Will one be left with scars after a tattoo removal?

I have a friend that had a medium size tattoo on her right wrist, but now she has this linear ugly scar. I haven't had the courage to ask her what happened because the position of the scar makes it a sensitive subject. Knowing her, I am inclined to say she removed the tattoo. Does tattoo removal leave scaring? Which type of tattoo removal leaves scars?


F, 32, Minnesota

Tags:woman age 25-34 scar scarring tattoo

If you are considering removing a tattoo, the most important thing you can do is find a tattoo removal specialist experienced in Picosecond laser technology. Picosecond lasers like Picosure offer the greatest possibility of tattoo removal with only a minimal risk of scarring.

Picosure is an FDA-approved laser technology that uses extremely rapid laser pulses to hit ink particles beneath the skin with immense pressure. The particle shatters into minuscule fragments, which are absorbed by the immune system and eliminated by the body.

While it’s still possible to successfully remove, or at least fade, tattoos using older laser technologies, the chances of scarring or unsatisfactory outcomes are slightly higher. Q-switched lasers aren’t as effective at removing stubborn tattoos and certain colors, and sometimes require ten or more treatments to reach a final result. Moreover, Q-switched lasers require sophisticated knowledge of the technology to ensure burns or scars don’t occur.

Treatment must be delivered with sufficient downtime between sessions and proper post-treatment care. It’s possible your friend developed a scar as a result of using an older tattoo removal technology delivered by an inexperienced provider. Tattoo removal should only be performed by an experienced doctor or dermatologist.

Although Picosure has significantly improved the experience, tattoo removal still isn’t guaranteed. Very vivid tattoos may require a mix of laser treatments for successful removal. It's essential that you have realistic expectations and are aware of the diverse factors that will influence the outcome. Some considerations include:

  • Tattoo location: tattoos in places like the arms and legs are further away from the heart, with slightly poorer circulation. This may result in slower healing following laser tattoo removal.
  • The depth that the ink is embedded in the skin: Tattoos with ink that has penetrated to a uniform level are easier to remove than tattoos where the ink penetrated the skin at different levels.
  • If the tattoo was created by a professional or amateur. Professional tattoos tend to be more saturated with ink, which can render them more challenging to remove.
  • The possibility of the skin darkening as a result of laser treatment. Inks containing titanium dioxide may darken immediately after laser treatment. This darkening can be reversed with further laser treatments, however.

Tattoo laser removal treatment generally has successful outcomes when performed by a qualified technician or doctor. Ask to see before-and-after photos of patients so you can get a better idea of the results to expect.

Tattoo removal is growing in popularity. Many individuals find that as they age the tattoos acquired during their youth no longer hold personal meaning to them or hinder their ability to secure employment. Fortunately, tattoo removal treatments are becoming safer and better, enabling people to reverse their unwanted tattoos a little easier than in the past.

The gold standard of tattoo removal nowadays is the PiQo4 laser, by Lumenis, which uses powerful pulses of light delivered in picoseconds (a picosecond is one trillionth of a second) to shatter tattoo ink into microscopic particles that are naturally metabolized and removed by the body. Unlike Q-switched Nd: YAG lasers, which sometimes require ten or more treatments to successfully fade a tattoo, PiQo4 produces similar results with only three of four treatment sessions and a quicker healing process.

The PiQo4 laser is also safer than earlier forms of laser technology because the pulses are highly specific, targeting chromophores, the skin molecules that contain colored ink particles. This causes minimal thermal damage to the surrounding skin. Any side effects experienced are usually very mild and may include temporary hypopigmentation or the development of small blisters. PiQo4 very rarely causes scarring or a textural change in the skin.

In your friend's case, it’s possible her tattoo was removed using an older method of laser tattoo technology. Sometimes these older methods leave scars or burns, particularly if the laser treatment was administered by an inexperienced practitioner.

Although tattoo removal laser technology has improved dramatically in recent years, it’s important to have realistic expectations about what can be achieved. Sometimes tattoo removal does leave scarring: the laser can leave a permanent raised mark, which may be what occurred to your friend. Some patients have a genetic predisposition or a skin type that is more prone to developing keloid scars, which are raised scars. If the tattoo was already raised to begin with it’s likely that a raised outline will remain following tattoo removal.

However, the vast majority of clinical literature outlines that hypertrophic scars associated with laser tattoo removal are most likely caused by inappropriate treatment devices, using an overly aggressive approach to treatments, or giving inadequate aftercare instructions. For example, it is essential to keep the tattoo clean and dry after laser treatment.

Laser tattoo removal performed by an experienced professional usually results in very satisfactory outcomes, although it’s not always possible to completely remove the tattoo: sometimes a ghost image of the tattoo will remain following treatment, and sometimes the tattoo will require ten treatments or even more to fade sufficiently. It’s impossible to know exactly how the tattoo will react to the laser because the outcome largely depends on the tattoo itself: the colors used, the grade and quality of ink, and the depth to which the ink is embedded in the skin are all major considerations.

If you have tattoos you’re contemplating removing, schedule a consultation with a dermatologist or plastic surgeon who specializes in tattoo removal. Lasers such as Picosure use a picosecond laser, capable of completely removing some tattoos with no adverse effects.

Hi alyssawhite29,

At our office we recommend the Medlite C6 laser for blue-black tattoos and the Alex TriVantage laser for multicolored tattoos. The laser targets the pigment in the tattoo. Tattoo removal should not leave scarring but you should have realistic expectations. You could be left with a ghost image of the tattoo. If the tattoo was somewhat raised to begin with as some are, the pigment could be gone but you will still see the raised areas.

-Lauren, Patient Coordinator