Dear Doctor Column, September 20, 2004

Can tattoos be removed? How much does it cost?

Answer:

In recent years, dermatologic surgeons have developed safe and effective techniques to successfully remove unwanted tattoos. The technique used depends upon the size and age of the tattoo, as well as its location.

The choice also depends upon how the tattoo was applied. For example, a tattoo applied by a more experienced tattoo artist typically is harder to remove than amateur-applied tattoos because the ink is deposited deeper into the skin layers, and professionals tend to use more colors than amateurs. Also, amateur tattoos usually are dark blue or black, which are the easiest colors to remove; green, yellow, and red are the most difficult, as are some of the newer inks and pastel colors used by professional tattoo artists.

Traditionally, surgeons have treated larger, multicolored tattoos in two ways:

• Surgical excision — the surgeon removes the tattoo with a scalpel and closes the wound with stitches. If the tattoo is very large, a skin graft taken from another part of the body may be necessary.
• Dermabrasion — the surgeon "sands" the skin, removing the surface and middle layers of the tattoo.

Today, lasers have become the standard treatment for tattoo removal, offering a relatively "bloodless," low-risk, highly effective approach with minimal side effects. The Q-switched Nd:Yag laser, the Q-switched Alexandrite and the Q-switched Ruby lasers are among the most frequently used lasers for the removal of unwanted tattoos. They all work in a similar manner: Pulses of light from the laser are directed onto the tattoo causing the pigment to disintegrate.

Each treatment takes approximately 15 minutes, depending on the individual tattoo. A cream may be applied to the area to numb the skin. Following treatment, a dressing is applied and the wound may ooze small amounts of blood for a few hours. Scabbing will occur over the following 2 weeks. Proper care of the area is required to reduce the risk of infection.

Side effects are generally minor, but may include scarring and skin discoloration at the treatment site, which is often temporary and fades to normal in a few months. The incidence of pigmentation change depends primarily on skin color — less than 5% in whites and 10% to 15% for darker skin. The incidence of scarring also is low — less than 5% in whites and 15% to 20% in darker-skinned individuals. The type of laser used also makes a difference in these side effects.

Several factors determine the cost of laser treatment for tattoo removal, such as the size of your tattoo and pigment colors. Most tattoos require multiple treatments, scheduled about a month apart. On average, professional tattoos require eight to 12 treatments; three to six treatments for amateur tattoos. The cost per treatment is approximately $300; health insurance generally does not cover these type procedures.

For a personal consultation, we suggest you make an appointment with a board-certified dermatologist or plastic surgeon experienced in cosmetic surgery.

For more information, and to find a physician in your area, visit the following Web sites: American Academy of Dermatology www.aad.org; American Society of Plastic Surgeons/Plastic Surgery Educational Foundation www.plasticsurgery.org; American Society for Aesthetic Plastic Surgery www.surgery.org; and American Society for Dermatologic Surgery www.asds-net.org.