Dermatology-Online

The best methods of tattoo removal

Synonyms in a broader sense

scientifically also tatooing = tattoo
English: tattoo

introduction

There are different methods for tattoo removal. Not only because newer methods of tattoo removal have been developed and refined over time, but also because not every method is perfect for every removal.
Therefore everyone has to find the individually optimal method for removing the tattoo. A combination of different methods can also be the best option.

However, the aim of the treatment is always the same: to remove the color particles from the tattoo. They are stored in the skin as bundled color pigments. There they are surrounded by a solid layer of collagen and encapsulated from the surrounding tissue. This is what makes a tattoo so long-lasting and resistant. Removal can be done by the following methods:

surgery
Laser therapy
Non-laser extroverted surgical methods

Surgical removal of a tattoo

Surgical removal of the tattoo is particularly suitable for small-scale tattoos on inconspicuous parts of the body. Residual pigments after laser treatment and minimal tattoos can be removed with a skin punch.
It is particularly favorable if the tattoo has an elongated shape. Here the piece of skin can be easily removed and the skin can be sewn up later. With medium-sized tattoos, the skin should be pre-stretched a few weeks beforehand using an expander and, if necessary, operated on in several steps (serial removal). Surgical tattoo removal is, in the truest sense of the word, a drastic method that completely removes the tattoo in the operated area, but not without scars. The wounds heal quickly with good care, hygiene and dressing control and the stitches can be removed after approx. 10 to 14 days. A skin transplant, especially with larger tattoos, is possible, but should be avoided for aesthetic reasons. The cost is around 1500 to 3000 euros for a palm-sized tattoo.

Laser therapy

Laser therapy for tattoo removal is the most common and effective method today and it is also very gentle. No special skin preparation is required.

Let's remember the structure of a tattoo: The color pigments are encapsulated in the skin and surrounded by a layer of collagen. The light from the laser penetrates the skin and is absorbed by all color pigments. This shoots up the color pigments and there is a brief burst or burst effect, which during the treatment can feel like a needle prick - similar to a tattoo. This principle is also called "photoselective thermolysis". The particles are crushed, the encapsulation dissolves and the free color parts are used by the body's own immune system (Macrophage system) transported away via the lymphatic system. The areas of the skin where there is no tattoo remain unaffected by the laser effect.
This radiation does not result in any injuries. In addition, a laser is light that is bundled in a certain wavelength, making it a very high-energy light source. The skin is not exposed to ionized radiation as it is with X-rays or UV rays. Cell changes on and in the skin are therefore not to be expected.

Regarding the course of treatment, it should be said that the length of the treatment session depends on many factors and cannot be precisely predicted. The type and depth of the pigmentation, which color was used, the quality of the tattoo and the responsiveness of the immune system have an influence on the duration. Basically all colors can be removed. But colorful tattoos can pose problems. The color "yellow" is difficult or impossible to remove. Mixed and unclean colors can also be problematic. Black tattoos are best because they absorb all wavelengths of light.

The right choice of laser is generally crucial for the treatment. Depending on the color of the tattoo that is to be removed, different types of lasers are used. Alexandrite chargers or ruby lasers are suitable for dark and green colors. The best way to remove red tattoos is with a neodymium-YAG laser. Only laser therapy centers that have these types of lasers can completely remove colorful tattoos. With the first laser, the fading effects are often stronger than with the subsequent treatments, since fewer color pigments are now available to absorb the energy. Often a gray haze remains, depending on the type of laser and energy consumption, a skin change (scar) appears over the tattoo.

In general, depending on the skin type, superficial skin irritation and reddening occurs after treatment with the laser, which is comparable to sunburn. Swelling and blisters may form. Under no circumstances should this be scratched or opened. Any scabs must not be scraped off either. It falls off on its own after one to two weeks. After the treatment, you should cool the area and disinfect it regularly for the first 2 days, avoid sporting activities for one or two days, not use creams or ointments and absolutely refrain from tanning and sunbathing. If the affected area is still exposed to extreme sun, sun protection with sun protection factor 60 is recommended. Soothing ointments such as ointments containing cortisone (e.g. Ebenol®) can only be applied after the third day. A new session can take place at the earliest after 28 days and after complete healing. This is why large colored tattoos can take months of treatment.

The age of the is also discussed in the treatment Tattoos. In general, it doesn't matter how old it is, but the color pigments are all the more deeply into the skin stored, the older it is. This can increase the number of treatments needed. Four to six are common, in rare cases up to 12 are possible. At least 28 to 40 days should have passed after the tattoo, so that the skin has time to regenerate.
While the tattoo is being removed, scars from tattoos may only become visible now, especially with multiple stitches. Further risks are the formation of shadows (hypo- or hyperpigmentation) of the skin due to the use of an unsuitable laser for certain color pigments. In addition, laser therapy can often not be sufficient if color pigments have been applied improperly. A skin transplant is often necessary and ugly scars are the consequence. Dark skinned or pre-tanned skin may occur after treatment Pigment spots have, but also dark-skinned or Asian people can have a tattoo removed. Depending on the pigment composition, pigment spots may remain. The skin pigment (Melanin) is, however, always newly formed and thus weakens existing ones Pigment disorders from. So let's summarize a favorable case for a tattoo removal again:

Ideal case

Lay tattoo / self-engraved
only black color (biodegradable)
Once and deeply engraved (like shading, etc.)
Not stung deep

A 100% success can usually be seen here after three to five treatments.

Worst case:

Tight and multiple tattoos
Green, blue and yellow colors (not biodegradable)
Very old tattoos (older than 35 years) usually very deep
unknown composition of color
in very sensitive areas (crotch, genital area, etc.)

The removal process is best assessed after the first treatment. All previous statements are mostly based on experience.

The cost of a treatment depends on the size / area and the number and length of the treatments. The prices are between 50 and 250 euros per individual treatment and around 300 euros per 20cm2. The health insurance companies do not cover these services.

All in all, everyone has to find the right method for themselves. Here is a brief overview of the advantages and disadvantages of the individual methods and techniques:

Non-laser extroverted surgical methods

Advantages:

Elimination of the colors to the outside
all colors are recorded
painless
even with large tattoos where surgery is not possible

Disadvantage:

increased requirements (qualification) to the practitioner
Wound management like after a tattoo

surgery

Advantages:

complete removal of the tattoo

Disadvantage:

only useful for small tattoos
not possible on all parts of the body
Scar management demanding
surgical intervention

Laser therapy

Advantages:

relatively closed wound conditions
short duration of a treatment session
scarce
painless (depending on personal pain threshold)

Disadvantage:

By-products of the paints often contain carcinogenic amines (carcinogenic)
Main elimination of colors via the lymph (lymph nodes)
relatively unsuitable for colorful tattoos
Color change due to oxidation possible
expensive

Non-laser extroverted surgical methods

This possibility of tattoo removal is one of the earlier therapies and can briefly also be used as a skin abrasion ("Dermabrasion“). The tattoo ink is mainly eliminated to the outside via the skin surface. This is done by removing the topmost skin (Dermis) by chemical (by a modified tattoo machine and an agent, or purely chemically with a strong acid), mechanical (diamond grinder-dermabrasion in the narrow sense) or thermal (by high-frequency fine current (special cautery) or by cold (cryosurgery) or a combination This means that with dermabrasion the skin is abraded until the pigments are exposed. A deep abrasion forms, which gets wet and takes several weeks to heal. The color particles are embedded in the scab and fall with the crust to the end of the Healing with ab. A wound that resembles a moderate burn develops. Therefore, the patient should be absolutely hygienic so that there is no infection. With this therapy two to three sessions are usually allowed for. The resulting scars can last for months Remain reddened until they slowly fade. The most precise work enables the bloodless high frequency Treatment for tattoo removal with the fine flow cautery.
Contrary to the opinion, the de-tattooing / removal of the skin without a laser is becoming more and more important compared to the laser treatment, as the tattoos are becoming more and more colorful and the dyes are becoming more and more light-stable and more difficult to laser. Overall, however, the method is the most complex, as many follow-up treatments and bandage changes are necessary.

Removal with lactic acid

Lactic acid is one of the so-called liquid tattoo removers. The solution usually contains 40% L (+) - lactic acid.
For the tattoo removal, this concentrated solution is put into the top layer of skin with the help of a needle, similar to the actual tattoo prick (epidermis) injected. This is intended to repel the color pigments naturally.
It should be noted that, according to the Federal Institute for Risk Assessment, this lactic acid solution is harmful to the eyes from a concentration of 10%, and even irritates skin and mucous membranes from 20%. Severe inflammatory reactions and scarring can occur.
The tattoo removal with the help of lactic acid is not one of the medically recognized procedures.

Results when removing with lactic acid

Usually three to five sessions are offered to remove a tattoo with the help of lactic acid. The lactic acid is said to serve as a natural removal agent. However, one rarely hears of good results with this method. If the acid gets a little too deep into the skin, it causes severe inflammation.
The color pigments encrust and actually fall off. What remains are often disfiguring scars. Anyone who wants to remove their tattoo is only advised to choose a medically approved procedure for it. Nowadays, the laser processes are particularly recommended.

Removal with citric acid

Citric acid is an aggressive agent that damages the body's cells.This is the thought behind tattoo removal with citric acid. The acid is said to destroy the pigmented skin cells of the tattoo. The destroyed skin cells should then be transported away by the body itself.
Acetone can be mixed with citric acid, which allows the acid to penetrate the skin better.

The tattoo removal with citric acid is not one of the established methods and carries health risks for the skin. If you want to have your tattoo removed, you should consult a doctor with years of experience to prevent risks such as deep inflammation of the skin and disfiguring scarring.

Creme Profade

Removing a tattoo doesn't always have to be painful and expensive. New types of lotions and creams promise that unpleasant tattoos can now also be removed painlessly without the use of a special laser. Above all, the so-called “Profade® Creme” is supposed to help make it easier to remove a tattoo.
The manufacturer of Profade® Creme states that tattoos can be reliably removed regardless of their color and the material used. In addition, the amount of color applied and the age of the tattoo should not play a role.

When removing a tattoo with Profade®, three different creams must be applied regularly to the colored areas of the skin. The active ingredients contained in these lotions penetrate the skin's surface into the deeper skin tissue, attach directly to the color pigments of the tattoo and dissolve them particularly gently. The gentle effect of Profade® cream for removing a tattoo is said to be primarily due to the fact that its ingredients are 100 percent natural.

The research results and evaluations of users to date do not suggest that regular application of Profade® cream leads to side effects. So far, no local skin symptoms, such as rashes, should have been observed. For this reason, the removal of a tattoo with Profade Creme should also be possible without hesitation in the face area.
However, users must take care that none of the three lotions come into contact with the eyes or lips.

With regular use of Profade® Cream, the first results should be visible after the first application. However, it can take up to four months to completely remove the tattoo.
However, whether the regular application of Profade® Creme really leads to results that are comparable to laser treatment remains a matter of debate. Profade® Creme can, however, also be used as a support for laser treatment. In this way, the number of individual sessions can be reduced. In this context, however, users must note that the lotions must not be applied 10 days before the laser treatment.

Follow-up treatment after a tattoo removal

Tattoo removal puts a lot of stress on the skin. This can lead to undesirable side effects such as infection of the affected area. In the worst case, this then heals with scarring and the skin is disfigured. Cooperation is required to prevent this. After a session, the skin may be red and swollen, this is normal. In this case, the affected areas can be cooled.
It is also normal for scabs or a proper crust to form. These should not be scraped off as this will allow germs to penetrate the wound and cause inflammation. When it heals, scars can then appear. You should just wait for the skin to peel off on its own.

Daily showering is allowed, whereas visits to the solarium, swimming pool or sauna should be avoided at first. A sunscreen with a high sun protection factor is recommended when exposed to sunlight.
A wound protection cream can also be applied to help the skin heal. Fresh air is good for the skin, so bandages or plasters should be avoided.

Tattoo removal costs

If you want to have a tattoo removed, the costs of the treatment also play an important role. It is important to know that due to the different methods that are available to remove a tattoo, different costs can arise.
Basically, there are roughly two methods of tattoo removal. A tattoo can be removed either through surgery or with laser radiation. Not only do these two procedures differ in terms of cost, but both procedures offer different advantages and disadvantages that must be taken into account when removing a tattoo.

When a tattoo is surgically removed, the entire tattoo is cut out. However, this method is only possible with small tattoos, as otherwise the skin defect would be too large to be properly sewn. When it comes to surgically removing a tattoo, the cost can vary greatly depending on the size and location of the tattoo. For a tattoo the size of the palm of your hand you should allow for a surgical removal of around 1500-3000 euros. In addition to these costs, the patient has to pay for the anesthesia required. Depending on whether you choose a kind of twilight sleep or general anesthesia, additional costs of around 300-800 euros arise here.

The cheaper option is removal using laser radiation. Here you have to pay around 50-250 euros per session. Here the prices are very different, especially from practice to practice. A minimum of three to five sessions should be scheduled for small tattoos, but eight to twelve sessions for larger tattoos. If the tattoos are done by a professional, there may be more sessions, as the color may be in the deeper layers of the skin, making it harder to remove.
If you have your tattoo removed, you have to consider that you have to pay for the entire costs yourself, as these are normally not covered by health insurance companies.

How many sessions does it take to remove?

How many sessions it takes to remove a tattoo depends on several factors. These include the size of the tattoo, how deep it was engraved into the skin, the choice of colors and also the strength of the body's immune system. With the laser procedure, eight to twelve sessions can be assumed.

How long does the tattoo removal take?

A session lasts around 10 to 30 minutes. If a tattoo is very large or very deep, it takes more time to remove it. It should be noted that there must be a certain time gap between the sessions. During this time, the treated skin should recover. In order not to stress the skin too much and to prevent scarring, there can be several weeks between the sessions. Thus, a tattoo removal can take a whole year.

Tattoo removal pain

Even the pricking of a tattoo is felt by many to be very painful. The pain can be particularly pronounced in areas of the body that have a large number of tiny nerve fibers. It is no different when removing a tattoo. The laser pulses previously used to remove a tattoo penetrate deep into the surface of the skin and attack the nerve endings. Because of this, removing a tattoo creates a lot of pain. In general, it can be assumed that the laser treatment for tattoos with dark colors is much easier and more painless. Removing light colors, on the other hand, usually causes severe pain. This is especially true for tattoos that contain red parts.

In addition to the occurrence of pain, it should be noted that clearly visible scars usually remain after the laser treatment. The intensity of the discomfort that arises when removing a tattoo depends largely on the region of the body. Especially tattoos on the inside of the upper and lower arm can usually only be removed with enormous pain. Removing tattoos from the décolleté is also perceived as extremely painful by most people.

In addition to the tried and tested methods, laser treatments are now also said to allow for a more gentle removal of tattoos. In this process, the color pigments of the tattoo are treated with a special picosecond laser. With the help of this laser, the color pigments can be literally smashed with ultra-short, high-energy laser pulses. This is followed by the residue-free removal of the color fragments by the body's own phagocytes. Due to the effect of the picosecond laser on the skin surface, there should be hardly any pain compared to the original laser treatment. However, a total freedom from pain cannot be assumed. In addition, it remains to be discussed whether the color pigments smashed by this method may contain toxic or carcinogenic components.

Also read our topic: Pain when tattooing

What home remedies help with tattoo removal?

There are no home remedies that can be used to simply conjure up a tattoo on your body at home. At least no methods that do not pose a significant health risk.

A tattoo should always be removed by a trained specialist or a doctor.
But there are ways to support the healing of the skin with simple means during a tattoo removal.

On the one hand, it helps to cool the skin with ice after the treatment. Avoid excessive water and heat. Taking a quick shower after a day or two is fine, but bathing in the tub or swimming pool is not good for skin healing.
Likewise, direct sunlight and visits to the sauna should be avoided for the time being.

On the other hand, fresh air and an antibacterial cream from the pharmacy against crust formation are helpful. Crusts, as soon as they appear, should by no means be scraped off, as this promotes the formation of scars.
Otherwise, you should make sure that the skin is not irritated by tight-fitting clothing or movement and sweat and that it can heal in peace.

Summary

With all methods of Tattoo removal no miracles can be expected. It is almost always advisable to try laser treatment before deciding on a surgical measure. Nevertheless, even with the Laser tattoo removal distinct Pigmentation disorders of the skin remain in the form of the tattoo and create scars. Even after many laser sessions, the tattoo can still be clearly seen, depending on the pigment, the laser device, ... and and and. In addition, you should be careful with the "experts" popping up like mushrooms! The competence of each should be questioned, as well as the duration of the training, the duration of the experience and the technique (number of lasers available; at least 3 are necessary).
Tattoo removal is not an easy, risk-free business.