Is 100% (literally 100%) pigment/tattoo clearance possible today?

100% tattoo removal is possible for a select number of patients.  Reasons it does not occur are as follows:
-patient followup- much of the tattoo is broken up by the tattoo laser.  the body will eliminate the tattoo in 1 of 3 different ways including lymphatic removal, macrophages removing the particles and simple elimination through the skin.  the tattoo takes time to be eliminated and patients do not return when it is 100% eliminated unless for another treatment.
-number of treatments- most patients see significant fading after several sessions and reach a satisfactory point.  each successive treatment often has less effect than previous
-coloration of tattoo vs skin- some patients skin color and tattoo becomes closer as the tattoo fades and becomes more difficult to completely remove in some patients
not all patients can have 100% removal of tattoo but most patients significant fading of the tattoo using a combination of pico and nano technology is the best approach.

Hi URLM.  100% tattoo clearance is already possible.  But often before and after pictures don't show it because the patient would need to come back 12-18 months later.  
You are correct that as a tattoo fades, the absorprtion of laser light also diminishes, making it hard to completely clear it.  If this occurs at our practice and a patient is anxious to complete the process, then we will step in with a fractionated laser to clean up any remaining ink quickly.  

Laser tattoo removal is the gold standard for removal. Tattoos should be removed with q switched or pico lasers. It will take a series of treatments. I recommend getting a formal evaluation with a laser tattoo removal expert. Best, Dr. Emer

Thanks for your question.  I know it's possible.  We see it regularly.  I think you are basing your assumption that most tattoos can't be fully removed from Before & After pictures.  Most practices have a hard time getting patients to return for a "final" picture.  I don't have any in my portfolio.  I guess you as seeing a before and a picture just before the final treatment.  We take a picture, apply numbing cream, wait 20 minutes, hit with the laser and the patient leaves.  If they are happy with the final treatment, they don't come back.As far as I know, femtosecond is just a working theory.  I don't think anyone has a working prototype yet.  For 100% clearance, you need time and patience.  Wait up to 6 months between treatments to minimize complications.  Best of luck.

While we cannot assure 100% clearing of tattoos, we do see this in many people.  Variability is density and depth of ink used and how your body is able to absorb and remove the ink.  The laser's job is to break up the ink particles small enough for your body to do this effectively.  After care is also very important.  Massaging the areas between treatments, a good quality medcial barrier cream (Epionce) to ensure the skin health returns to the maximum and avoiding sun exposure.  We wait 8 weeks between treatment to preserve skin health - it will thicken and be resistive to treatment if treated too often. The nanosecond wavelength still has a place in initial very dark ink (to break up large molecules) then switching to the picosecond wavelength for further clearing.  We've seen great results in less treatments with the Cutera Enlighten and we've had 4 prior lasers.

In my experience the biggest reason we don’t remove 100% of ink is because the patient gives up before we’ve had a chance to do the full recommended treatment course. We’ve discharged a good many patients with ZERO pigment and perfect, native skin—and many more are well on their way.

On occasion I will excise a tattoo. When I do this I am often shocked to see tattoo ink has penetrated completely through the dermal layer of skin (ie it's deep!) A few years ago our center started using fractional erbium laser to vaporize small channels in the skin and then using traditional tattoo lasers in the same treatment setting. This allowed us to get deeper clearance. Best, Dr. M