Is tattoo excision safe for me? Are there any risks?

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. Tattoo excision — also called surgical removal — is generally considered safe when performed by an experienced plastic or dermatologic surgeon, but it does come with specific risks and limitations. In this procedure, the tattooed skin is cut out, and the remaining skin is stitched together. For small tattoos like your 5 cm x 5 cm designs, this can sometimes be done in a single session under local anesthesia, though placement (especially near joints like the back of the knee) can make healing and mobility a bit more complicated. The main risks include infection, wound healing issues, thick or stretched scarring, changes in skin texture or pigmentation, and reduced flexibility if the area is under tension. Because the red ink is physically removed, allergic reactions usually stop once the pigment is gone, making excision a good option for people with pigment allergies or fears of laser-triggered reactions.

Hi, thank you for sharing the details and your concerns. Based on what you’ve described, tattoo excision can be a safe and effective way to remove tattoos, especially when scarring isn’t a concern. Since your main worry is the red ink and possible allergic reactions, surgical excision actually avoids the risk of the immune-mediated reactions that sometimes happen with laser removal of red pigments.

Here’s what you should know about tattoo excision:

Procedure: Excision involves surgically removing the tattooed skin and then closing the area with sutures. For tattoos your size (around 5 cm x 5 cm), the amount of skin removed might require careful planning, and sometimes a staged approach if the area is large or tight.

Risks beyond scarring: Even if scarring isn’t a concern, there are other things to consider:

Infection: Any surgical procedure carries a small risk of infection, but proper wound care greatly minimizes this.

Delayed healing or wound breakdown: Areas with more tension or movement, like behind the knee or shoulder, may take slightly longer to heal.

Changes in skin sensation: Some temporary or rarely permanent numbness or tingling can happen in the excised area.

Pigment remnants: If the tattoo is very deep or wide, small pigment fragments might remain if not all tissue is removed.

Allergic reactions: Since excision removes the pigment physically, the risk of an allergic reaction to the red ink is extremely low—this is one of the reasons excision is sometimes preferred for problematic red tattoos.

Overall, given your situation, tattoo excision is a reasonable option with manageable risks, especially since scarring isn’t a priority for you. The most important factors are proper surgical technique, post-procedure care, and allowing your body adequate time to heal.