Your Complete Guide to Tattoo Removal

“When one gets a tattoo, the ink is placed beneath the epidermis, which is the top layer of the skin,” says Adrienne O’Connell, DO, the Medical Director and President of Laguna Beach Aesthetics in Laguna Beach, California. “This makes tattoo removal more complicated, more painful, and more expensive than the original tattoo application.” Removal can take one or more sessions, 

How does tattoo removal work?

Although it’s not the only way to get rid of old ink, laser tattoo removal is the favored method of removal for a few reasons. “Laser removal is the most successful and cost-effective way to remove a tattoo,” says Dr. O’Connell. “Most people will opt for laser removal [over surgical or dermabrasion removal] as it is the most readily available, easiest downtime, and gives good results.”

Here’s how it works: a laser (the Q-switched Nd:YAG laser, specifically, according to Dr. O’Connell) targets ink in the skin and delivers a single, powerful pulse to heat and shatter the tattoo ink, which is then broken down in the body through the lymphatic system.

“Essentially, the laser targets the pigment in the ink and breaks it down and the body then eliminates it through certain cells in our immune system,” Jeffrey Fromowitz MD, a board-certified dermatologist in Boca Raton, Florida, explains. “It is best to think of the ink as boulders. Each session breaks the boulders down into progressively smaller rocks ultimately pebbles then sand, and then the skin should be clear.”

This takes a lot of time and patience, as the ink breaks down in the skin gradually. “On the initial treatment patients will experience a ‘frosting effect,’ where the tattoo will immediately turn white,” Rochonchou explains, “but it will return to its natural pigment in the first couple of minutes.” The tattoo will continue to slowly fade, but it takes multiple visits to completely remove the ink from the skin. The amount of sessions and time to completely eliminate the ink depends on the size, color, location, and age of the tattoo. From beginning to end, the process could take up to a year. 

Some other less-popular removal options include surgical removal and dermabrasion. Surgical removal requires a local anesthetic and a scalpel to remove the skin the tattoo was inked into before stitching together the edges of the skin. “Surgical removal is an effective alternative for smaller tattoos,” Dr. O’Connell says. “If you have a small tattoo and just want a ‘one and done’ treatment, you [may] be a good candidate for surgical removal.”