Tattoo removal – options and results

U.S. Food and Drug Administration (FDA)

Sometimes people get a permanent tattoo then later decide they no longer want it. Life situations change, or maybe the tattoo just didn’t come out as hoped. Removing a tattoo isn’t as easy as it might seem. It can be painful, and risks include possible scarring and infection. When done by a trained health care professional, laser tattoo removal can be safe and effective. If you want to remove a tattoo, talk with a health care professional about the laser procedure, expectations, benefits, and risks.

While state and local authorities oversee the practice of tattooing, the inks and pigments used in tattoos are subject to U.S. Food and Drug Administration oversight as cosmetics. The FDA takes action to protect consumers when safety issues arise related to the inks.

At the other end of the tattoo process, the FDA also regulates laser devices used to remove tattoos. The FDA has cleared for marketing several types of lasers for tattoo lightening or removal. The lasers are cleared for use by, or under the supervision of, a health care professional. Laser tattoo removal requires using the correct type of laser, understanding the reaction of tissue to laser, and knowing how to treat the area after the procedure.

Laser Tattoo Removal

Tattoos applied with a needle are meant to be permanent.

Artists create tattoos by using an electrically powered machine that moves a needle up and down to inject ink into the skin, penetrating the epidermis, the skin's outer layer, and depositing a drop of ink into the dermis, the second layer of skin. The cells of the dermis are more stable, compared with those of the epidermis, so the ink will mostly stay in place for a person’s lifetime.

Permanent makeup also is a type of tattoo that is applied to look like eyebrows or eyeliner or lip liner, for example.

Laser tattoo removal is the most common method health care professionals use to remove or lighten tattoos. The laser light energy shatters the tattoo ink into small particles, which the body’s immune system clears over time.

The type of laser used to remove a tattoo depends on the tattoo’s colors. Because different colors of ink absorb different wavelengths of light, multi-colored tattoos may require the use of multiple lasers. Colors such as green, red, and yellow are the hardest colors to remove, while dark blue and black are the easiest. Flesh-colored tattoos, white ink, and permanent makeup are particularly tricky, because the pigment in these colors can oxidize (turn black) when treated by laser. Oxidized pigment is no longer treatable by laser.

Laser tattoo removal requires multiple treatments, with a few weeks in between procedures, to give the skin time to heal. The length and number of treatments depends on several factors, including the size of the tattoo and the colors used. Complete removal of the tattoo can take many treatments, and in some cases may not be possible.

Pain and Side Effects of Laser Tattoo Removal

Does tattoo removal hurt? Laser tattoo removal is like snapping a thin rubber band against the skin. If it is painful, a small amount of numbing cream can be applied to the skin before the procedure.

Laser tattoo removal can leave behind skin that is lighter than the skin around it. Other risks include possible scarring, infection, pinpoint bleeding, redness, or soreness, none of which should last for long.

Other Methods of Tattoo Removal

Besides laser, there are other, less commonly used ways to lighten tattoos. They include:
• Dermabrasion (“sanding” away the top layer of skin using a motorized wire brush or abrader).
• Ablative (non-tattoo) lasers that burn off the entire top layer of skin.
• Surgical removal of the tattooed skin.

Technically, these methods do not remove the pigment. Instead, they wound the skin above and around the pigment to stimulate an immune response that may lighten the pigment as the skin heals. The results are highly variable. At best, the pigment may be lightened, but there is greater potential for scarring and undesirable cosmetic effects. In general, the use of these methods is not optimal and less common for these reasons.

A Note About Creams

The FDA has not approved tattoo removal ointments and creams or do-it-yourself tattoo removal kits. The ingredients in these creams may include retinol, bleaching creams, and peeling agents that superficially exfoliate the skin, but they cannot reach tattoo pigment that is in the deeper dermis. The FDA has not reviewed these products and is not aware of any evidence that they are safe or effective for tattoo removal. These products may cause skin rashes, burns, or scars.