Most dermatologic surgeons caution that complete tattoo removal is not possible for everyone. Tattoos are meant to be permanent, so removing them is difficult. Having said that, there are several methods of tattoo removal which have proven effective. The degree of remaining color variations or blemishes depends upon several factors, including size, location, the individual's ability to heal, how the tattoo was applied and how long it has been in place.

For example, a tattoo applied by a more experienced artist may be easier to remove since the pigment was evenly injected in the same level of the skin. New tattoos may also be more difficult to remove than old ones.

Doctors say they can't predict the exact degree of removal because they generally don't know which of the 100 tattoo inks available today were used. (The U.S. Food and Drug Administration currently lists tattoo pigments as "color additives," which are intended only for application to the top layer of the skin.) Consult with a removal specialist -- be sure to take a list of questions along.

What Methods Are Used for Tattoo Removal?

Before lasers became popular for tattoo removal starting in the late 1980s, removal involved the use of one or more of these often-painful, often scar-inducing surgeries:

• Dermabrasion, where skin is "sanded" to remove the surface and middle layers;

• Cryosurgery, where the area is frozen prior to its removal;

• Excision, where the dermatologic surgeon removes the tattoo with a scalpel and closes the wound with stitches (In some cases involving large tattoos, a skin graft from another part of the body may be necessary.).

Although the procedures above are still used in certain cases today, lasers (Light Amplification by the Stimulated Emission of Radiation) have become the standard treatment for tattoo removal because they offer a bloodless, low risk, effective alternative with minimal side effects. Each procedure is done on an outpatient basis in a single or series of visits. Patients may or may not require topical or local anesthesia.

As early as the 1960s, lasers had been developed for industrial uses. When researchers developed lasers that emitted wavelengths of light in short flashes called pulses, medical use became viable. These lasers can effectively remove tattoos with a low risk of scarring, according to the American Academy of Dermatology .

The type of laser used to remove a tattoo depends on the tattoo's pigment colors. (Yellow and green are the hardest colors to remove; blue and black are the easiest.)The three lasers developed specifically for use in tattoo removal use a technique known as Q-switching, which refers to the laser's short, high-energy pulses:

• the Q-switched Ruby,
• the Q-switched Alexandrite,
• the Q-switched Nd: YAG, the newest system in this class of lasers and particularly advanced in the removal of red, blue and black inks

Lasers work by producing short pulses of intense light that pass harmlessly through the top layers of the skin to be selectively absorbed by the tattoo pigment. This laser energy causes the tattoo pigment to fragment into smaller particles that are then removed by the body's immune system. Researchers have determined which wavelengths of light to use and how to deliver the laser's output to best remove tattoo ink. (If you're wondering if the laser might also remove normal skin pigment, don't worry. The laser selectively targets the pigment of the tattoo without damaging the surrounding skin.)

The unfortunate thing about tattoos is that both getting them and having them taken off can be uncomfortable. The impact of the energy from the laser's powerful pulse of light has been described as similar to  being snapped by a thin rubber band.  Because black pigment absorbs all laser wavelengths, it's the easiest to remove. Other colors, such as green, selectively absorb laser light and can only be treated by selected lasers based on the pigment color.

In preparation for a laser procedure, doctors recommend that non-aspirin products, like Tylenol, be used for minor aches and pains prior to the procedure, because aspirin and nonsteroidal anti-inflammatory agents such as Ibuprofen can produce pronounced bruising after treatment.

Further pre-treatment steps might include the application of a prescription anesthetic cream two hours before the laser session. It is wiped off just before laser surgery begins. (Some patients say they don't need this.  Pinpoint bleeding is sometimes associated with the procedure.) Then pulses of light from the laser are directed onto the tattoo, breaking up the pigment. Over the next few weeks, the body's scavenger cells remove pigment residues

More than one treatment, which actually only takes 15-30 minutes, is usually needed to remove an entire tattoo -- the number of sessions depends on the amount and type of ink used and how deeply it was injected. 3-4 week intervals between sessions are required to allow pigment residue to be absorbed by the body.

Following treatment, the nurse will apply an antibacterial ointment and dressing to the area, which should be kept clean with continued application of ointment as directed. A shower or bath the day after treatment is okay, but the treatment area should not be scrubbed. Your skin might feel slightly sunburned for a couple of days and the treated area may remain red for a few weeks. The site might also form a scab, which should be handled gently. After healing, the site will gradually and continually fade.

Side effects of laser procedures are generally few but may include hyperpigmentation, or an abundance of color in the skin at the treatment site, and hypopigmentation, where the treated area lacks normal skin color. Other possible side effects include infection of the site, lack of complete pigment removal and a 5 percent chance of permanent scarring.