How to remove a tattoo: the available techniques

Saying goodbye to a tattoo is possible: today the most used method is the laser.

From the tribal symbol to the phrase in Chinese characters, up to the drawing that represents an important event in our lives. The possibilities of choice for those who want to get tattooed are truly endless, but there are many who, immediately after doing it or after some time, regret it. It seems that in Italy, out of seven million people with one or more tattoos, one in three would like to delete it.

Retracing your steps today is possible, as long as you are willing to have a little patience. It is important, however, to remember that the result is subjective and depends on variables such as the type of skin, the size of the tattoo, its location on the body and the presence or absence of color.

The removal techniques are many and the choice varies from case to case. The advice is to always consult an expert (dermatologist or medical expert in aesthetic medicine) who can evaluate the type of skin, pigmentation and its state of health and the characteristics of the tattoo, in order to recommend the most suitable and effective intervention.

The laser

It is by far the most used technique and involves “bombarding” the tattoo with light radiation at different wavelengths depending on the color to be removed. The radiation is in fact absorbed by the pigment, which fragments and can be attacked more easily by macrophages, “scavenger cells” that remove ink particles.

The easiest colors to remove are black and blue, while among the most complex we find red, green and yellow, which instead of disappearing could turn into other shades.

Today there are two modes:

• the Q-switched laser, which is able to remove skin spots and promote skin rejuvenation
• The picolaser, faster and more powerful.

The first allows you to “whiten” little by little tattoos and imperfections of the skin and concentrates its beams of light within nanoseconds. The picolaser, as the name suggests, instead uses pulses a thousand times shorter than a nanosecond (the picoseconds in fact), managing to release a greater amount of energy. For this reason, picolaser treatments have a shorter duration than those with Q-switched lasers.

The number of sessions for the removal of a tattoo normally varies from 3 to 12 depending on the characteristics of the tattoo itself and the technology used. In addition, it is good to know that in the case of smokers the sessions become more numerous; Tobacco has an immunosuppressive effect on the body’s cells involved in the removal process, which can therefore be slower.

As for the type of tattoo, it is easier to remove the “older” ones and those performed with an amateur decoration than a professional one (in which the pigment is located deeper and the color is denser). The position is also important: a tattoo on the trunk is easier to treat than those on the limbs, as they are areas more subject to circulatory problems and therefore must be treated with greater care.

Normally the session is not painful, also because before the treatment an anesthetic cream is applied to the affected area.

Laser therapy usually leaves no scars, although, like any surgical procedure, removing a tattoo also carries with it the risk of some side effects. People predisposed to the formation of hypertrophic scars or keloids, for example, have a higher percentage of not getting perfectly clean skin. For this reason, before deciding to undergo an operation of this type, it is better to schedule a visit with an expert to evaluate your case.

Until the removal of the tattoo is finished, it is not recommended to expose yourself to the sun. And even once removed it is necessary to use a cream with high sun protection to protect the skin from UV rays during the first outings in the open air. A few days or weeks must pass between one session and another because the skin tends to redden and crusts may appear.

To facilitate this process, at the end of each session the part of skin affected by the tattoo to be removed is covered with gauze with an antibacterial cream.

Alternative techniques

Among the techniques used to remove tattoos before the advent of laser was dermabrasion, which consists of scraping the most superficial layer of the skin, scraping away the color with a brush instrument.

It is a practice now largely outdated due to the pain during and after the procedure and the consequent injury, which may require treatment up to ten days after surgery. The risk of scarring is also very high.

Another endangered technique for tattoo removal is cryotherapy, for which liquid nitrogen is usually used at -200 ° C.

To these is added the chemical peeling: it consists in the application of chemical agents on the tattoo that cause the formation of blisters that cause the detachment of the skin. Also in this case lesions may remain on the skin. Triggering an inflammatory process, in addition, causes swelling and redness.

In the case of small tattoos it is possible to resort to surgical removal of the affected part. It is an operation under local anesthesia that involves the removal of the dermis fragment with ink. The two flaps of skin are then sewn back (surgery that brings with it a visible scar).

Before the advent of the latest generation of lasers, pulsed light was used for tattoo removal, a technique currently used for hair removal. For this reason, even those who undergo permanent hair removal should rely on a specialist who makes sure not to fade the tattoo during the session.

Particular attention should be paid to tattoos on the face and in particular to cosmetic ones, such as eyebrows. The zinc and titanium oxide contained in this type of decoration makes it dangerous to use the Q-switched laser, which could blacken the area. For this reason it is advisable to opt for another technique, or to evaluate the reaction of the skin on a small area.

To edit it, without deleting it

For those who do not want to remove the tattoo, but only modify it, the “cover up” technique comes to the rescue. In this case the first thing to ascertain is the skill of the tattoo artist, who must in fact cover or make a restyling of the old design.

Another alternative to removal is the filler, a very small tattoo that fits between two others acting as a filler. In this case it does not change what already exists, but it can help to complete a design or rejuvenate a tattoo made years before and of which you are bored.

The Decalogue of Removal

The AICPE, the Italian Association of Aesthetic Plastic Surgery, has released a decalogue containing the information to know before deciding to remove a tattoo.

1. Contact only experienced professionals in the field who can evaluate the most suitable techniques and tools
2. Removing a tattoo is a long process that requires many sessions and is not cheap
3. It is not possible to know in advance how many sessions will have to be done to erase the tattoo
4. The duration of each session depends on the surface of the tattoo to be erased (for a tattoo of 4 centimeters it takes about ten minutes)
5. The laser does not always erase the tattoo completely (it depends on depth, density and pigment). In this case we speak of “tattoo ghost”, a kind of shadow that can remain on the skin for a few years or even forever
6. Before removing cosmetic tattoos of pink, brown or orange color on lips and eyebrows do a test on small areas
7. The patient can stop the removal but aware that the work is not complete
8. Treatment with the Q-S laser is painful. For this you use an anesthetizing cream
9. Removal is more problematic for those with dark skin, less for light subjects. For this reason, you should avoid exposure to the sun or use tanning lamps in the period before the start of treatment (as well as between sessions)
10. After treatment, bubbles form on the skin: the indication is to use antibiotic ointments.