Pain during laser tattoo removal. Does the injection, and topical cream really help the pain?

Hello, thank you for your question.  In our office we do lidocaine injections to manage the discomfort during laser tattoo removal. With lidocaine injection the treatment area is completely numbed and you should have very little if any discomfort.  When injections are offered, it can at times be a little more expensive than a facility that does not do lidocaine injections. Topical numbing doesn't seem to do much to help with discomfort due to the cream only penetrates the surface and ink is usually deeper than surface.  If the tattoo is small, smaller than a half dollar and not real heavy in ink, icing can be effective because it does numb the skin temporarily, deeper than topical numbing.  The latest technology in laser tattoo removal is pico-second technology. The PicoWay Laser (Candela/Syneron) uses photoacoustic
impact/pressure waves rather than photothermal/heat.  This process has less heat, therefore it is
more comfortable and the chances of hyperpigmentation are less.  The Pico-second pulse shatters the ink into
even smaller particles, allowing the body to more easily absorb the ink.  This type of technology can usually remove a tattoo in about half as many treatments as the traditional Q-switch devices.  You can click on the weblink below and put in your zip code to see if this technology is available in your area.Good Luck!

Good anesthesia for tattoo removal is practical and possible when the practitioner takes the issue seriously.  I have learned that just about anyone can get through anything at least once, but the problem here is the return visits.  If the procedure hurts too much, people bail, and that doesn't get tattoos removed.
I can only speculate on why two combined methods failed with your friend, but I believe it's important to choose one anesthetic and fully maximize it.  In my practice, Lidocaine/Prilocaine cream with 2 hours set-up has patients relaxed and chatting/laughing with me throughout the procedure, reporting 1-4 out of 10 on the pain scale.  Patients tend to look forward to their next treatment, instead of dreading it.
Tattoo size has a major influence on safe and adequate anesthesia, so my advice is to be sure you're getting treatments at a physician's office--and one that takes your comfort extremely seriously.