Ink, Rethinked

Want a truly clean slate? Here's everything you need to know about taking it all off.

Tattoos are powerful ways to celebrate the body and create a permanent reminder of life's milestones. But in the spirit of a new year and fresh starts, we wondered: What does it really take to erase ill-begotten ink?

If your resolution is to rid yourself of a tattoo, you're not alone: almost two in every ten tattooed Americans wish they weren't. That’s over 61 million people walking around with unwanted ink (including Mark Wahlberg, who has been vocal about his own removal process on a host of recent television appearances). In fact, 23 percent of all adults have at least one tattoo — an increase of seven percent in only seven years. And, when you hone in on adults between 18 and 45, the number soars. Thirty-five percent have at least one, while 23 percent have two or more. Unsurprisingly, as tats become a commonplace commitment, dermatologists report being asked to remove more and more botched ink. 

Ancient Greeks used a cocktail of pigeon droppings and salt to slough off tattoos; thankfully modern-day docs have it down to a more civil science. Here’s what you need to know:

1. Total removal is a myth
"Tattoo removal is a misnomer," says Alan Izikson, MD, a dermatologist and laser specialist at the New York Dermatology Group in New York City. "It should be called tattoo reduction since it’s impossible to completely remove a tattoo. In most cases, patients are left with a light tinge of color or a white shadow."

2. Usually, lasers are your best bet …
When you get a tattoo, the tattoo artist uses a needle to inject tiny blobs of ink into the second layer of your skin called the dermis. To remove it, "a doctor uses a Q-Switched laser to send a shock wave through the pigment particle to burst it open. This makes the pigment particles small enough to get carried away by your lymphatic system," Dr. Izikson says. Imagine the arcade game Asteroids: you shoot the asteroids (the pigment), they explode in smaller pieces and float away. 

3. …but sometimes, you need to get it surgically removed
The only way to completely remove botched ink is surgical extraction, in which a doctor cuts away the tattooed area and stitches the surrounding skin together. But this process leaves major scars and should only be used when your dermatologist feels lasering isn’t an option (for example, when you have an allergic reaction to your tattoo).

4. Start today
If your 2012 resolution is to get rid of your lower-back butterfly by bikini season, you need to get started now. "Generally people should bank on at least six or seven laser-removal sessions, but sometimes patients need closer to twelve," says Dr. Izikson. Depending on how quickly you heal, appointments are spaced about one month apart, so a small tattoo can take about six months. Start now and you may be free and clear by June. Plus, skin is at its palest in blizzard season so you won’t risk erasing natural pigment while you zap your tat.

5. Be ready to spend

"A small tattoo, like a name, will cost between $300 and $400 per session, while something larger and more intricate can cost up to $1,000 per session," says Dr. Izikson. Multiply that by the number of sessions you’ll need and you’re spending a total of around $1,800 to $12,000 on removal. 

6. Color matters 
Certain tattoo pigments, such as black, brown and dark blue, absorb the laser’s wavelengths better, so they break down more easily. Purple, yellow, red, green and orange, on the other hand, are harder to target so you’ll need more sessions to get the same results.

7. Tattoos by amateurs are easier to ditch than pro ink 
Good news: a tattoo by a first-timer (you know, the kind that looks more like a splotch of mud than a sun on your ankle) is easier to zap than one by the Kat Von D’s of the world. Each brand of tattoo ink has a unique chemical composition. Amateurs will often stick to one type of ink, while more experienced tattoo artists will blend different pigments. Mixing up ink makes it harder to target and break down pigments in your skin. Another bonus? "Less experienced tattoo artists tend to ink more superficially, so their work sits closer to the top layer of skin," says Dr. Izikson. Translation: easier access for lasers.

8. It hurts way more than getting one
Of course, everyone’s pain tolerance is different, but "without lidocaine injections prior to treatment, laser treatments hurt," says Anne Chapas, a dermatologist and the medical director of Union Square Laser Dermatology in New York City. Imagine hot rubber bands being snapped on your skin. You can also slather on topical numbing cream a half hour before getting zapped if you’ve sworn off needles for good. And, just like getting a tattoo, fingers, toes and faces are the most sensitive areas because you’re close to the bone.

9. Blistering is a boon (so is scabbing)
"Blistering is totally normal since it’s an intense inflammatory response that helps lighten pigment," Dr. Izikson says. As your skin heals after each laser session, it will also crust and scab — another good sign, since both are normal parts of healing. What’s not good? Swelling, pain and redness around your blisters, a fever or even swollen lymph nodes as these are symptoms of an infection.
 
10. Follow the doctor’s orders

You want a dermatologist on the job, not a technician at a tattoo removal clinic. Clinics may succeed with straightforward cases, but often the person treating you is not a doctor and can’t spot possible complications like pre-existing infection. Plus, a botched laser job can leave you with scars, infections and — in some cases — an even darker tattoo. Stick to a board certified dermatologist (find one at AAD.org), and favor those who specialize in laser procedures, recommends Dr. Chapas.