Permanent isn't forever — Tattoo removals increase

Lifestyle changes prompt laser treatment

Failed relationships, evenings better forgotten, and a desire to go against society norms are just a few of memories evoked by tattoos that a growing number choose to remove.

In 2006, 43,000 Americans underwent laser removal treatments for their tattoos, according to the Millennium Research Group, a Toronto-based research firm that specializes in medical technology. Also in 2006, almost 3.7 million people, or 20% of people with tattoos, researched removal methods, according to the Millennium Research Group.1

Although tattoos have increased in popularity and the number of people getting tattoos continues to grow, there also is a steady flow of people seeking removal, says Brian Zelickson, MD, medical director of the Abbott Northwestern Hospital Laser Center in Edina, MN. "Ages of people seeking removal treatments are all across the board, with the majority of patients in their 30s and 40s, he says. "Reasons for removing the tattoos include marriage, new jobs, and discontent with the tattoo.

Roy G. Geronemus, MD, director of the Laser & Skin Surgery Center of New York, is seeing an increase in the number of patients asking for tattoo removal. While he sees patients of all ages, several parents have brought their minor children in for tattoo removal recently, he says. Although tattoo artists are not supposed to work on children, fake identification is often used to obtain the tattoo, he explains. Because the child is not able to sign a surgical consent, the parents must do so, but the child must agree to the procedure, he says. If the child does not want the tattoo removed, the parents and child are asked to come back when they can all agree to the procedure, he adds.

"I also see a number of young women who are new mothers and don't want their children to see tattoos on their mothers as they grow up, says Geronemus. There are also young professionals and others who decide that a tattoo from college is no longer acceptable and cannot be hidden by clothing, he adds. All of these situations lead to a steady, increasing stream of patients, Geronemus says.

"I don't anticipate the number of patients asking for tattoo removal to decrease any time soon, he says. "I've seen reports that as many as 25%-30% of all college freshman have a tattoo. Many of these students will finish college, enter the work world, start their families, then realize that tattoos are not part of their new lives, Geronemus says.

When Zelickson was interviewed in 2004 by Same-Day Surgery on the topic of tattoo removal, dermabrasion and surgical excision were two techniques used in addition to laser treatments. "Now, dermabrasion is rarely used, and only a small number of patients opt for surgical excision, he says. "Laser removal is the most common and, in most cases, the most effective.

The most common lasers used for tattoo removal are the Q-switched ruby laser, which works well on green but not red inks, and the Q-switched neodymium YAG and the Q-switched alexandrite lasers, which remove green but not red inks, Geronemus says.

New ink simplifies removal

There is a new tattoo ink that at press time is scheduled for release this month that will change the way that people think about tattoos, says Geronemus.

"Freedom-2 Inc. [of New York City] are designed to be easily removed by laser, he says. While the ink is permanent and will not fade, if the patient decides that he or she no longer wants the tattoo, it can be easily, safely, and completely removed, he adds. Current inks are hard to remove in some cases, with bright colors and blacks presenting the greatest challenges, says Zelickson. "A professional tattoo can require between eight and 12 treatments for removal, and some ink may not be completely removed, he explains. Tattoo removal is not covered by insurance, so the $100 to $400 cost per treatment, depending on the size and color of the tattoo, can be significant, he adds.

An ink that can easily be removed will change the way people think about tattoos, points out Geronemus. "Today, people get a tattoo thinking that it is permanent, but inks that promote easy removal may make tattoos more of a fashion accessory that can be changed often, he says. The increased ease of removal will create more business for outpatient surgery providers who offer tattoo removal, he adds.

Even with easily removed inks, it is important to educate patients up front, says Geronemus. "Patients need to understand that results may not be exactly what they want, he says. "It is important for the physician to honest about what may and may not be removable.

There are some risks with any surgical procedure, including laser tattoo removal, Zelickson points out. "In rare cases, a delayed hypersensitivity may result in the area becoming inflamed and itchy, with symptoms spreading, he says.

The more common risk is the property of inks that contain iron oxide to turn black when the laser is applied, says Zelickson. "Because this is a risk, I try one pulse on the ink; then if it turns black, we stop, he says.

Although tattoo removal can be a simple laser procedure, be sure you have a clean environment and adequate anesthesia, suggests Zelickson. "We use ice or cold packs, topical anesthesia, and local lidocaine injections if necessary, he says. "The level of anesthesia is determined by the size and color of the tattoo, as well as the patient's tolerance of pain.


  1. Millennium Research Group. U.S. Markets for Aesthetic Lasers 2007. Toronto; 2007.


For more information about tattoo removal, contact:

  • Roy G. Geronemus, MD, Director, Laser & Skin Surgery Center of New York, 317 E. 34th St., New York, NY 10016. Phone: (212) 686-7306. Web:
  • Brian Zelickson, MD, Medical Director, Abbott Northwestern Hospital Laser Center, 4100 W. 50th St., Edina, MN 55424. Phone: (952) 929-8888.

For information on Freedom-2 tattoo ink, go to the company's web site at