What is the real efficacy of a TCA peel (done correctly) to fade a tattoo?

No, the best treatment for tattoo removal is laser tattoo removal. An alternative is the Eclipse MicroPenTR. It will take a series of treatments. See an expert for a formal evaluation with an expert. Best, Dr. Emer

TCA is a nonselective skin killer!  If TCA is used to try to remove a tattoo, it will almost certainly cause a bad scar and is unlikely to remove the tattoo.  Laser tattoo removal on the other hand is selective where specific laser light targets specific colors of tattoo ink.  The light pulses are very short and do not create much heat, so the tattoo ink can be removed in most cases without leaving a scar.   The only problem is that not all tattoo lasers are the same.  The best tattoo removal doctors have at least 2 lasers that include 1064nm, 532nm and 755nm or 694 wavelengths of light and also have one or 2 picosecond (newer technology) lasers.  As for the pain, tattoos can be made completely numb before treatment with local or tumescent anesthesia so the treatment does not hurt.  Don't try to remove your tattoo with TCA.  It is a bad, bad, bad idea!!!

The real answer is yes, high strength TCA can remove tattoos, so can salt dermabrasion, or dermabrasion, as can sulphuric acid, all reported in the literature, and all well known to us. The trade off is that your tattoo will be replaced with a wound that may take 2-3 months to heal, or require grafting, followed by hypertrophic scaring. These are the facts, however it is up  to the patient to pursue their own treatment of choice, having been informed of the real risks (and benefits) of these treatments. Dr Davin Lim, Brisbane Dermatologist. Australia.