Estimates from the US show that around one in ten people have at least one tattoo and that half those people want to remove or change them. With many teens impulsively getting tattoos they later regret, tattoo removal is an increasing issue in Australia.

Laser treatments are the most popular method of tattoo removal, both for their effectiveness and ability to target specific ink colours separately. Dermabrasion and surgical removal are also options, but can be messy, painful and less effective. There are many other alternatives—including creams—that may be unsafe and are far less effective.

The most effective removal method depends upon the size of the tattoo, location, depth to which the ink has been placed, the type of ink and the number of pigments used. It is usually easier to remove tattoos that were created by a professional tattoo artist, because their work usually has a better consistency than the work done by amateur artists.

Smaller tattoos can be easily removed surgically, but that option is not available if the tattoo covers a large area. Some tattoo inks respond well to laser treatments whereas other types and pigments are trickier. However, most dermatologists caution that complete tattoo removal is not possible.

Converting original tattoos into a different image or disguising the tattoo altogether with cover-up makeup are other ways to deal with unwanted tattoos.

Reasons for choosing to have a
tattoo removed

People want tattoos removed for a variety of reasons:

• They no longer feel the emotions that they felt when they acquired the tattoo; or have moved on to a different phase in their lives.
• They regret the decision to get a tattoo, because they took it rashly or under the influence of drugs or alcohol.
• Family members or loved ones object to the tattoos.
• The effects of ageing have caused the tattoos to deform, making them look ugly or unsightly.
• It is difficult to get the type of jobs they want with a tattoo visible outside work clothing.
• Medical complications such as allergies to the ink or other skin conditions may necessitate tattoo removal.
• Those who have distinct tattoos that mark them, as part of a group, society or gang may want them removed once they leave the group. Their need for removal stems from social, personal, professional or safety reasons.

It is not safe to try to remove a tattoo on your own. Your first step should be to consult a dermatologist about the best options for removing your specific tattoos. You can ask your family doctor for a referral to a suitable dermatologist.

Tattoos are meant to remain permanently etched on the skin without fading over time. When you get a tattoo, tiny droplets of tattoo ink or pigment are placed underneath the topmost layer of skin, using a continuous series of injections. Because the pigments are placed beneath a layer of skin, the removal process is more complicated and painful than the relative ease of getting a tattoo.

Tattoo removal can be a costly and time-consuming exercise. Removing a tattoo is more difficult for people with dark skin or if multiple colours have been used.

Things to consider once you’ve decided to have a tattoo removed

There are a number of ways that you can remove tattoos:

Dermabrasion

An abrasive element is used to remove top layers of the skin all the way down to the tattooed ink layer below the surface of the skin. Even though this treatment is performed with local anesthesia, as the layers of the skin are removed some pain may be experienced. There may also be a significant amount of bleeding. After the dermabrasion process, the skin heals, and there should be few signs of the tattoo left. Because it can be painful, this method is usually best confined to the removal of very small tattoos.

Surgical removal of tattoos

Surgical excision is mostly used to remove smaller tattoos. It involves cutting out parts of the skin, cauterising the edges and then stitching the area closed. Tattoos covering larger areas can also be surgically removed, but a skin graft with skin obtained from another part of the body may be required. Both types of excisions can lead to scarring and should only be performed by a qualified surgeon under sterile conditions.

Laser treatments

Lasers have become the most popular method of removing tattoos. Because lasers are very effective, most techniques that existed prior to laser removal have lost favour. A laser treatment involves firing beams of concentrated light at a targeted area. The light penetrates the skin and breaks down the coloured pigments of the tattoo ink embedded within the skin. Any ink debris are absorbed slowly into the skin, and the tattoo will gradually fade away and disappear.

Laser removal becomes complicated where multiple ink colours have been used. Tattoos with blue and black pigments respond well because they absorb laser beams with different wavelengths. Other colours require a different kind of laser beam. Green and yellow are the most difficult colours to remove.

You will be asked to wear protective eye shields during the removal process. Your skin will be tested to determine how it reacts to the laser, to help determine optimum energy levels used during the treatment.

Your practitioner will operate a hand-held laser light and activate the beams. Patients describe the sensation of a laser pulse as being similar to the snapping of a rubber band against the skin.

Laser treatments usually require more than one visit. After each treatment, the tattoo will become lighter in shade. Smaller tattoos require a fewer number of laser pulses to be delivered than tattoos covering large areas of skin.

Laser treatments are usually performed on an outpatient basis. Although most people do not need anaesthesia, you can request a local anesthetic if your pain threshold is low. This will be given in the form of a topical cream applied to the skin or an injection of a pain reliever into the treatment area. Some parts of the body are more sensitive than others, and may therefore be more sensitive to pain.

After tattoo removal

You will need to apply an ice pack to the treated area immediately after the procedure. An antibiotic ointment or cream will be prescribed to prevent any infection to the treated area. You will also be asked to apply a bandage or a patch to protect the treated skin. You should avoid sun exposure, and if unavoidable then you will need to use sun block.

Possible risks and complications

Regardless of the method used, tattoo removal may lead to

• Scarring, which can be common in some tattoo removal procedures. Scarring is especially likely in places where the treated area rubs against clothes or skin.
• Hypopigmentation, where the treated skin ends up being a lighter shade than the rest of the skin. This can happen when lasers used to remove reddish and brown ink destroy the melanin pigments in the skin. Hyperpigmentation, when the treated area becomes darker than the surrounding skin, can also occur. Some types of discolouration are long lasting, while others can be treated to fade over time.
• Laser burns from excessive exposure, which can cause inflammation.
• Inflammation caused by the removal process. This is not so much a risk as an expected consequence of tattoo removal.
• Infections, which can develop if removal is not done properly or proper care of the treated area is not taken. Antibiotic creams and applications are usually part of the post treatment healing process.

Using unsafe methods, including tattoo removal creams, without medical supervision can lead to various adverse reactions including skin irritation, infection or other complications.

Finding an experienced dermatologist or cosmetic surgeon to perform your tattoo removal will help reduce the level of risk involved. Issues like scarring cannot be entirely avoided.

Rough costs involved

Tattoo removal usually takes many more treatments than the couple of sessions it takes to get a tattoo. Each removal session can cost around $200 (AUD), and may be higher, depending on the extent of skin covered by the tattoo.

When laser tattoo removal is used and there’s more than one colour in the tattoo, more than one type of laser may be needed to remove particles of different pigments, making the removal process more expensive.

Tattoo removal is not usually covered by insurance unless it is considered medically necessary.

You should expect the costs to be higher if you are having combined treatments at the same time.

This information is correct as of 2019.