YTF Cosmetic Surgery Patient Network  

 
Tattoo Removal

• What Is Tattoo Removal?

• Your Options In Tattoo Removal

• Are You a Candidate for Tattoo Removal?

• What to Expect at Your Consultation

• Your Preoperative Appointment

• Preparing for Your Treatment

• How Tattoo Removal Is Performed

• The Road to Recovery

• Risks Complications & Contraindications of Tattoo Removal

• The Average Prices of Tattoo Removal 

• Temporary Tattoo Cover Up

• Frequently Asked Questions About Tattoo Removal

• References 

• Talk About Tattoo Removal On Our Message Board RECOMMENDED!

As long as there are tattoos (be they intentional or a product of injury) there will be a need of tattoo removal.  Some tattoos are mint to live their life forever where they were placed -- some are thought of as mistakes.  Regardless of your reasons, if it was intentional or from objects being forced into the skin due to trauma, there is a removal process which can lessen the look or completely remove the tattoo.

Please know that not all tattoos are capable of being fully removed with lasers or non-scarring treatments and may need to be excised.  There are different methods for different colors and types so please consult with a qualified tattoo removal physician for more information.  

What Is Tattoo Removal?
Tattoo removal is the procedure to lessen the look or completely remove ink or other substances which have been implanted into the dermis either intentionally or by accident.  These methods may be excision, laser resurfacing or removal, dermabrasion, chemical removal or with intense pulsed light.  Salibrasion is also another method as are injections of a saline solution.

This tattoo may be the tribal band, your exes name, or that Taz or dolphin you thought you wanted or something as simple as a tattoo left by a jab with a sharpened pencil tip.  Some tattoos may be the result of matter implanted accidentally from falls, or accidents which caused dirt and rock to enter a wound.

Your Options In Tattoo Removal
There are several options for tattoo removal, however not all physician's offices will offer each one.  Please discuss this before you consult or make an appointment to discuss your options for more information on what is available in your area.

• Laser Removal: Laser removal is the penetration and break up of the ink articles that were implanted into your skin.  This procedure essentially speeds up your body's natural process of ridding your body of the foreign object that is ink.  This procedure uses various types of lasers or intense pulsed light therapy machines depending upon the color of the ink.  This procedure once took an average about 2 years to fully remove a tattoo and even then it was not guaranteed.  Although modern lasers and light systems can remove it in less time, this process is entirely dependent upon the laser type, number of sessions and the patient's body's ability to rid it self of the ink.  This procedure is performed under a topical anesthetic, or with none at all.  See our Laser Resurfacing Section For more information.  Or if you're in California, visit the DrTattOff.com website for a ton of photos and the average costs for removal through their clinics.
• Intense Pulsed Light: The same concept as above however Intense Pulsed Light (IPL) is utilized.  IPL was pioneered by Dr. Patrick Bitter Jr. and is based on emitting high intensity pulses of light (not lasers) to penetrate the skin and rid you of various complaints.  There are different machines for different levels or types of penetration.  This procedure is performed under a topical anesthetic, or with none at all. See our Intense Pulsed Light section for more information.
• Dermabrasion:  This method is not without it's scars.  Most Tattoos are deep within the dermis and in order for the tattoo to be removed this skin and all the ink must be removed with it.  Dermabrasion is the procedure which utilizes manual abrasion (with either fine grit surgical sandpaper or a Dremel® like tool) of the skin to usually remove acne scarring, hyperpigmentations, wrinkles such as peri-oral (around the mouth) wrinkles, scar revision and of course, tattoo removal.   Although this procedure is usually performed by itself for the above indications, dermabrasion can be used in combination with other types of treatments as well.  This procedure is performed under local anesthetic or local and oral/IV sedation.  See our Dermabrasion section for more information.
• Excision: This method also leaves a scar but is suitable for smaller tattoos -- the results are immediate and the treatment generally inexpensive.  The tattoo it literally cut out of your skin and the wound sutured.  It is relatively simple and has a mild recovery phase if no infections or other complications arise. This procedure is performed under local anesthetic, depending upon the size.
• Salibrasion: This is a very old method of abrasion where the treatment area is literally rubbed with salt.  This procedure is probably one of the oldest resurfacing techniques known.  This procedure is performed under local anesthetic.
• Saline Injections: Injections can be given to help break up a tattoo - this usually does not remove the tattoo but they can blurry it significantly.  Some tattoo artists suggest this if the area will be getting a cover up anyway.  This helps blur and fade the old tattoo to make way for a customized cover up tattoo.

Are You a Candidate for Tattoo Removal?
Not everyone is a candidate for Tattoo Removal -- however if the tattooing process was carried without any complications (keloid, hypertrophy, etc) you are generally able to have a removal procedure.  If you are prone to keloids, hyper or hypo pigmentation or do not react well to burns or excessive scarring due to minor cuts and abrasions, tattoo removal may result in more noticeable scar, post-treatment.  The abrasive medium literally rubs off  the top layers of skin to reveal younger-looking, fresh skin beneath.  If you scar badly from abrasions, or scrapes, the results of dermabrasion could be disastrous.  Also, if you have ethnicity (i.e. Greek, Italian, Asian or African-American, etc.) in your biological family, you may be prone to hyper or hypopigmentation resulting from any level of dermabrasion.  Lasers literally burn the skin so if you scar badly from burns, this could also be a problem. Other methods may also scar you and leave only a thick scar in the place of where your tattoo was -- defeating the purpose.

Also, you should NOT have a removal treatment on the affected area if you have the following:

• Undiagnosed lesions
• Warts
• Active, weeping acne (stages 3-4)
• Active Rosacea
• Unstable diabetes
• Auto-immune system disorders
• pigmentation problems

*source for the immediate above, Medscape Medical Journal (1999)

Communication is crucial in reaching one's goals.  You must be able to voice your desires to your surgeon if he/she is to understand what your desired results are.   Discuss you goals with your surgeon so that you may reach an understanding with what can realistically be achieved.

You must be mentally and emotionally stable to undergo an cosmetic procedure.  This is a procedure which requires patience and stability in dealing with the healing period.   There is sometimes a lull or depression after long periods of treatment or surgical operations and if there is already a pre-existing emotional problem, this low period can develop into a more serious issue.  Please consider this before committing to a procedure.

What to Expect at Your Consultation
After checking a few physicians' backgrounds and credentials, you will make an appointment for a consultation. You will meet with these physicians and discuss your goals and you will disclose all information regarding your health; if you smoke, what medications or vitamins you presently take, etc., this is very important.  You really should consider smoking cessation as this can significantly decrease healing. Visit the Medication & Supplements List for more information. 

You will discuss your complaints and concerns and discuss the various techniques, the amount that can be corrected, etc.  He or she should discuss the risks associated with tattoo removal procedures with you, as well. 

If you would like more information on consultations or a list of questions to ask your surgeon please visit the Consultation Help Page.  If you should choose to book or reserve a surgery date you will usually give a deposit to hold your surgery date.  Most times if you cancel a few days beforehand, this amount is non-refundable. After paying your deposit and scheduling a treatment date, you will also schedule a pre-operative appointment...

Your Preoperative Appointment
This appointment addresses more questions you may not have thought to ask at the initial consultation, such as more surgical details, concerns and even ascertaining that your surgeon is aware of what you desire from your procedure.  Just as your surgeon will make certain that you know what it realistically possible from this procedure.

You will also discuss your pre-operative instructions and speak about the recovery period instructions and what to expect in the months ahead.  You will be given prescriptions for antibiotics, pain relievers, perhaps blood pressure medicines, prescription anti-inflammatory drugs and perhaps a box or directions for gaining a box of Arnica montana.  Would like to know more on the benefits of Arnica montana?   Perhaps you will be instructed to obtain Bromelain or other types of remedies, although many surgeons would rather have you not take ANYTHING other than your prescription medications, please do not go against your surgeon's wishes.  Remember, always ask your doctor before taking any of these products. 

Please do not hesitate to address any concerns that you may have during this time and even after your pre-operative appointment. If you remember something when you get home or the next day or even the day of surgery -- don't be afraid to ask. 

Preparing for Your Treatment
You should be given a pre-operative information packet that explains everything you should do and know before your surgery date.  This is highly dependent upon the method being used for removal so please discuss this matter with your surgeon.  Please see the Preparation Information Index and ask for a pre-op sheet from your physician.

How Tattoo Removal Is Performed
This process depends upon your chosen method and if you will be sedated.   Many tattoo removal procedures do not necessitate sedation.

• Laser Removal: The laser or pulsed light is applied with pulses lasting micro-seconds.  Sometimes it is accompanied by a short burst of cooling spray or other freezing agent shortly before to minimize pain.  It takes about 180 pulses for a small tattoo.  You will wear special protective glasses or goggles over your eyes. It is really quite simple. T his procedure is performed under a topical anesthetic, or with none at all.
• Intense Pulsed Light: Your technician or doctor will ascertain your comfort and if desired a topical anesthetic may be applied. After the treatment area is numb and cold, soothing gel will be applied and a glass prism (pyramid) will then be placed over the gel and treatment area.  An intense flash of light, or pulse, is flashed through the prism where it is directed at the treatment area to rid you of your complaints.  This initial treatment may not be as aggressive as your following treatments so as not to possibly damage the skin and to determine your skin's tolerance for further intensive treatment.  Treatments are usually performed every 3-4 weeks.  This procedure is performed under a topical anesthetic, or with none at all. 
• Dermabrasion:  Your surgeon will then begin to manually abrade your skin with a fine grit type of surgical sandpaper or with a sanding machine somewhat similar to a Dremel® or acrylic nail sander.  Your surgeon may may several passes or one simple, yet deeper pass until the tattoo is removed.  This procedure is performed under local anesthetic or local and oral/IV sedation. 
• Excision:  The area is injected with local shots of lidocaine and epinephrine and tattoo it literally cut out of your skin and the wound sutured.  It is relatively simple and has a mild recovery phase if no infections or other complications arise.  This procedure is performed under local anesthetic, depending upon the size.
• Salibrasion: The area is injected with local shots of lidocaine and epinephrine the treatment area is literally rubbed very aggressively with salt or a salt sanding block.  anesthetic.
• Saline Injections: The area is injected with local shots of lidocaine and saline which helps break up a tattoo - this usually does not remove the tattoo but they can blurry it significantly. 

Please consult with your physician for specific details of your procedure as many treatments are carried out differently and are entirely individual-dependent.

The Road to Recovery
You will feel as though your skin has a windburn or sunburn when the anesthetic starts wearing off (if you had any) and will find that your skin is tight.  Do not make excessive or widely exaggerated movements of the treatment area if you can help it.  This can be uncomfortable, cause tearing of the skin and bleeding.  Below is a typical after care instruction sheet, please ask your physician or skin care specialist for your own specific instruction sheet.

Some patients experience a lull or down period where they become depressed or feel unattractive during longer healing periods.  This is very normal.  Please print out our Emotional Preparation Sheet so that you will be able to remind yourself that you will get through your low period.

Risks, Complications & Contraindications of Tattoo Removal
Severe burns or scarring from defective machinery and/or unskilled technicians are possible as well as infection of the treatment areas so please take care in only touching the area with clean hands or sterile fabrics.  Scarring is possible if severe burns are experienced. It is possible that one may develop hypopigmentation (lack of melanin/color in the treatment area) or hyperpigmentation (too much melanin/color production)/

With Dermabrasion specifically:  Ascertain that your surgeon discusses all of the risks and complications with you at your consultation. There could be allergic reactions to the anesthetic. Just make sure that you disclose your medical history and this is very important -- your nationality.  If you are susceptible to Keloid scarring or have active skin infections or afflictions, you may not be a good candidate for tattoo removal via Dermabrasion. 

If your skin is olive, black, brown and even yellow-toned -- take care in your choice of resurfacing measures.  Dermabrasion, Laser resurfacing and chemical peels can cause noticeable damage to ethnic skins.  You should request a "spot test" if you or your doctor are uncertain.  You can never be too careful.

There is also the risk of bullae (blisters), milia (or small whiteheads), infection, thicker scar tissue of the treatment area and hypopigmentation as well as hyperpigmentation, as said before.  You must also be very careful if you have taken Accutane within the past year and a half (12 to 18 months).  Accutane causes dermal thickening and can cause increased scarring.

The Average Prices of Tattoo Removal
This procedure varies significantly for several reasons: treatment area size, treatment type, amount of treatments needed, surgeon, region, anesthesia use.  The average cost can be anywhere from $150. for excision of a small tattoo (intentional or trauma tattoo) to $5,000.US for a large piece which may take several treatments or combined treatments under anesthesia.