There are many reasons you may decide to remove a tattoo. Perhaps it was done out of impulse and you regret getting it. Or maybe you are dissatisfied with the way it turned out or are experiencing an allergic reaction to the ink. Although expensive and often painful, tattoo removal is possible. There are many procedures that can help lighten or even completely remove the unwanted body art. Long-term effects of laser tattoo removal are something to consider if you are considering going through the treatment to get rid of your ink.

Hyper- and Hypopigmentation
The process by which tattoos are removed via laser begins with a laser emitting highly concentrated light beams into the skin. The tattoo ink absorbs the light, which breaks the ink particles into smaller, more manageable chunks that are effectively removed by your body's immune system. In the process, occasionally the laser will affect the epidermis by lightening or darkening the color of the skin, according to Tattoo Health. This could leave you with noticeably light or dark patches on your skin, where the tattoo was, in the same general shape as the tattoo. This is a permanent condition.

Scarring
When you have a tattoo removed via laser, you may endure bleeding and blistering as a result of the intensive procedure. The blisters can pop and secrete liquid, and remain open, leaving you susceptible to infection, which in some cases can eventually lead to scarring. Scars result when a wound doesn't heal well or heals too slowly, so you may notice signs of scarring around the area where the tattoos used to be. To ensure that scarring doesn't happen, obey the warnings that your dermatologist gives you, including keeping the area covered after the procedures, and keeping the area clean and dry for faster, neater healing.

Partial Ink
Some colors of the spectrum don't absorb light very well, resulting in partial tattoos or ink that cannot be removed. The easiest colors to remove are black and gray, since both readily absorb the white light from the laser. Unfortunately, lighter colors don't absorb as well, which means some people with colored tattoos will still have partial ink left, even after extensive laser treatment. The general outline or some of the colors in the tattoo might be left behind and deemed permanent by your dermatologist. Your options would be to remove only parts of the tattoo, leaving the lighter portions intact; cover the tattoo with a new tattoo; or leave the tattoo as-is.


REMOVAL OPTIONS

Laser Treatment
According to the Skin Laser Center, laser treatments can be safely used to remove tattoos. Laser systems, like the Palomar Q YAG 5, work by focusing a laser on the tattoo. This laser passes through the top layer of skin and into the ink of the tattoo. As your skin absorbs the light, the resulting heat fractures the tattoo ink into tiny fragments. The lymphatic system of the body then carries these particles away to be shed naturally from the skin. The Mayo Clinic explains that tattoos with several colors may require multiple treatments with different laser wavelengths. After the procedure, the skin may swell, bleed or blister. Use antibiotic ointment on the affected area to encourage healing. Multiple sessions may be required to lighten or erase the tattoo completely.

Dermabrasion
Experts at the American Society for Dermatologic Surgery explain that dermabrasion is a common tattoo removal technique. In this procedure, a doctor or dermatologist sands away the top layer of skin, at the site of the tattoo, with a quickly revolving abrasive brush or wheel. This technique helps the tattoo ink to leach out of the skin. In addition, it encourages the body to absorb the leftover ink. For several days after the procedure, the skin will feel sore and irritated. A doctor may prescribe medication to help deal with the discomfort. After about seven days, new skin will begin to form to replace the tattooed skin.

Surgical Removal
Smaller tattoos can be surgically removed. The Mayo Clinic says that a surgeon will first numb the skin with an anesthetic. Using a scalpel, a doctor cuts out the tattoo and then stitches the skin back tighter. An antibacterial medication will need to be used after the procedure to encourage proper healing. Although this method is effective, it will leave a scar behind-making it unpractical for larger tattoos.

Worries About Pain
Homemade tattoos and any tattoo with deep blue and black ink colors are among the most difficult to remove. The procedure is not painless-people often describe the laser procedure as similar to that of hot oil on the skin or a slap from a rubber band. Some anecdotal reports indicate that patients who received anesthesia by local injection required additional treatments, because the injection causes swelling. This spreads the tattoo ink, and makes it more difficult for lasers to act on ink particles.

Other Concerns
Side effects are usually minor, but can include skin discoloration, infection or scarring. A raised or thickened scar may appear three months to six months after tattoo removal. Some researchers are trying to determine if tattoo removal treatments affect the lymph nodes, with scientists in Europe reporting that lasers used on certain pigments had created toxic or carcinogenic byproducts.

Number of laser treatment sessions needed?

Complete laser tattoo removal requires numerous treatment sessions, typically spaced at least four to six weeks apart. Treating more frequently than four to six weeks increases the risk of adverse effects and does not necessarily increase the rate of ink absorption. Anecdotal reports of treatments sessions at less than four weeks lead to more scarring and dischromia and can be a source of liability for clinicians.

At each session, some but not all of the tattoo pigment particles are effectively fragmented, and the body removes the smallest fragments over the course of several weeks. The result is that the tattoo is lightened over time. Remaining large particles of tattoo pigment are then targeted at subsequent treatment sessions, causing further lightening. The number of sessions and spacing between treatments depends on various parameters, including the area of the body treated and skin color.

Tattoos located on the extremities, such as the ankle, generally take longest. As tattoos fade clinicians may recommend that patients wait many months between treatments to facilitate ink resolution and minimize unwanted side effects.

Post-treatment considerations
Immediately after laser treatment, a slightly elevated, white discoloration with or without the presence of punctuate bleeding is often observed. This white color change is thought to be the result of rapid, heat-formed steam or gas, causing dermal and epidermal vacuolization.

Pinpoint bleeding represents vascular injury from photoacoustic waves created by the laser's interaction with tattoo pigment. Minimal edema and erythema of adjacent normal skin usually resolve within 24 hours. Subsequently, a crust appears over the entire tattoo, which sloughs off at approximately 14 days post-treatment.

As noted above, some tattoo pigment may be found within this crust. Post-operative wound care consists of simple wound care and a non-occlusive dressing. Since the application of laser light is sterile there is no need for topical antibiotics. Moreover, topical antibiotic ointments can cause allergic reactions and should be avoided. Fading of the tattoo will be noted over the next eight weeks and re-treatment energy levels can be tailored depending on the clinical response observed.

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