What is the best removal option for a large lower back tattoo? (photos)

Two years ago, while intoxicated, I got a large, black ink, lower back tattoo (5.5inches in height and 4inches in width). I sobbed on and off for weeks afterwards and I haven't worn a bathing suit since then. I am finally in a position to be able to pay for removal and need help on deciding the best method. I am willing to accept the scarring that both lazer and excision removal can leave behind although I am leaning more towards excision. What do you think?

Doctor Answers 12

Picoway for Tattoo Removal

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Thank you for sharing the pictures.  I believe you may want to consider the Picoway technology.  It has been known to deliver great results with as few as six treatments.  


Tattoo Removal with Laser

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Hi,I understand your loathing the tattoo - but replacing the tattoo with a scar is not a good option at all!  And excision , especially over the lower back, is bound to leave a bad scar!  I have been using the Picoway in dark Indian skin types, for tattoo removal, and one of the first things I notice, is the lack of significant dyspigmentation/ scarring, that was quite common with the nanosecond lasers for pigment removal. Do consider consulting a doctor that provides Picosecond lasers for tattoos, and you should be fine!

Tattoo Removal

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State of the art lasers, including the Alex TriVantage Laser is used to remove small to large tattoos on various skin tones. This laser specifically operates on three wavelengths and has the broadest color treatment of any laser available today. Laser treatment is non-invasive, safe, and not as painful as other treatments such as surgical excision. The light from the laser breaks the ink particles up, and may be absorbed by the body in a few weeks. Tattoos may require multiple treatments. Our established laser center has helped hundreds of patients in tattoo removal since 1997.

Usha Rajagopal, MD
San Francisco Plastic Surgeon
4.6 out of 5 stars 43 reviews

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Laser Tattoo Removal

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You should definitely start with laser therapy. Picosecond lasers work quite nicely, Q-switched laser can work quite well too, but seem to require more treatment sessions. Dark ink tattoos like yours sometimes respond very well to laser treatment and it would be a shame to jump straight to surgical excision when a much more elegant option exists for you.

Joshua L. Fox, MD
Long Island Dermatologic Surgeon
5.0 out of 5 stars 22 reviews

Laser tattoo removal in Los Angeles

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Our office specializes in laser tattoo removal. Your tattoo would be an excellent choice for laser tattoo lightening or laser tattoo removal based on the density of the ink. 

Dr. Karamanoukian 
Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Best Tattoo Removal Option For the Lower Back

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Surgical excision requires the removal of an entire section of skin. Therefore, it may be recommended in certain cases where the tattoo is quite small. Inevitably, it will leave a permanent scar.

The use of laser would be the best possible option for your lower back tattoo. With laser, scarring can occur, but it is not inevitable as in the case with excision.

At our clinic, we use the Spectra laser by Lutronic. It uses a wavelength that is safe for all skin tones. And it is able to offer very reliable results.

Fortunately, your tattoo design has a couple advantages for removal

  1. It is black which is the easiest color to remove. It absorbs laser energy more readily than other colors
  2. It is centrally located in your body, as opposed to being in the extremities. Therefore, it has easier access to a greater concentration of blood vessels. This is essential for clearing away the shattered tattoo pigments.

Choosing an experienced doctor would also need to be an important consideration for the best results. 

Below is a video link from our clinic featuring a patient who had experienced the complete removal of her upper arm black tattoo using the Spectra laser.

Sanusi Umar, MD
Redondo Beach Dermatologic Surgeon
4.6 out of 5 stars 33 reviews

Tattoo regret

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I am so glad that you are in a position and ready to remove the tattoo that's caused you so much regret.  Laser technology has come a long way in successfully removing unwanted tattoos.  Scarring from laser tattoo removal occurs less than 1% of the time.  The latest and best system is the Picosure laser.  In less than half the number of treatments of the older generation lasers the Picosure can successfully undo that ink.  Please don't consider excising the tattoo.  The resulting scar would not be a good exchange for the tattoo.

Wishing you all the best! Dr Carr

Pamela Carr, MD
Sugar Land Dermatologic Surgeon


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Thank you for your question. The Picosure laser is the latest in tattoo removal technologies requiring less treatments then past lasers. It works great on black tattoos. I recommend setting up a consult with a qualified physician in your area to map out a treatment plan for you.

Bruce E. Katz, MD
New York Dermatologic Surgeon
3.8 out of 5 stars 17 reviews

Black ink tattoo removal

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Black ink tattoos are the best ones to remove by laser. 

There are many laser options including picosecond technology lasers and nanosecond technology lasers and all would be good for this tattoo. 

The number of sessions depends on ink density which is not so much in your case. 

The number of sessions could also be based on the numbers of ink colors, some of which (like the reds) require different types of lasers 532 nm KTP or PicoWay and others (pastels) which are difficult to treat no matter what types of laser is used. 

You should have a good outcome with yours since it is black ink and not so dense. 

Tattoo Removal

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There are so many good options for removal as compared to excision ( which can leave a huge scar and would require a flap if done on the back ).  I would suggest looking into pico laser removal and/or MicropenTR which both work well.  the micropen has no limitation to skin type of color.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.