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

Question

I had a friend who went and had one session done of laser tattoo removal a year ago he said he had the injection and the cream but never went back for another session because the pain was so bad. I am nervous about getting my tattoo removed because it's a large tattoo on both ribs and under boobs. Does the injection, and topical cream really help the pain? I know everyone is different, but I want to know I'm going to be able to handle the pain.

Jason Emer, MD · Answer

This is difficult to answer, because pain can be variable. The injection and cream can make you more comfortable during a laser tattoo removal treatment. I recommend getting a formal evaluation with a laser tattoo removal expert. Keep in mind, it will take a series of treatments. Best, Dr. Emer

Jessica H. Kim, MD, FAAD · Answer

The degree of discomfort from laser treatments is variable from patient to patient.  Typically, a combination of topical and injectable anesthetic and Zimmer cold air can be used.  Consult with a board-certified provider to discuss pain managment.

Robert Pettis, MD · Answer

Hello and thank you for your question.  Pain tolerance and discomfort levels are so very individual it is hard to compare one person to the next.  That being said, we recommend that you seek a consultation with a well qualified and experienced clinician and honestly discuss your pain and tolerance concerns, there are a number of ways to enhance the patient comfort level during laser tattoo removal.  We use a specialty, compounded numbing cream, the key is to be sure it is left on the skin for the proper length of time.  With the numbing cream that we use, our patients are usually quite surprised that the discomfort level is less than anticipated.  We also use chilled air for surface cooling which contributes to minimizing discomfort.  Tattoo removal takes time and a series of treatments, so be sure you find a clinician that you are comfortable with and who is responsive to your concerns.
All the best to you!

Mark A. Blair, MD · Answer

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!

Richard Rosol, MD · Answer

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.

Jean M. Casello, MD · Answer

I think it is possible to make patients comfortable during tattoo removal.  We have not had any problems with discomfort during this procedure.  It is important that the topical cream be "strong" enough and is left in place long enough to get good anesthesia.  We also combine this with icing and chilled air.  You should discuss your concerns with your provider prior to your treatments to make sure that they have protocols in place that will make you comfortable.

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