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Table of Contents

Magill’s Medical Guide, 9th Edition

Tattoo removal

by Amanda Guilmette, , MS-III.

Category: Procedure

Anatomy or system affected: Skin

Specialties and related fields: Dermatology, general surgery

Definition: The use of lasers to break up tattoo ink under the skin.

INDICATIONS AND PROCEDURES

Tattoos were previously handmade using a manual method. Each individual piercing into the skin led to a very long, expensive, and excruciating process. In the 1800s, the electronic tattoo machine was invented which decreased the application time slightly as well as the cost. Application of a tattoo includes needles penetrating ink down into the dermal layer of the skin. When the skin heals from the multiple punctures, the design remains permanently in place. Throughout history, multiple procedures for removing tattoos have been tried. One of the first procedures that was used to remove tattoos was the salabrasion method. In this method, the epidermal layer of the skin was removed via mechanical force or chemical compounds and then salt was rubbed in the wound. Due to excessive scarring and pain associated with the procedure, other techniques such as dermabrasion, electrocauterization, or cryosurgery were used. Like the salabrasion method, scarring was a major unwanted outcome.

Currently, laser therapy is the most effective way of removing unwanted tattoos. Optimal clearance of tattoos is based on selection of different laser wavelengths and parameters. Laser therapy works by different wavelengths of energy being absorbed by molecules in the skin. When the molecules absorb the energy, a chemical reaction occurs that produces heat that penetrates the surrounding tissue. In order to have optimal clearance of the pigment without damaging all the surrounding tissue, the molecule must undergo the reaction and produce heat in a shorter amount of time then it would take for the molecule to lose heat after the reaction (thermal relaxation time). The Food and Drug Administration (FDA) has approved several types of lasers for tattoo removal. The standard device now used is some form of Q-switched laser, which produces a pulsed beam with much higher power at the peak of the pulse than a continuous wave laser. When applied to a tattoo, the ink embedded in the skin absorbs the pulse of energy. The laser energy causes the tattoo ink to break up into fragments that can be removed by cells of the body’s immune system. The treatment feels like a rubber band snapping against the skin, and local anesthetics may be necessary when attempting to remove large tattoos. Immediately after the laser treatment, the treated area turns white and might swell slightly; over the next few days, blisters and scabs may form. Within seven to ten days, the skin will look normal. Several such treatments are required, spaced several weeks apart. Although the Q-switched laser is the standard device, there has been development of a new laser, the picosecond laser (PS), that has a greater potential for increased tattoo clearance with fewer side effects compared to the Q-switched laser. The PS laser works in picoseconds compared to the Q-switched laser which works in nanoseconds. Both lasers have the same mechanism of action. The only difference is that the PS laser has shorter pulse lengths and faster disruption of the ink within the molecule. Because an average tattoo ink particle has a thermal relaxation time of ns, the PS laser has the potential of clearing the pigmentation with less surrounding tissue injury.

USES AND COMPLICATIONS

The number of treatments required to remove a tattoo depends on several factors: the color of ink, the amount of ink, the depth of the tattoo, and the location of the tattoo. Professional tattoos may require more treatments to remove than those applied by amateurs, because professionals tend to use more ink and to apply the ink deeper into the skin. Ideally, treatments are spaced several weeks apart to allow the body’s immune system to remove the maximum amount of ink between sessions; this time is also necessary to allow the skin to recover fully before the next treatment.

It is more problematic to remove tattoos from areas of the body with thin skin, such as the face, genitals, and ankles. In the case of tattoo removal, laser treatments are designed to remove the unwanted buildup of abnormal pigment (ink) in the skin; however, people with dark skin have high amounts of natural pigment (melanin) in their skin. Sometimes, lasers cannot distinguish between tattoo ink pigment and normal skin pigment. As a result, both types of pigment are destroyed, leaving pale patches on the skin; these patches can fade with time. Conversely, an increase in pigmentation can be seen after treatment, causing dark patches on the skin; these patches can also fade with time. It is recommended that patients stay out of the sun before and after treatment for tattoo removal. Tattoo removal can lead to scarring, but with the modern laser methods, this is becoming rarer. The most striking side effect of laser tattoo removal is the cost, typically much higher than the cost of the original tattoo. Nonetheless, according to the American Society for Dermatologic Surgery, its members performed some 100,000 tattoo removals in 2011, up from 86,000 in 2010.

See also: Blisters; Dermatology; Healing; Laser use in surgery; Pigmentation; Skin; Skin disorders; Tattoos and body piercing.

For Further Information:

1 

Ahluwalia, Gurpreet S., editor. Cosmetic Applications of Laser and Light-Based Systems. William Andrew, 2009.

2 

Camphausen, Rufus C. Return of the Tribal: A Celebration of Body Adornment: Piercing, Tattooing, Scarification, Body Painting. Park Street Press, 1997.

3 

Graves, Bonnie B. Tattooing and Body Piercing. LifeMatters, 2000.

4 

Hewitt, Kim. Mutilating the Body: Identity in Blood and Ink. Bowling Green State U Popular P, 1997.

5 

“Inked and Regretful: Removing Tattoos.” US Food and Drug Administration, 30 Jan. 2013.

6 

Kirby, William, Emily Holmes, Alpesh Desai, and Tejas Desai. “Best Clinical Practices in Laser Tattoo Removal.” Dermatologist, June 2012, pp. 23-28.

7 

Kurniadi, Ivan. “Laser Tattoo Removal: Fundamental Principles and Practical Approach.” Dermatologic Therapy, 17 Oct. 2020, onlinelibrary.wiley.com/doi/10.1111/dth.14418.

8 

Miller, Jean-Chris. The Body Art Book: A Complete, Illustrated Guide to Tattoos, Piercings, and Other Body Modifications. Rev. ed., Berkley, 2004.

9 

“Unwanted Tattoos.” American Society for Dermatologic Surgery, 2013.

10 

Wilkinson, Beth. Coping with the Dangers of Tattooing, Body Piercing, and Branding. Rosen, 1998.

Citation Types

Type
Format
MLA 9th
Guilmette, Amanda. "Tattoo Removal." Magill’s Medical Guide, 9th Edition, edited by Anubhav Agarwal,, Salem Press, 2022. Salem Online, online.salempress.com/articleDetails.do?articleName=MMG2022_1326.
APA 7th
Guilmette, A. (2022). Tattoo removal. In A. Agarwal, (Ed.), Magill’s Medical Guide, 9th Edition. Salem Press. online.salempress.com.
CMOS 17th
Guilmette, Amanda. "Tattoo Removal." Edited by Anubhav Agarwal,. Magill’s Medical Guide, 9th Edition. Hackensack: Salem Press, 2022. Accessed October 22, 2025. online.salempress.com.