Tattoo excision? Staged surgical excision? (photo)

Question

I've had this tattoo for about 2 1/2 years - I've wanted to get rid of it for a year now, maybe more. I've seen many good reviews about excisions/staged, however I feel mine is going to be the biggest project. I'm really looking for something/someone that could genuinely get rid of this and to have a beautiful outcome; I understand the potential of scarring. Is there a way of minimal raising of scar? What would the cost be like?? Do you have to pay for it all at once?

Glenn Messina, MD · Answer

I perform a lot of laser tattoo removal and send patients to a local plastic surgeon very frequently so I am quite familiar with both processes. I feel bad to say this but your tattoo is large for excision even staged because they would remove a strip of skin just wide enough to close with sutures then wait. After a few months they repeat the process however in your case the overall amount of skin removed would leave you disfigured. Im not talking scar alone, I mean mis shaped as well. The surgery would require a graft and that area will never look normal.
Lasers will in all estimation not remove all of this ink, I don't care what laser anybody has the gold/yellow would be nearly impossible to remove, the flowers are not pure red they have a white in them which also does not respond to lasers, The black and greens should but you will need a provider with multiple lasers. I use 4 and I would not tell you this would come off cleanly.
Now the good news, there is another option layering this tattoo with the proper lasers about 3 times spaced about 8 weeks apart. That should fade it enough for you to put another tattoo on that you appreciate. I know its not what you hoped to hear but its the truth.

Reza Nassab, FRCS (Plast) · Answer

Thanks for your question and unfortunately that tattoo is quite big.  Surgical excision is unlikely to be an option in this case unless you have skin grafting or consider tissue expansion.  These would be extensive procedures and require multiple operations.  I would recommend trying laser in the first instance.

Hardik Soni, MD · Answer

Thank you for your question and photograph. In my office, I like to use Picosure laser which has a short pulse duration that exceeds photothermal action and results in an intense photomechanical impact. It works best on darker inks such as black and blue. The number of sessions required to remove a tattoo can range from 6-10 sessions. The cost depends on the size and also how is the tattoo responding to the treatment. I recommend you consult with an expert to determine the best treatment plan for you. All the best!

Stephen E. Small, DO · Answer

I would not recommend excision. Picosecond lasers work amazingly well and for a large tattoo it is my opinion that this is the best option. Staged excision would result is a significant scar that might be as bad or worse than the tattoo you want removed.

Kristin J. Tarbet, MD, FACS · Answer

I would not recommend excision of your tattoo. You would be a good candidate for laser removal however. I would recommend using PICO technology like we have in our office.

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