Read This Before Getting Your Tattoo Removed

It sounds like something from the Dark Ages: As little as 20 years ago, one of the best ways to remove a tattoo called for the actual destruction of the skin. Your first option was salabrasion, a technique that used an abrasive tool to, quite literally, scrap the tattoo off the skin. (Ouch!) Your second, dermabrasion, wasn't much better: a rotary device was used to sand the tattoo away. Neither were all that effective — and they both hurt like hell and left scars.
Thankfully, we now have less barbaric means of removing dubious ink — all thanks to lasers. But as anyone who has searched “tattoo removal” online knows, there is an overwhelming number of treatment options, machines, and practitioners who promise to delete your ink in a flash. Suffice it to say, it’s hard to know where to start.
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We talked to Andrew Miller, MD, a board certified plastic surgeon and laser specialist in New Jersey and New York City for a roadmap and definitive directions. Get everything you want to know about professional tattoo removal, ahead.
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Understand Your Options

There are a ton of tattoo removal devices on the market, but they’re not all created equal. Miller suggests sticking with the big three, all Q-switched lasers (a type of laser), when looking to stamp out a tattoo: Nd:YAG lasers, ruby lasers, and the PicoSure laser.

All three options work the same way to eliminate ink. That is, after a burst of energy pops the pigment in skin, your body's natural cells carry it out of the body.
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You may need fewer sessions, but it’s a very expensive laser, so the treatments may be more expensive.

-Dr. Miller
Selecting the best laser for your tattoo depends on the colors used in the design, Miller says. “The ruby laser is thought to be better for some colors that are harder to get rid of, like green and yellow,” he says. Meanwhile, “Dark blue, black, and red inks are easier to remove. Yag lasers and the PicoSure usually do a pretty good job with that.”

While Q-switching lasers have been around for more than a decade, the PicoSure is the newest of the trio. Because it has a shorter and more powerful pulse duration, Miller notes that some doctors feel it breaks up more pigment, though results vary greatly from person to person and tattoo to tattoo. “You may need fewer sessions, but it’s a very expensive laser, so the treatments may be more expensive,” he says. Though a laser that treats all ink colors with uniform success would be optimal for tattoo removal, Miller says he’s not aware of any such technology that’s on the horizon, so tattoo removal will likely always be a bespoke procedure, at least for the near future.
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Prepare for Pain

Anyone who has watched Eva Longoria or Khloe Kardashian’s snaps of their own tattoo removal sessions knows that the process isn’t exactly a picnic. Miller says the sensation that patients feel is akin to having a rubber band repeatedly snap on your skin. And there’s no part of the body that experiences this sensation more or less strongly, he says. “It hurts everywhere. If it doesn't hurt isn’t not doing anything,” he says — kinda like getting a tattoo itself. But derms and cosmetic surgeons do have a little something in the arsenal to take the edge off, if needed: good ol' numbing cream.
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Manage Your Expectations

Miller stresses that results are not always guaranteed, no matter how experienced your practitioner may be, how many sessions you try (this completely relies upon your ink, so your best guess is after a consultation, but around 10 isn't unusual), or what laser you use. “Nobody can guarantee that it’s going to go away, but most people are happy because it either goes away or comes close to going away. Have reasonable expectations and it will be ok,” he assures.

Ink color isn’t the only thing that can trip up total removal. Research published in the American Medical Association’s Archives of Dermatology reports that smoking can reduce the chance of successfully removing a tattoo by nearly 70%, after 10 treatment sessions. (Just one more reason to finally quit.)
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It’s harder to remove tattoos on the lower leg because the skin is thicker, which means it’s tougher for the laser to penetrate.

-Dr. Miller
Placement of the design on the body matters, too. “It’s harder to remove tattoos on the lower leg because the skin is thicker, which means it’s tougher for the laser to penetrate.” He also says that ink deposited in deeper layers of the skin (like with some stick-and-poke tattoos), are hard to remove because the laser can’t reach the depths needed to bust up the ink.

What does this all mean? First, it's important to decide which you prefer: Your unwanted tattoo, or a shadow of your unwanted tattoo, as it may not be totally removable. A consultation should help quell your fears by giving you more clarity on your ink.
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It's a matter of finding the best laser for your particular tattoo.

-Dr. Miller
The good news? Unlike with lasers used for facial treatments or hair removal, these lasers can work for any skin type and tone, the pro says. “If you have a darker tone, you have a higher chance of pigmentation changes around areas of [former] tattoo — but it’s not that bad,” he assures. (Another thing to consider for those with dark to deep complexions!)

Bottom line: “You never know until you start going through the treatments. Sometimes people try one laser then switch to another," Miller says. "It's a matter of finding the best laser for your particular tattoo.”
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Find a Pro

Just ask the Internet: In some cases, a one day course will certify someone to remove a tattoo. (You probably have apples in your fruit bowl that are older!) Just as you wouldn’t trust a tattoo artist who's been in the game for only a day or two, you shouldn’t trust a tattoo removal practitioner unless they have real, lengthy experience, Miller says. “Look for a well established plastic surgeon or dermatologist with a lot of experience,” he advises. “Ask the office: ‘How many tattoo removals have you done?” and ‘How many years have you been doing this?’”

Then, once those questions are satisfactorily answered, ask some more: Find out exactly what type of laser will be used. There are other machines aside from Q-switched lasers whose makers claim to remove tattoos — and being treated with them carries more risk.

Moral of the story: Look for someone with a ton of experience, manage your expectations, and always ask what kind of laser they'll be using. Final remarks from our pro? “Make sure you’re going to a place that uses Q-switched Lasers: Nd:YAG laser, PicoSure, or ruby lasers,” Miller says. “Be proactive and ask exactly what it is!”
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