8 Things You Never Knew About Tattoo Removal

Regretting that funky tattoo you impulsively decided on in your teens? Or dissatisfied with that tattoo of yours? While tattoos are generally considered permanent, the inks on your skin can now be removed through laser treatment, thanks to advancements in laser technology. However, the effectiveness of the treatment depends on various factors.

Here are 8 things you should know about tattoo removal:

1. The colour of the tattoo. Black and red inks are easier to remove, while blue and green inks are harder to remove. Having said that, do not be disheartened if you have tattoos in colours that are harder to remove. Most inks can still be lightened with repeated laser treatments, and if your aim is to cover up or modify an existing tattoo, laser treatment can help to lighten the tattoo to facilitate the modification.

2. The quality and size of the tattoo. Tattoos done by professional tattoo artists are harder to remove compared to tattoos done by amateurs. This is because professionally inked tattoos are usually more compact, and the tattoo pigments are placed deeper into the dermis layer of the skin. Laser treatment will break down tattoo inks in the skin into tiny fragments, which your lymphatics (immune system) will then work to remove. As a result, a larger tattoo will require more laser sessions to remove.

3. Time interval between tattoo and tattoo removal. If you regret your freshly inked tattoo, you will not be able to remove it immediately. Tattooing inserts ink pigments into the skin via needles, and the repeated act of needling causes injury to the skin. You will have to let your new tattoo heal fully, which usually takes between 6 to 8 weeks, before starting laser treatment. Laser treatment of partially healed skin is not recommended, as the risk of complication is a lot higher and may result in scarring. Scars are much harder to treat than tattoos.

4. The location of the tattoo. Tattoos on the hands and feet are harder to remove than tattoos on the face and body. This is due to the face and body areas having more lymphatic supply, which means the lymphatic system will be able to remove the tiny tattoo fragments more easily from these areas. Areas with less lymphatic supply, such as the hands and feet, will require more laser sessions to yield results.

5. Skin colour. Darker-skinned individuals will require more laser sessions than lighter-skinned individuals. The risk of side effects from laser treatment (hyperpigmentation and hypopigmentation) is higher for darker-skinned individuals, hence more caution is needed when treating darker-skinned patients. To reduce the risk I prefer to use a lower energy setting for darker-skinned patients, and this translates into more laser sessions.

6. The quality of the laser treatment. Picosecond lasers can generate laser pulses in picoseconds compared to nanoseconds and this helps to break the tattoo inks into smaller fragments. This also creates more of a photo-acoustic (mechanical) effect compared to a photo-thermal (heat) effect. The lymphatic system will have an easier time clearing the smaller fragments, which results in fewer laser sessions. As less heat is generated during picosecond laser treatment, the risks of post-inflammatory hyper or hypopigmentation (PIH) are reduced. Does this mean that nanosecond tattoo lasers are redundant? Not necessarily – some studies have shown good outcomes when a combination of nanosecond lasers and picosecond lasers are used together. Nanosecond pulses are first used to shatter the larger and deeper tattoo inks before picosecond pulses are used to target the smaller and shallower ink fragments.

Nano second vs Picosecond laser for tattoo removal

7. The doctor behind the machine. Treatment outcome is very dependent on laser settings and skin judgment. A skilled and experienced doctor using a nanosecond laser can achieve a better outcome than an inexperienced doctor using a picosecond laser. You should also only go to a certified doctor or clinic with a proven track record for laser tattoo removal. I have seen and treated numerous cases with complications after “treatment” at beauty salons. These patients were treated with intense pulsed light (IPL) in beauty salons which advertised “laser tattoo removal” services. Please remember that only certified doctors are allowed to operate medical grade lasers.

8. The pain during the treatment. Yes, tattoo removal is painful! Certain areas like the wrists and feet are also more sensitive to pain. There are various ways of managing the pain and discomfort. The pain can be reduced with the application of medical grade numbing creams and cooling sprays throughout the laser session. Treatment for larger tattoos can also be broken down into multiple sessions to reduce the treatment duration, and hence the amount of pain. Based on experience, most patients have found the pain and discomfort to be tolerable, and thus far none of my patients have backed out from their treatments due to pain.

Removing a tattoo takes time, sometimes several months or even more than a year. You may feel frustrated but it’s important to be patient. It can be quite costly as well but I cannot stress the importance of going to a qualified doctor to minimise any risks of infections and scarring.

Written by Dr. Wu Jiwei,

MBBS, PG Dip (Clinical Derm) (UK)