Tattoo Removal Not Working. How Do I Find Best Provider for Excision or Dermabrasion?

I have had 18-20 treatments over the past 3-4 years for a 4" blue/turquiose/white star. At this point i go for free, but it's not working and hasn't been for at least the last 10 treatments. It's still very "there". I want to consider excision or dermabrasion. I don't mind a scar although I do hope that over time i can mimimize it. I'm patient. Anytime i try & research doctors, I get laser doctors. How do I find the person who will do the best job?

Doctor Answers 2

Blue tattoo

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there might be other wavelengths that could be more effective than the one you have had. It might be worthwhile seeking different lasers to see if they might lighten the color some more.  Staged excisions or using a chronic skin expander and then performing one large excision, will certainly leave a large scar that may spread, and can disfigure the surrounding skin with lumps as the skin comes together.  Dermabrasion sometimes has to be done more than once, but each time it's done, some more pigment may extrude. These scars are often very red and raised and can get very itchy. They are not preferred over the tattoo necessarily. Think very hard before you embark on such a destructive treatment.

Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Infrared Coagulator Works For All Kinds of Tattoos

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Unfortunately, while it may be fairly easy to get a tattoo applied, it’s safe to say, it’s much harder to get one removed, and, for that matter, much more expensive. Prior to the introduction of light-based therapies, a variety of procedures were used for getting rid of them. These included dermabrasion, salabrasion, cryotherapy, chemical peeling. and surgical excision.

Dermabrasion involved the use of a motor-driven wire brush to abrade the skin surface; salabrasion, the use of coarse salt crystals; cryotherapy, freezing with liquid nitrogen; and medium-depth chemical peels, the application of caustic materials. Each of these techniques relied upon stripping away the epidermis, the topmost layer of the skin, and exposing the pigment-laden dermis. Following exposure, the ink would be extruded as part of the healing process.

Surgical excision skirted the issue of dealing directly with the embedded pigment. Instead, if the lesion were small, it was cut out entirely and the resulting wound sutured together. If it were very large or its location difficult to work with, the removal was done in stages, allowing each surgical wound to heal before proceeding to excise another part. In general, these methods are successful at obliterating the tattoo, but at least some degree of scarring is inevitable. It is a trade-off--an acceptable scar in place a highly visible and undesirable tattoo.

Lasers and other light therapy devices, such as the Infrared Coagulater (IRC), have become the treatments of choice today. Lasers work by emitting short, intense pulses of light that pass through the skin and target the ink. The energy from the laser light fragments the large particles of tattoo pigment enabling the body’s natural immune system to more easily scavenge the pigment and carry it away. This process usually takes several weeks, and multiple treatment sessions are often necessary to achieve maximal clearing.

Since black pigment absorbs all wavelengths of light, it is ironically the easiest pigment to remove. Colors, such as green, do not absorb as well, and sometimes a variety of lasers, with varying wavelengths, are needed to effectively treat a multicolored tattoo.

Potential complications include permanent scarring, temporary or permanent loss of pigment or excessive pigmentation. Fees for laser treatments may range from $1000-$3000 or more, depending upon the number of treatment sessions required, and the size, shape, colors, and location of the particular tattoo.

IRC, my personal favorite, uses non-laser infrared light to heat the area containing the pigment. It is quick and easy to perform, and generally requires fewer treatments than lasers. Most small tattoos can be treated successfully in one to three sessions. Very importantly, the IRC’s efficacy does NOT depend upon the particular color of the pigments involved. And it is for these reasons, that it has become my preferred method for dealing with small tattoos. Larger tattoos may be treated in segments.

The procedure is quick and simple. The area is first numbed with local anesthesia. Next, very short pulses of infrared light are directed at the tattoo in a gridlike fashion, leaving tiny spaces between each treated site. Since each burst of energy is just a fraction of second, an entire treatment session requires only a few minutes to complete. It is within the course of the next few weeks, as he wound heals, that the pigment is extruded.

To complete the removal, the intervening spaces are generally treated between two to four weeks later. Fees for a series of three sessions generally run about $1500. As with laser treatments, potential complications include scarring and temporary or permanent pigmentary changes. Most people, however, are quite gratified and relieved to be free finally of their tattoos. 

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 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.