Tattoo removal options

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Dr. Nachbar answered questions he has heard from his patients about tattoo removal.

The first question was: Can the laser be used to completely remove a tattoo?  And, how many treatments does that require?

Dr Nachbar noted that he has been doing laser tattoo removal for sixteen years, and it is very effective.  The laser works because it is focussed light in a single wavelength, and depending on the wavelength (color) of the light, it can pass right through the skin, but then be absorbed by the dark tattoo pigment particles.  The laser is a "Q-Switched" laser, which means that it has a very fast pulse, which shocks the pigment particles, breaking them up into smaller particles.  The body's white blood cells can then clean up and remove the smaller particles.

The effectiveness of the laser treatment therefore depends on the color and other physical properties of the tattoo pigment particles.  Black pigment particles absorb a lot of light energy, and so they respond most quickly to the laser treatments.  Colors, especially blues and greens, are harder to treat.  The treatments are usually spaced four to six weeks apart.

For black tattoos, Dr. Nachbar usually tells patients that they may take between six and twelve treatments, although some tattoos may take fewer than six, and others more than twelve, depending on the type, amount, and depth of the pigment.

Even when the tattoo pigment is completely removed, there may be some skin changes, or "ghosting", of the tattoo, but often it can be made to no longer look like a tattoo.

The second question was: Is it painful to remove a tattoo using a laser?

Dr. Nachbar said that, yes, there is some pain with the treatments, but each treatment is typically quite fast, often ten to fifteen seconds, depending on the size of the tattoo.  While it is possible to inject the tattoo with local anesthetic before the treatment, the injections themselves are somewhat painful.  Most patients either do not use any anesthetic, or if they do, they put some topical anesthetic on the skin before the treatment.  

Those topical anesthetics are now available over the counter.  To work well, they should be put on one to one and a half hours before the treatment, with some plastic wrap to hold the topical anesthetic in place.  The instructions, especially regarding the dose of the anesthetic, should be read carefully, as it is possible to overdose on the topical anesthetic.

The third question was: If I don't want to wait to have the tattoo removed with a laser, can the tattoo just be cut out?  How large a tattoo can be cut out?

Dr. Nachbar is seeing more patients who cannot wait the six to twelve months that a course of laser treatments can take, and who are opting for surgical removal of their tattoo.  

Surgical removal is especially appropriate for smaller tattoos, when the patient cannot wait.  For example, patients who want to enter the military cannot have visible tattoos when they enroll, so tattoos on the face, neck, or hands may need to be removed.  In other cases, the name of a former loved one, in a visible place, causes such irritation that surgical removal is preferred.  Generally, this can be done in the office under local anesthetic in less than an hour.

Larger tattoos can also be removed, but may take more than one excision, and may produce somewhat larger scars.  Dr. Nachbar showed the before and after photos of a young lady with a tattoo on her shoulder which he removed in two separate procedures in the office.

Dr. Nachbar noted that he personally performs all of the treatments, including all of the laser treatments, performed in his office.  Arizona law allows a laser technician to treat patients after only 40 hours of classroom training and 24 hours of practice on only 10 patients, which Dr. Nachbar does not believe is adequate before using a dangerous piece of equipment like a medical laser.  In contrast, Dr. Nachbar has had decades of training and experience.

More information about Dr. Nachbar, including before and after photos of tattoos he has treated using laser or excision, is available on his website, www.plastic.org

Scottsdale Plastic Surgery, LLC is a paid advertiser of Sonoran Living Live