Surgical or Laser Removal
Today, almost as many women (13%) as men (15%) have tattoos. A recent telephone survey among young adults, aged 18–29, found that 36% have tattoos. Despite their popularity, about half of people with tattoos eventually regret having gotten them.
M.R., Age 32
Procedure: Tattoo removal
Before, 2 weeks after third-stage excision
Removing a tattoo is more painful and costly than getting one.
Tattoo removal presents a number of challenges. Often, multiple colored dyes are used by the tattoo artist, and the pigment is typically injected deep into the dermis.
Dark ink tattoos (blue and black) are most successfully treated with the laser.
Laser treatments use light that is delivered on specific wavelengths that are absorbed by the pigments in the skin. One laser cannot treat all colors. The Q-switched Nd:YAG and ruby lasers work well on black and blue dyes, but not as well on green (the Q-switched alexandrite laser works better for this), and not at all on red or yellow colors (a pulsed dye laser is needed for these). The pigment may even be made darker by laser treatments, particularly flesh-toned pigments. Multiple treatments are needed, as many as 10, at monthly intervals, some colors are difficult or impossible to remove, and there is always a blemish that remains. Patients are invariably disappointed to hear about the limitations of laser treatment, the expense, and the time investment.
However, there may be no alternative treatment. Laser treatment is the only option for large tattoos or tattoos that are placed in areas where surgical excision is not feasible. Examples would be a large tattoo on the back or a circumferential arm tattoo.
For small tattoos, it is usually preferable to have them surgically removed, although this does leave a scar and may necessitate staging (repeated excisions) if the tattoo is too large to be removed in one treatment. Most patients are willing to trade their tattoo for a scar, particularly if the tattoo has negative psychological connotations or may create a limitation in the workplace.
A common example of a tattoo that lends itself to surgical removal is a dolphin tattoo on an ankle. Although such a tattoo may be small, the skin is tight, with little room to stretch, so that two or three excisions may be needed. A more ideal placement would be the lower abdomen, where there is plenty of loose skin and the scar would lie inconspicuously along the bikini line. It is usually possible to remove a small or intermediate-sized tattoo in one stage in this location.
Depending on the size of the tattoo and the location, one or more procedures are needed.
The scar is longer than the diameter of the tattoo.
There may be puckering at the ends of the incision that will gradually settle down.
Complications include scarring, hypopigmentation, darkening of flesh-toned tattoo colors, and inadequate clearance of the tattoo, especially multicolored tattoos.
Complications are the same as for any surgical scar—scarring, infection, wound dehiscence, and hematoma (rarely). The scar is the trade-off for the removal of the tattoo. If the scar is under excessive tension, due to removal of a large tattoo, it is likely to spread more and may require a revision later on. This tendency for scars to widen under tension is the reason it is often better to remove a sizable tattoo in stages rather than trying to do too much in one operation.
Getting Back to Normal
The wound should be kept clean. Resume bathing right away. Apply topical antibiotic ointment twice a day. Depending on the location of the tattoo removal and the skin tension, the sutures come out in 10–14 days.
Q: Does laser treatment work?
A: Laser treatment does lighten tattoos, but there are limitations depending on the number of colors used in the tattoo. Complete elimination is usually not possible—there will be a gray blemish that will remain.
Q: If I have it removed surgically, how big is the scar?
A: The scar needs to be longer than the diameter of the tattoo.
Q: How many treatments will I need?
A: It all depends on the site and size of the tattoo. This will be discussed at your consultation.