Regret or relief? Options for tattoo removal

Everyone makes mistakes. Sometimes, the repercussions of those mistakes last longer than others. Tattoos are symbols. Those symbols can represent an unfortunate night out on the town with friends. Sometimes those symbols can represent an affiliation, relationship or mindset from which we no longer agree or want to disassociate.

No matter what an old tattoo represents, options available today can help fade past regrets and give patients a new canvas to work from.

Understanding tattoo removal

Tattooing is the artistic process of using needles to deliver ink pigments into the dermis layer of the skin. Your epidermis is the topmost layer of skin, while the dermis is the deeper, middle layer. Tattoos are wounds in the skin that trigger the body's inflammatory response system. Specific cells called macrophages attempt to remove the irritating ink. Their job is to weed out foreign invaders. Other cells called fibroblasts soak up the dye. A combination of fibroblasts and macrophages remains in the dermis, suspending the color and producing a lasting image.

One method for tattoo removal involves laser treatment. A laser breaks down ink particles so cells in the immune system can remove the remaining colors.

"Typically there are several different lasers that could be used for tattoo removal, but the two most popular are YAG lasers, and then there's the PICO laser," said Gregory Greco, DO, FACS.

He explained that these lasers target specific colors, breaking them down and gradually fading the image.

"It's then blasting through the skin into the pigment, and it's breaking apart the pigment," said Dr. Greco. "So, the process of breaking that pigment apart then dissolves it essentially, and then it gets taken away through the immune system."

Laser tattoo treatment is the most popular option, but it can take several sessions over many months – and may even take more than a year. There are other, quicker methods that can also fade the signs of past regret.

"I've had police officers who weren't able to start work until they got tattoos off of their forearms," said Larry Weinstein, MD. "I had to do skin grafting for them."

Skin grafting is more painful and on the extreme side of tattoo removal, but it can yield faster results for those who don't mind the potential for scarring.

The ins and outs of laser tattoo removal

Skin grafting and dermabrasion are other tattoo removal options, but laser treatments are less invasive and come with minimal downtime, as long as individuals are committed to the process.

"Laser sometimes takes three to five treatments," said Dr. Weinstein, but you should expect laser treatment to vary in length depending on the tattoo's location, colors and size.

Some colors respond well to laser treatment, while others are more complicated to dissolve. Dr. Greco said that blacks and dark greens respond well to laser treatment.

"The hardest colors we have difficulty with removing are things like yellow, blues, especially the lighter shades of blue," said Dr. Greco. "Certain reds are very complicated."

It's not like tattoo artists don't just open a standard jar of ink and get to work. Many have special blends of ink they create for particular clients or art pieces, making targeting these unique colors challenging.

The size and location of the tattoo can also make a difference since tattoos in areas with less tissue, like the ankle, may require laser adjustments.

"So, if it's over a bony area over an ankle, there's not a lot of tissue there," said Dr. Greco. "You don't want to cause a burn."

Certain areas may need additional treatments, and larger tattoos that cover more space may also require extra time and treatments to remove them effectively.

What to expect from the process and recovery

"The biggest thing with tattoo removal is that it can sometimes be uncomfortable," said Dr. Greco. "So, we try to use topical numbing creams for patients. Tattoo removal is not a walk in the park. Then again, neither was getting the tattoo in the first place. Many people experience some pain and discomfort during the laser treatment process. Again, depending on the tattoo, expect multiple sessions to fade the ink.

After treatment, the area should be kept clean during your recovery.

"Most often it's a small dressing they keep covered just to prevent it from getting infected," said Dr. Weinstein.

While most patients face few to no restrictions after treatment, Dr. Weinstein advises his patients against going into hot tubs, which can be breeding grounds for bacteria.

Healing can take three to 10 days, after which a patient may be ready for the subsequent laser treatment. Dr. Greco also recommended that patients use sun protection during healing to protect their sensitive skin from burns and sun damage.

For individuals looking to fade a tattoo just enough to get it covered with a different design, you don't want to hurry the process.

"I would say wait about six months before you do anything from your last treatment," said Dr. Greco. "Don't rush it or be hasty."

Patients must also understand that tattoo removal is just as much an art as a science. Many people respond well to laser treatments, but the process doesn't always mean leaving a person with a completely blank canvas. Every person is unique. Some patients, you can't tell they ever had a tattoo at all, while others see a significant fade, but some pigment remains.

At the end of the day, you want to seek personalized tattoo removal treatment from a board-certified plastic surgeon. They have the resources, tools and skills to develop a treatment plan that factors in your complexion and skin tone and your tattoo size, color, design and location.

Not all lasers are created equal. The tools necessary to effectively remove tattoos are expensive. Med spas or other providers may utilize less powerful and less costly laser technology, which doesn't produce the same results. Seeking treatment with an experienced plastic surgeon is also essential because they can manage potential complications, like laser burns, if they occur.

A mistake, bad choice, past affiliation or abusive relationship does not define you. Nor do you have to live with the constant reminder or regret of a time long past. With the help of a board-certified plastic surgeon, you can find ways to trade old souvenirs for a fresh start.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.