Neil J. Zemmel, MD, FACS
Megan J. Goff, PA-C
Rachel M. Duke, NP, CANS
Short Pump Office
11934 W Broad Street, Suite 200
Richmond, VA 23233

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Laser Tattoo Removal

Laser treatments are currently the gold standard for permanent tattoo removal and are effective for all ink colors and skin types. Tattoo removal is currently the most common laser procedure performed at Richmond Aesthetic Surgery. Dr. Zemmel and his team achieve complete tattoo removal in most cases. The current lasers have come a long way in allowing for permanent removal with very few side effects and no down time.

How Does Laser Tattoo Removal Work?

At Richmond Aesthetic surgery, our board certified Nurse Practitioner Rachel Duke, NP, utilizes the Q-switched Nd:YAG laser with excellent results. The laser sends out pulses of colored light that stream through the most superficial layers of the skin. The tattoo pigment then absorbs the laser energy causing the pigment to break apart into smaller molecules. Once the ink is broken into microscopic fragments, the body’s immune system is activated. The body’s lymphatic system then clears the fragmented ink particles. Visible fading is seen 4-8 weeks after the treatment and can continue for up to ten weeks. This advanced technology targets only the pigment of the ink and is able to leave the surrounding skin unaffected. Most professionally placed tattoos require an average of 6 treatments for removal. Amateur tattoos often require less than 4 treatments. The number of treatments can vary for each individual depending on several factors such as the type of ink used, color of ink, depth of ink placement, location on the body, a persons’ medical history, skin type, and a person’s response to the laser. Individual layers of the skin are targeted during each session. With each subsequent treatment the intensity level or energy of the laser will be increased in order to target the tattoo pigmentation deeper within the skin.

Who are the Best Candidates for Laser Tattoo Removal?

The Q-Switched laser is very effective on all skin types and ethnicities. The laser is most effective when targeting black and dark blue pigment because the laser is able to differentiate those colors most effectively from the surrounding skin and we know which wavelengths these colors absorb the best. Yellow and green pigments are more resistant to treatment but it is still possible to fade them to satisfactory levels. Ankle and lower legs tattoos on are more difficult to treat as these areas have less blood flow that is essential for wound healing. These areas typically heal slower and therefore must be treated more conservatively. Usually treatments are spaced further apart for these areas to ensure adequate healing time between treatments. It is also more difficult to remove revision tattoo work, where one tattoo has been placed on top of another in order to “cover” it. The concentration of ink is much higher and requires longer intervals between each session.

In a small percentage of all patients it is possible that areas of the tattoo will not be completely removed despite optimal treatment. There are a number of factors that can contribute including the depth of pigment placement, the type of ink used, the technique of tattoo placement, and a patients individual healing characteristics.

Is Laser Tattoo Removal Painful?

Tattoo removal is mildly to moderately painful but there are various techniques Dr. Zemmel and Ms. Duke use to make it more comfortable. For patients with tattoos on more sensitive areas, such as the ankle or wrist, a topical local anesthetic is offered to help decrease the pain. Patients may also be given ice packs applied to the treatment area to make the procedure tolerable. Most patients compare it to the sensation of “localized pinpricks” when the laser is firing, with the pain discontinuing soon after the laser treatment ends. On rare occasions, the discomfort may linger for several minutes to an hour. Depending on the size of the tattoo, each treatment can last from 1 to 30 minutes. It is not uncommon to develop mild superficial blistering after the first treatment, which heals within 3-5 days with proper care. Immediately following each session, an ice pack, and antibiotic ointment, and dry dressing are applied for additional comfort and to aid the healing process. Ms. Duke will provide you with detailed aftercare instructions.

What Side Effects Should I Expect?

Common side effects of laser tattoo removal include redness, swelling, and localized blistering of the treated area. Rarely, more severe side effects occur with multiple treatments and include hyperpigmentation (darkening) or hypopigmentation (lightening) of surrounding skin, localized skin infection, or scarring.

What Other Options are Available to Remove Tattoos?

Alternate options that are available include surgical excision, dermabrasion, chemical acids, and topical lightening creams. All of which, either leave significant scars or are not effective. Laser tattoo removal is currently the number one treatment for permanent removal with very few adverse events and no down time.