The Ultimate Tattoo Removal Guide

Overview about Permanent Tattoo Inks

Getting a tattoo seems fun, but what most people seem to overlook is that tattoos require dedication. Tattoos can last longer than the fame of your favorite rock bands, pop stars, your friendship, and even your current relationship. Before getting a tattoo, make sure that the words, symbols or images mean a lot to you. Print or draw a picture of the design you want and hang it on your bedroom door so you’d see it day in and day out. But what if it’s too late? What if you already got a tattoo which you now regret?

The good news is that there are many ways on how to remove permanent tattoo. The bad news is that most cause short-term side-effects such as swelling, bleeding, redness and tenderness. If not given proper aftercare, the treated area may suffer from infection, hyperpigmentation, hypopigmentation, and ugly scarring. If you’re willing to take the risk to remove your pesky tattoo, then this book will prove to be most useful. To begin your tattoo-removal endeavor though, you should be familiar with the ink in your skin.

FDA and Tattoo Inks

The FDA does not regulate the distribution of tattoo inks. As a result, manufacturers are not required to disclose the concentrations of the ingredients of their inks. Modern tattoo inks are classified as cosmetic and color additives. Surprisingly, the FDA also does not approve of injecting these inks into the skin. The same standard applies for UV and glow-in-the-dark tattoo inks.

Black Ink

Tattoo inks are basically pigments mixed with carriers. The inks can be purchased premade but sometimes, your tattoo artist would mix the dry pigment with the carrier to make customized inks. Modern black permanent tattoo ink (not henna) has traces of iron oxides, metal salts, and nickel. This is the easiest color to remove, especially through laser tattoo removal.

White Ink

White tattoo ink has traces of titanium, lead, zinc and barium.

Red, Yellow, Orange, Blue and Green Ink

The traces of heavy metals, chemicals, and metal oxides in the colors mentioned are as follows:

Red: Mercury, iron, ferricyanide, cadmium, naphthol (as pigment), cinnabar

Yellow: Cadmium, zinc, curcuma (from ginger)

Orange: cadmium, azo-chemicals

Blue: cobalt, sodium aluminum silicate, cobalt aluminum oxides

Green: Lead, aluminum, ferrocyanide, azo-chemicals

Since tattoo inks have small amounts of metals, it is helpful to do a liver detoxification regimen after you’ve undergone tattoo removal.

Liver Detoxification

In most tattoo removal procedures, such as laser and IPL therapy, the tattoo ink is broken down into small molecules and carried away by your body’s immune system via your bloodstream. The liver would then filter the tattoo ink molecules from your blood. Liver detoxification is recommended if you decide to undergo IPL therapy or laser tattoo removal. Take milk thistle capsules because those contain silymarin that helps detoxify your liver.

MRI Complications and Tattoos: Myth or Truth?

A lot of people assume that permanent tattoos will react negatively with MRI (magnetic resonance imaging) scans. The truth is, the trace metals contained in tattoo inks will not interfere with MRIs. Blood contains iron yet it does not cause complications with MRI. Modern tattoo inks contain too few micrograms of heavy metals to react with an MRI. Only old, black tattoos contain high concentrations of heavy metals that react with MRI. MRI complications, however, can happen to people with metal body piercings in unusual places. Also, if the tattoo artist accidentally lodged a broken needle into the skin, then the person can suffer serious complications.

How Tattoo Ink Gets Deposited into the Skin

Basically, tattoo ink is injected by fast moving needles into your skin. The tattoo machine is capable of making 50 to 30,000 punctures per minute. The needles deposit the ink around 1 to 2 mm deep into the skin. Therefore, the tattoo ink lies in your epidermis and dermis.  Tattoo artists always use a carrier substance along with the pigment because the ink penetrates the skin better with the help of a carrier.

The usual carriers used are glycerin, denatured alcohol, rubbing alcohol, ethyl alcohol and propylene glycol. Carriers are important as they help deposit the pigment while keeping pathogen-associated risks to a minimum. They also keep the pigment evenly distributed in the skin. Without them, clients might end up with a blotchy tattoo and with an adverse reaction to the ink.

Tattoo Process

The tattoo artist will start by sketching the design on your skin using a pen. The pens used to draw the initial design on the skin have sterile and medical grade ink. The actual process of tattooing begins with outlining, in which the artist would draw the design using a tattoo machine with a single needle. The artist would then switch to a machine with multiple needles and start shading the design. Coloring is done last. Bleeding is normal so after the entire session, the tattoo artist will put a disposable bandage over the tattoo to absorb the blood. The client will be asked to keep the tattoo covered with sterile bandage for a few days.

Why do Tattoos Fade Over Time?

Once tattoo ink gets deposited into the skin, the immune system considers it a foreign substance or an “invader.” Tattoos will inevitably fade overtime because their ink molecules are being broken down slowly by phagocytic cells in the body. This process takes place as long as the skin has tattoo ink; however, the action of phagocytic cells alone won’t completely remove the tattoo.

Different Ways to Remove Permanent Tattoos

 Laser 

Using laser is the most popular method of removing permanent tattoo. The type of laser used nowadays is Q-switched. This method involves using specific light wavelengths to target certain colors. As a result, ink that is very similar to the skin in color can be hard to remove. Black ink is best removed with laser because it absorbs all light wavelengths. Other colors may require a laser with a specific wavelength. When the laser blasts light impulses, the molecules of the tattoo ink are disintegrated by high-intensity light.

The ink is, therefore, eliminated by the body naturally (through the bloodstream) because, as mentioned before, the immune system views the ink particles as foreign matter. Immediately after the procedure, the doctor will give you an ice pack to reduce both swelling and pain. The skin would then be treated with an antibiotic cream and covered with a dressing to avoid infection. Laser fades tattoos significantly, and that is why a lot of people prefer it.

Advantages

Because this is a popular tattoo removal method, most dermatologists offer laser tattoo removal procedures at varying costs. Laser can fade and remove tattoo regardless of tattoo age, location, and color. There is also little risk for scarring, unlike methods such as dermabrasion, salabrasion and excision. Professionally done tattoos will take more sessions to be removed because the ink is deposited deeper into the skin. Laser removes tattoo quicker than other tattoo removal methods; it can take as little as 2 to 4 sessions and as many as 10 sessions if your tattoo covers a large surface area of your skin.

Disadvantages

Laser tattoo removal can be painful. People describe the pain as someone snapping rubber band on their skin. Despite this, local anesthesia is not a necessity, except when the tattoo to be removed is located on sensitive areas like the face. Although laser removes permanent tattoo quickly, cosmetic tattoos (such as eyeliners, lip liners, and eyebrows) can darken after laser treatment. However, hyperpigmentation will fade on its own after a few months (depending on the size of the treated area). There is also a risk for hypopigmentation.

If you are worried about the cost, here’s something you should know – most, if not all, insurance services do not cover the costs of laser removal because it is regarded as a cosmetic procedure. It is better to discuss the expenses upfront with the person who will perform the laser tattoo removal. Obtain a written summary of costs before committing so it can serve as evidence in case the clinic charges you more than what was disclosed.

 IPL Therapy 

Intense pulse light or IPL therapy is often confused with laser tattoo removal because these involve similar processes. However, IPL differs in the type of light it emits. This method uses beams of broad spectrum light to burn away the top layer of the skin which contains the tattoo ink. The treated skin would then take a few weeks to fully heal, after which the patient is recommended to undergo follow-up procedures until the tattoo is gone. Since IPL uses broad spectrum light (multiple light wavelengths per pulse emitted), it is quite versatile; it can target different tattoo colors per light impulse, unlike laser. IPL is also used for hair and thread vein removal.

Advantages

IPL therapy uses broad spectrum light, making it suitable for treating large skin areas with tattoo. It is also less painful than laser. The incidence of scarring during this procedure is just 2%. IPL therapy is best suited for Caucasians. People with Greek, Italian or Arab roots may be at risk for hypopigmentation in which the treated skin may end up being lighter than the rest of the skin.

Disadvantages

IPL therapy can fade tattoos, but some patients experience blistering. In some cases, ink rejection happens. The cost of IPL therapy depends on how many pulses of light is emitted, making it quite expensive. Large pulses of light emitted makes this method unsuitable for small tattoos because the light beams might burn or damage the surrounding, non-tattooed skin. Because IPL therapy is incapable of treating very specific skin areas, it is more popular as a hair removal method.

 Dermabrasion 

Dermabrasion is more popularly used for anti-aging face treatments, but it can also be used to remove permanent tattoos. This method involves sanding away a layer of the tattooed skin with a dermatome until the skin becomes red and swollen. Some clinics freeze a layer of tattooed skin so sanding it would be easier. A week before the procedure, patients will be requested to stop taking aspirin or blood thinners to lessen the bleeding due to dermabrasion. Patients will be given local anesthesia, unlike in facial dermabrasion. Several sessions are required to fully remove the tattoo. A medicated bandage will be placed on the treated area until the skin heals.

Advantages

Dermabrasion is cheaper compared to other tattoo removal methods. It also works on all tattoo colors. There are also dermabrasion kits available for purchase but those can only fade the tattoo a little. If you want to fade your tattoo significantly, then dermabrasion done by a professional is a good option. Also, if you want a more conservative approach, then this method is good for you.

Disadvantages

This method will not fully remove tattoo. In addition, the treated area will need several weeks to heal. If you have sensitive skin or an active lifestyle, this may not be for you. Also, if you have a tendency for hyperpigmentation and hypopigmentation, avoid this method.

 Salabrasion 

Salabrasion is an old method of removing permanent tattoos. The procedure involves using a salt compound to sand away the skin area with the tattoo. The doctor will repeatedly rub the area to the point of exposing raw skin in order to remove skin layers with tattoo ink. Patients will receive local anesthesia before the procedure. As soon as the skin becomes bright or deep red in color, the doctor will stop scraping and a medicated dressing will be applied. Just like other tattoo removal methods, salabrasion may require multiple sessions.

Advantages

If you have a tattoo done by an amateur artist, this method may work. Unprofessionally done tattoos do not go as deeply into the skin. Salabrasion ideally works for small tattoos not exceeding 3” in diameter.

Disadvantages

The skin area without the tattoo can also be damaged because it can be hard to exclusively sand over the skin with tattoo. Because the skin will be wounded, scarring is inevitable. Aftercare is also meticulous to avoid infection. People have reported hyperpigmentation or skin discoloration on the treated area even after healing. People who are prone to keloids should never undergo salabrasion.

 Excision 

Excision is an invasive tattoo removal procedure. In this method, the skin with the tattoo is literally cut out. The edges of the remaining skin without the tattoo are then sewn together. Usually, the surgeon will remove the inner part of the tattoo, followed by the tattoo’s outline in the second session. The appearance of the scar will depend on how big the removed tattoo is. Patients will either be given a local anesthesia or a numbing topical solution. This method should be exclusively done by a professional.

Advantages

Through excision, permanent tattoo can be fully removed regardless of age. However, this method is best suited for small tattoos to avoid extensive scarring. If you have a busy schedule wherein you can’t afford to squeeze multiple numbers of tattoo removal sessions, then this method might be for you.

Disadvantages

Because excision literally removes a layer of the skin that contains the tattoo ink, it can be impractical for large tattoos. When excision is done on large tattoos, the surgeon may need to graft skin from another body part (usually the buttocks or thighs) to cover the raw skin. Larger tattoos may also require a second excision session. This is not suited for people who have a hard time healing wounds. Also, if you develop keloids when you scar, avoid excision.

 Cryosurgery/Cryotherapy 

This method was not initially intended for tattoo removal; it was first used (and is still being used) to remove moles, warts, and skin blemishes. Cryosurgery involves the use of liquid nitrogen to freeze a few millimeters of skin. The freezing temperature would then “kill” the skin cells, causing the skin to peel. Contrary to its name, cryosurgery is not invasive. Cryosurgery is least effective for green and yellow tattoo inks.

Advantages

Cryosurgery is cheaper and less painful than laser. Moreover, there is no risk for scarring because the skin won’t be wounded. However, most doctors like to speed up the peeling process by combining it with other tattoo removal methods. Cryosurgery is usually paired with dermabrasion to remove the dead skin layer.

Disadvantages

Cryosurgery may require the patient to undergo multiple sessions to fully remove the tattoo. The reason why most doctors like to combine cryosurgery with other tattoo removal methods is that it takes quite a long time to remove tattoo using cryosurgery alone. People who have sensitive skin should not avail of cryosurgery. This method is quite uncommon when used for tattoo removal; therefore, some clinics may not offer it.

 Saline Solution Fading 

This is a technique wherein some tattoo artists or doctors will tattoo (not inject) a saline solution (instead of ink) into the skin area to lighten or fade the permanent tattoo. The saline solution is usually made from sea salt. The salinity will cause an osmotic condition which will cause the cells to forcibly lift the tattoo ink out of the skin’s epidermis (tattoo ink is deposited in as deep as the dermis), causing scabs that will later heal. The scabs contain the tattoo inks. This is especially effective when done on old tattoos. This method is not as popular as laser so not all dermatology clinics and tattoo shops may specialize in this service.

The pricing depends per area. A 1”x1” tattoo usually costs US$75 per saline solution treatment, and a 5”x5” tattoo can fetch US$200 per treatment. Some tattoo artists even use this method to make cover-up tattoos more vivid.

Advantages

Saline solution tattoo fading or removal causes lesser discomfort compared to traditional laser tattoo removal. The saline solution also removes any tattoo ink color, unlike laser which depends on specific light wavelengths to remove certain colors. This method can also remove tattoo regardless of age and location. Moreover, saline solution tattoo removal does not cause scarring or blistering. The treated area will also heal a lot faster as opposed to laser-treated skin. This method is cheaper and safer compared to other tattoo removal options. A numbing solution can be applied if you don’t want it to be as painful as getting a new tattoo.

Disadvantages

It can be hard to find a clinic that specializes in saline solution tattoo removal. Just like other methods of removing tattoos, this one needs an aftercare regimen. The aftercare regimen is usually prescribed by the clinic. Saline solution tattoo removal also requires more than one treatment; however, it would not be as expensive as laser or IPL therapy. The main disadvantage would probably be the unsightly black scabs due to the expulsion of tattoo ink from the body, even though the ink is white.

DIY Permanent Tattoo Removal

 TCA Peel 

TCA (or trichloroacetic) acid peel is a strong chemical solution that offers medium to deep peels. A 100% TCA solution is used for spot treatments, particularly to remove warts and moles. Weaker solutions ranging from 5 to 15% can be used at home for “lunchtime” facial peels. Solutions ranging from 20 to 30% are used to remove dry skin and calluses.

To use a TCA peel for tattoo removal, wrap cotton around a stick and then soak the cotton in TCA; make sure it’s not dripping. The important thing is to avoid contact with the solution with your bare fingers. It is best to start using a 30% TCA solution. After the treatment, wait for the skin to peel and let your skin rest for 3 weeks before you begin applying TCA again. Remember that a TCA peel will make your skin sensitive to the sun. Some people use as much as 45% TCA on their skin but any concentration above 30% is not recommended for home use due to risks of chemical burns which can lead to uglier scars.

Advantages

TCA peel does not cause extensive scarring, although scabs are normal for strong concentrations. The advantage of TCA peels is the price. You can use a 30, 60, or 1200ml bottle multiple times. If you have a tattoo not more than 6” in diameter, then a TCA peel is ideal.

Disadvantages

The higher the concentration, the more painful the peel will be. In addition to that, TCA peels have a downtime of about 2 to 3 weeks, meaning that your skin will look dry and leathery before it will flake or peel off. Peeling can take about 2 weeks. The fresh skin should not then be exposed to direct sunlight. Because TCA peel is not that deep compared to cryosurgery, you may need to do multiple peeling sessions. If the area to be peeled is constantly rubbed (knees, elbows, buttocks), the skin may end up darker.

 Tattoo Removal Creams 

This cream speeds up the activity of the phagocytic cells in your body to carry away tattoo ink molecules. Tattoo creams are cheap compared to laser, IPL, and other ways of removing tattoos. If you want to save money, you can use tattoo removal creams before committing to clinical ways of tattoo removal.

Advantages

Tattoo removal creams do not cause scarring, swelling and bleeding which are usually normal with traditional tattoo removal methods. If the cream does not work, you won’t be left with any ugly marks. Getting a 6-month supply of tattoo removal cream is cheaper than undergoing multiple laser sessions.

Disadvantages

Not all tattoo removal creams work for all people. If you search for reviews, you’d notice that are mixed results. At best, tattoo removal creams would only fade tattoos to a certain extent because creams alone cannot reach the dermis effectively. Complete removal is not possible with creams, but it can reduce your tattoo to an almost unnoticeable state with continuous use.

What to Expect from Permanent Tattoo Removal

Tattoo removal may be partial or permanent, depending on the methods used and on the size of the tattoo. When you want to have your tattoo removed, it is best to avoid expecting a perfect removal. Even laser tattoo removal cannot clear the skin of tattoo after one session. The ink of permanent tattoos, as mentioned before, has big molecules. Each of these molecules is lodged deeply into the skin. What most tattoo removal methods do is blast the molecules into smaller units that are easier for the body to remove. Some methods remove the skin layers with tattoo ink deposits. It really takes time for your skin to return to its tattoo-free state. Do not expect your tattoo to be fully removed within a short time frame.

There are instances where the treated area would feel sore or itchy. It is advised not to scratch the area to prevent your skin from getting darker (hyperpigmentation) due to irritation. Do not expose the treated area to direct sunlight. Strictly follow the aftercare regimen to prevent infection.

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