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 Treatment

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 ten, 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.

Surgical Removal

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.