Guide to Tattoo Removal: Results from Lasers, Creams, and More
Approximately 45 million individuals in the U.S. alone sport a minimum of one tattoo. However, a portion of that segment of people eventually regret their decision to get a tattoo. As a result, tattoo removal is becoming a common cosmetic procedure, available via laser treatments, surgical removal, or other methods.
- Tattoo Process
- Why Remove?
- Health Concerns
- Laser Tattoo Removal
- Surgical Removal
- At Home Treatment
- Face Tattoos
- Affecting Factors
- Professional Removal
- List of Sources
With 45 million Americans have decided to get at least one tattoo, it stands to reason that some of those people would regret their decision to have ink placed upon their skin. A small percentage - approximately 5% - choose to cover up one regretful tattoo with a different style of body art, while 11% or so select laser tattoo removal instead.
According to the American Society for Aesthetic Plastic Surgery, there were 15,745 non-surgical tattoo removal cosmetic procedures performed in 2017, not including surgical tattoo removals, nor those performed on a do-it-yourself basis.
Although the common assumption is that young people in their late teens are the main ones getting tattoos, it has been reported that 32% of the participants from 14 years of age to 29 had tattoos, while 45% of people aged 30 to 49 enjoyed some level of ink. Folks older than 50 with tattoos dropped to 28%. Even though 72% of the people who were surveyed said they didn't regret their tattoos, that still leaves a large portion of the population who may have thought twice about their artful decorations. As such, many tattoo recipients seek ways to get rid of their unwanted tattoos for good.
A majority of people who regret getting their tattoos received them when they were under 20 years of age, or in their 20s.
Understanding the Tattoo Process and Layers of Skin
Before taking a deep dive into the tattoo removal procedures available these days, it helps to first learn about the tattoo process itself, along with the layers of skin that tattoo pigments normally affect. In order to create a permanent tattoo, ink is injected into the skin with a needle. The puncture of the needle makes a small wound, which signals the body to swallow foreign materials, such as the tattoo ink, and seal up the wound.
The tattoo will then become permanent, unless the body's immune system becomes successful in destroying the particles of pigment in the skin.
The Multiple Layers of the Skin The American Academy of Dermatology explains that the skin is comprised of three basic layers, although within some of those layers there are further defined layers:
- The Epidermis The epidermis is the layer of skin on the outside, the layer that is visible to the eyes and responsible for the tone of our skin. The waterproof nature of the epidermis helps the body retain needed moisture and prevent dehydration. The epidermis layer of "thick skin" - such as that found on the palms of hands and soles of feet - has 5 layers, while "thin skin" epidermis layers found elsewhere on the body have 4 layers.
- The Dermis Deeper than the epidermis, the dermis represents the thicker second skin layer that is made up of sweat glands, strong connective tissue, and hair follicles. The dermis is the level where the tattoo ink is generally injected in order for the ink to remain. If the tattoo doesn't reach the dermis and is injected into the epidermis layers only, the tattoo ink will fade away and “bleed out” during the healing process.
- Subcutaneous (right below the skin) fat After the dermis comes a deeper bottom layer of subcutaneous tissue, which is comprised of connective tissue and fat. This hypodermis layer has the main job of storing fat and attaches the skin to muscles and bones. Tattoo ink can move from blood vessels into the lymph nodes, according to the U.S. National Library of Medicine’s National Institutes of Health. “Tattoo blow‐out” likely happens when ink is injected too deeply into the subcutaneous fat layer.
Why Complete Removal of Tattoos is Often Desired
The reasons for ridding the body of a tattoo can be varied. Some of the main ones include the following:
- Dissatisfaction with how the tattoo appears in the quality
- The design includes the name of a previous partner
- The individual develops an allergic reaction or infection as a result of the tattoo
- The tattoo represents a once-held belief system that no longer is in line with current thoughts
- The wearer has experienced problems gaining employment or military positions due to the tattoo
- Tattoo recipients may tire of wearing heavy makeup or clothes like long-sleeved shirts, turtlenecks, or pants to hide regretful tattoos
- The ink has faded and no longer looks appealing
Health Concerns: Should You Have Your Tattoo Removed?
The American Society of Plastic Surgeons suggests that any tattoo could potentially be removed, but advises potential candidates to be realistic about their removal expectations. Individuals seeking the removal of their tattoos should be non-smoking patients in good health.
The size, color, age, and other factors regarding the tattoo have a bearing upon how difficult it might be to remove. Smaller black tattoos on lighter and contrasting skin would be easier to remove with a laser than larger designs and those on darker skin.
Removing a tattoo generally is an outpatient procedure that may include local anesthesia.
How to Eliminate Unwanted Tattoos
The most effective and popular means of getting rid of an unwanted tattoo includes receiving a series of laser treatments. However, other options of tattoo removal such as dermabrasion, surgical removal, chemical peels, and do-it-yourself techniques exist.
Getting rid of a tattoo you no longer want can be a lot more complex than getting tattoo ink injected. The first step in your tattoo removal process should be to consult a medical professional, including a board-certified plastic surgeon or dermatologist, who can guide you in selecting the best method.
Laser Tattoo Removal Treatment
When it comes to using lasers, tattoo removal works when laser energy penetrates the skin and breaks the tattoo down into smaller ink particles that the immune system flushes out of the area. The process may not completely remove all ink. Various types of lasers and differing settings are utilized for different ink colors, all with the aim of zapping the tattoo pigment away while not harming the skin or surrounding tissue.
The laser tattoo removal procedure uses laser energy and may take multiple sessions to effectively remove stubborn colors. The Mayo Clinic notes that certain tattoo inks respond better to laser treatment than others. Meanwhile, even though some small tattoos can many times be easily removed by surgical means, the chances of a scar being left from the scalpel's incision may make laser tattoo removal more attractive, although the possibility of scarring still exists. Laser therapy is an option that has minimal side effects and low risks.
Q-Switch Lasers Advancements in laser treatments include Q-switched lasers, which send powerful bursts of laser energy in single pulses that deliver blasts of heat in a nanosecond. With three wavelengths that target different ink colors - including settings for black ink, red and orange ink, as well as blue and green ink - the Q-switched laser helps remove tattoos on darker skin without permanently changing skin color. Laser procedures may last from 5 to 20 minutes or more, based on the size and complexity of the tattoo.
PicoSure® PicoSure® is another type of laser that rids users of unwanted tattoos, but the FDA-approved technology does it by using rapid laser pressure waves and pulses, not heat. One picosecond of an energy blast is released quickly, which is equal to 1,000 nanoseconds or a one trillionth of a second.
The rapid and powerful pressure shatters ink particles into the size of dust that the immune system eliminates. PicoSure® is considered another treatment that works well against stubborn tattoos, with enough of an impact that fewer treatments are often necessary, although some shades may represent a challenge to remove fully.
PicoSure® is an advanced laser technology that's also known as PicoWay® and Pico Genesis™ , which is successful in zapping away certain tattoo pigments, although Fitzpatrick skin types 4, 5, or 6 may experience more difficulty with removal.
Dermabrasion involves the sanding and sloughing off of skin using a rotating device that abrades the skin with a brush or wheel. Unlike microdermabrasion, dermabrasion sands away at the skin layers to let tattoo ink seep out of the skin. The treated area will be left raw and need several weeks to recover. However, dermabrasion only reaches as deep as the uppermost layers of the dermis, and would likely only be more effective on tattoos that weren't placed deep enough in the skin, to begin with. Dermabrasion abrades superficial, and potentially dermal, skin layers.
During a dermabrasion session, a dermatologic surgeon performs surgical skin-resurfacing in order to sand away tattoo layers. However, the procedure is not as popular as laser treatments, which might be more effective at removing tattoos.
Dermatologic Surgery: Cutting out the Tattoo
The choice to have a tattoo surgically excised is an option that's best suited for the surgical removal of small tattoos – although it is invasive, unlike other methods of dissolving tattoos via lasers. Tattoos that are large aren't a good choice for surgical removal since it would necessitate removing copious amounts of skin along with body art. The scalpel option is one reserved for individuals who don't mind having incisions, sutures, and a possible scar in the wake of their surgery.
Tattoo Removal At Home
Due to financial limitations or time constraints, many tattoo wearers search for ways to try and remove their tattoos at home, using solutions such as hydrogen peroxide, lemon juice, salicylic acid, or other means of exfoliation. Although the product may work to cause some fading of the tattoos, they often do not penetrate into deep enough skin layers to get rid of the tattoo pigments residing beyond the top layer, well into the dermis.
Exfoliation methods touted online, such as pumice stones and other methods, tend to only slough away the top layer of skin, causing only a minimal fading - if any - on the unwanted tattoo.
Tattoo Removal Creams According to the Mayo Clinic, creams that purport to help remove tattoos are accompanied by no evidence that proves they work. While the creams may work to lighten tattoo ink, they are oftentimes not as effective as other methods, such as laser tattoo removal. Not only will the faded tattoo still be readily seen, but removal creams also come with side effects such as skin irritation.
In fact, the FDA issued a special note about creams claiming to remove tattoos. The government agency for safety noted that none of the do-it-yourself tattoo removal creams that can be purchased online have provided clinical evidence that they are effective.
Myths Surrounding the Removal of Tattoos
Not all individuals who seek the laser removal of tattoos are great candidates for the process. The manner in which the laser works makes the process more complex for patients with darker skin.
According to the American College of Mohs Surgery fellow, since laser energy is targeting tattoo pigments in the skin, it may also target the skin's melanin. Therefore, darker skin types may make it more difficult to distinguish the tattoo colors from the melanin, and as a result, potentially cause burning or hyperpigmentation. Speak with your dermatologist about tattoo removal and how it affects darker skin tones.
Home Tattoo Removal Methods That Don't Work, Including Dangerous Solutions
Several supposed DIY methods of removing tattoos have floated around for years, but they don't actually work - and could be dangerous.
Scrubbing Salt On the Tattoo: Salabrasion Salabrasion adherents advise people who want to get rid of their tattoos to scrub salt into their skin to scrub off the body ink. However, such a procedure would mean scrubbing away the first layer of skin in order to reach the dermal level where the tattoo resides. Such deep and intensive scrubbing could cause scarring, burns, painful rashes, infections, and skin pigmentation problems. Salabrasion can also be a very painful method of removing skin layers.
Using Vaseline to "Draw Out Ink" From the Skin The myth that Vaseline® will suck out tattoo pigments began when tattoo artists recommended that people with fresh tattoos avoid applying balms that are petroleum-based on their new tattoo. The assumption was created that Vaseline® fades a new tattoo. However, the reality is that such petroleum-based products don't allow the treated area of skin to breathe and heal properly. Therefore, the avoidance of Vaseline® was due to infection prevention, not tattoo fading abilities.
Aloe Vera, Glycolic Acid, or Natural Exfoliators Other methods touted for getting rid of tattoos may only fade them at best - or work as soothing agents, such as with aloe vera gel, in the wake of the tattoo being removed via other means. Natural exfoliators only work to slough off dead skin cells from the epidermis, and won't reach the dermis. Therefore, for the true removal of tattoos, speak to a dermatologist about your options.
Tattoos on the Face
Due to the complexity and intensity of certain methods of tattoo removal mentioned previously, the growing popularity of face tattoos is a choice that should be deeply considered before being undertaken. Tattoos on the neck's nape or in other less conspicuous locations are still more common, but the growing popularity of face tattoos represents a shift in what was once viewed as an extreme type of body art.
However, with face tattoos going mainstream due to celebrities and music artists adopting them, so should the knowledge of what it would take to remove them if the face tattoo wearer decides to reverse their decision in the future. Face tattoos are such a visible prospect that they are more difficult to hide without heavy cover-up cosmetics, and could have a negative effect upon gainful employment in certain industries.
Factors that Affect the Tattoo Removal Process
Upon visiting a medical professional to learn about ridding yourself of tattoos, you will learn that several factors play into how difficult or easy it will be to remove the tattoo.
The age of the tattoo plays a big role in the ease of its removal since older tattoos oftentimes experience pigment fading and might be easier to remove.
Where the tattoo is located also has a big bearing on its removal prospects. Tattoos located in areas with a bigger blood supply - like the back or chest - will usually need fewer treatments to remove them, as opposed to areas that have less vascularity and tend to heal slower, such as the hands, feet, or lower legs.
The amount and type of tattoo ink used will dictate how easy the designs will be to remove, such as professional tattoos, which often have a larger volume and density of tattoo pigments that have been driven deeper into the skin, more so than amateur tattoos.
Tattoos that have been layered upon one another will also require more laser treatments than artwork comprised of translucent tattoo ink on a single tattoo.
Skin and ink colors have a bearing on tattoo removal, such as the removal of black tattoos on lighter-skinned individuals being easier to remove than fluorescent green and purple colors.
The age and condition of the skin matter when it comes to the success of removing a tattoo. People who smoke on a regular basis tend to require more laser energy treatments than patients who don't, because of how smoking affects the skin's ability to heal.
The Importance of Professional Laser Tattoo Removal
When considering laser tattoo removal it's essential to seek a medical professional to perform the process. It can be a safe and effective procedure if the person conducting the removal has been trained in the health aspects of the treatment, unlike some tattoo artists or aestheticians without medical training.
Utilizing a professional to remove your tattoos can lessen the chance of side effects such as burns, wounds, scarring, and skin texture changes.
Conclusion: The Future of Tattoo Removal
With the American Society for Dermatologic Surgery reporting a rise in tattoo removal procedures year after year, it’s clear that getting rid of unwanted ink will continue to be a desire from many regretfully tattooed individuals.
According to the American Academy of Dermatology, lasers are one of the best methods of removing tattoos, far outshining other cosmetic procedures that seek to do the same. And with the popularity of body art and permanent makeup cosmetic treatments that use pigment ink that participants may one day want to be removed, expect laser treatments to continue to be used to remove everything from cosmetic lip-liner tattoos to the standard faded butterfly ankle art tattoos.
Additionally, the American Academy of Dermatology reports that those who want their tattoo removed in a rapid period of time are able to experience quicker removal of tattoos as dermatologists seek faster ways to provide their patients with their hearts' desires. A study referenced by the AAD notes that tattoo removal participants were able to undergo four laser treatments in only one day in a safe manner. Utilizing different lasers also made a difference, with one patient experiencing a 50% reduction of tattoo ink in one session.
All in all, the future of tattoo removal looks bright, and that brightness is the laser energy that tops other tattoo-removal methods, such as dermabrasion, DIY tattoo creams, and scrubs, along with the surgical excision of tattoos.
List of Sources
- Unwanted tattoo? FInd out tattoo removal treatment options available from your dermatologic surgeon.
- Lasers in tattoo and pigmentation control: role of the PicoSure(®) laser
- Surgical Excision for Unwanted Tattoos
- Tattoo removal cream: Does it work? - Mayo Clinic
- Tattoo Removal Candidates | American Society of Plastic Surgeons
- Laser Tattoo Removal Pre and Post Care Instructions - URMC
- Laser Tattoo Removal | Conditions & Treatments | UCSF Medical Center
- ASAPS 2017 Statistics - American Society for Aesthetic Plastic Surgery
- Tattoo removal: Lasers outshine other methods | American Academy of Dermatology
- Consumer Updates > Tattoo Removal: Options and Results - FDA
- Tattoo ink nanoparticles in skin tissue and fibroblasts
- Blurry halos around tattoos: a new case of “tattoo blowout”
- Laser Tattoo Removal: A Clinical Update
- Unwanted tattoos. ASDS website.