

Results to expect

Tattoo factors that may influence this include the age, complexity (ie color, pattern), and size. “Older, smaller amateur tattoos tend to respond better than new and professional tattoos,” says Brauer. Individual factors include skin type and body location. “We are more conservative in our approach when treating tattoos in individuals of darker skin, often requiring more sessions spread out over longer intervals.  Tattoos on the distal extremities (arms/legs/hands/feet) often take longer/more treatments,” says Brauer.

“Tattoo ink is unfortunately not closely regulated, so we do not know exactly what your specific tattoo is composed of, nor exactly where it is placed within the skin,” warns Brauer. In general, tattoos are made from particles of varying size and chemical composition, and this could include everything from carbon (black), cadmium (yellow), to copper/cobalt (blue). Brauer explains that that information about tattoo ink not being closely regulated is more to allow the reader to understand that unless the ink is made themselves, no one can tell you exactly what is and where it is being placed within the skin.

When a tattoo is created, the artist injects ink into the layer of skin known as the dermis, which sits just below the top layer, known as the epidermis. “Once the needle is inserted and ink is placed, the body recognizes the process as ‘wounding’ or injury and the particles as foreign, provoking an inflammatory/immune response,” says Brauer. These lasers are meant to heat and break down those color particles that are tattooed into the skin. “A specific cell, known as a macrophage, attempts to remove the free ink particles, literally engulfing and containing the ink in an attempt to break it down and remove it from the area. The majority of the ink usually cannot be cleared and instead stays within the macrophages that reside in the dermis for the remainder of its life cycle,” says Brauer.

Basically, lasers heat and destroy those color particles we have tattooed into the skin.  “Just as there are different components within the tattoo ink, there are multiple wavelengths of lasers that can be used to effectively achieve tattoo clearance,” says Brauer.

“The process is one in which there is preferential absorption of the laser energy by the ink particle,” he adds, “which subsequently expands and fractures. More recent developments have resulted in lasers that also work by creating pulses so short (picoseconds) that the shock wave these lasers create literally shatters the particle, independent of the heating. This, in turn, releases gas which is evident during the tattoo removal process as a ‘whitening’ or ‘frosting’ of the treatment area.”

The appropriate selection of the laser wavelength as well as additional parameters (energy, spot size, pulse duration) is dependent upon the individual, their skin type, the colors of the tattoo, the location on the body and more.  

“Traditionally the gold standard has been the Q-switched or nanosecond pulse duration lasers,” says Brauer, but that doesn’t mean that’s the only type of laser removal out there. “More recently, picosecond pulse duration lasers have been developed and investigated and shown in many cases to improve our ability to safely and effectively remove tattoos. The specific wavelengths utilized include 532nm, 670/694nm, 755nm, and 1064nm,” says Brauer. The choice of using one over the other is usually due to the specific color being targeted.

The risks associated

There are risks of scarring, as well as lightening and darkening of the involved skin, as well as the inability to achieve complete clearance.  “In general, newer and professional tattoos can be more difficult to treat, whereas “amateur” and older tattoos are often easier to remove. How long it takes to fully remove it and how many treatments depend on a number of things such as the color of the ink in the tattoo, the size of the tattoo and where it is located on the body,” says Brauer.

In general, risks are greater for individuals of darker skin. “These lasers target pigment —both exogenous, as in from the tattoos, but also endogenous, as in the skin’s melanin,” says Brauer. Therefore appropriate patient, device and parameter selection are paramount.

Additionally, while the general risks are discoloration and scarring, certain tattoo inks, such as white, pink, skin tones may require treatment with additional lasers that carry a different side effect profile than traditional tattoo removal lasers, Brauer says.

If you’re a commitment-phobe, consider Inkbox Tattoos, which look like permanent tattoos but only last for one to two weeks. You’ll have all the fun and beauty of a permanent piece with none of the potential for a costly and painful removal process when your taste and preferences evolve. Just a heads up, Inside Out is powered by the folks at Inkbox. It’s all part of our shared mission to empower you to tell your unique story, be it for now or forever.

Related: How Much Does It Cost to Remove a Tattoo?

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