Tattoo Excision After 20 Laser Treatments? (photo)

I have gone through nearly 20 laser tattoo removal sessions over the past 10 years, totaling over $5,000. At this point my tattoo is still very visible and now has what appears to be hyper pigmentation and the skin tends to raise when exposed to heat. I have read about surgical tattoo removal, could this be an option for me? I am aware that surgical removal will leave a scar and I am comfortable with that, since it would look better than what I’m currently living with.

Doctor Answers 5

Surgical tattoo removal

Hi Kalliemarie, I would suggest surgical tattoo removal.  Save your money on future laser treatments.  Surgical tattoo removal can be performed in the office.  The tattoo remnants would be locally anesthetized. The tattoo and the hyperpigmented areas can then be directly excised.  You will not need a skin graft.  Sutures will be placed, but all of the sutures will be absorbable and do not need to be removed.  You would have a scar, however the scar would fade with time.  Please contact an experienced, board certified Plastic Surgeon.  Sincerely, Dr. Katzen.


​We Use the PicoSure FOCUS to Remove Hyperpigmentation

We use the PicoSure Laser with the FOCUS lens array everyday treating pigment, fine lines and wrinkles.  It is safe for all skin types.  We warn our patients that their skin may be come blotchy and pigment may appear darker for the next 3-5 days, although in rare cases it may last up to 2 weeks. 


The PicoFOCUS gently delivers bursts of energy deep in the dermis without causing harm to the overlaying skin.  The pulses work to break up pigment and stimulates new collagen and elastin production.  Your body’s own healing process sweeps away older, damaged tissue and ramps up skin turnover.  Some pigment will actually travel to the surface making it initially appear darker.  We normally recommend a series of 4 treatments; 1 every 4 weeks.  Do not be concerned if your pigment goes away and then comes back within days to weeks; pigment is usually multiple layers deep and clears layer by layer.


We recommend finding an experienced physician in your area.  Treatment prices vary by market.

Laura Riehm, MD
Fort Worth Physician
5.0 out of 5 stars 1 review

No excision

This is problem that is seen from time to time. I would definitely not recommend excision - a tattoo of that size would need a skin graft and that would be much more noticeable. This is going to sound weird but post inflammatory hyperpigmentation (PIH) can be treated with a 1064 Q-switch YAG (a laser used to remove tattoos). We use a very light setting to do this. Additionally, PIH often lightens with time. Consider doing nothing for 6-8 months and see if it begins to lighten. Good luck, Dr. M

Jared Mallalieu, DO
Annapolis General Surgeon
5.0 out of 5 stars 8 reviews

Tattoo Removal -- Q Switched Laser -- Post Inflammatory Hyperpigmentation

This can happen after any laser treatment. Lightening creams and aerolase laser work well to help this improve.  I would continue laser treatments but start using fractional laser or radiofrequency such as fraxel or intensif.  I suggest seeing a cosmetic dermatologist with experience in laser combinations.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 166 reviews

PIH after tattoo removal

I don't think I would go the route of excision. The scar will be much worse than the current problem. I would seek another opinion to treat the remaining hyperpigmentation. Other lasers might be needed. If you do surgical excision, my bet is that you then do laser treatments to improve the scar. 

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.6 out of 5 stars 27 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.