9 Factors That Determine Tattoo Removal Success

Written by Daniel Friedmann, MD, Board Certified Dermatologist on May 23, 2014 26 Comments

Picosure tattoo removal laser image

The number of treatments needed to successfully remove a tattoo can differ dramatically due to tattoo size, location, color and density of tattoo ink, and device used, among other factors. While it is nearly impossible to guarantee the removal of a tattoo within a specific number of treatments, tattoo removal experts can assess the following variables to predict tattoo removal success:

Ink color: Typically green, blue, and black inks are easier to remove, while red, orange, yellow, and white inks are progressively more challenging. New devices, such as the PiQo4 laser, have improved the efficacy and efficiency in treating these tattoo colors. A recent study demonstrated that 1-2 treatment sessions led to at least 75% clearance of blue and green pigments with the PiQo4 device, with more than two-thirds of tattoos approaching 100% clearance. Another 2012 study also showed 75% clearance in black pigment as early as 2-4 treatment sessions.

Tattoo Age: Older tattoos are prone to pigment fading and may be more easily removed compared to newer tattoos.

Tattoo Size: One variable that is undisputed is that larger tattoos require more treatments than smaller tattoos. A 2010 study published by the Journal of the American Medical Association noted that tattoos over 12 inches in diameter were least successfully removed after 10 treatments.

Smoking: The study mentioned above also directly linked the negative effects of smoking on tattoo removal. Subjects who smoked regularly had a 70% lower rate of removal after 10 sessions compared to their non-smoking counterparts. This lower success rate is most likely related to smoking’s direct effects on wound healing.

Skin Color: Tattoo removal is more effective for individuals with lighter skin (specifically Fitzpatrick type 1 or 2 skin types). Because lighter skin does not significantly absorb laser light, most of the laser energy is focused on the tattoo pigment. In contrast, dark skin siphons a portion of laser light from the tattoo. Also, most laser operators use lower energy settings on patients with darker skin types, as they are more susceptible to unwanted side effects.

Location: Tattoo removal is harder in areas that have a limited vascular supply and slower healing. Thus, tattoos on the feet, lower legs, or hands require more treatments than tattoos in areas like the chest or back.

Amount of Ink: The amount of ink used is another parameter that affects laser tattoo removal. Professional tattoos have a greater density/volume of pigment that resides deeper in the skin. On the other hand, amateur tattooing is usually uneven, superficial, and done with dramatically less ink.

Scarring or tissue damage: Some people, especially those with dark skin types, are at risk for developing scars or other tissue damage during the tattooing process. Ink pigment that resides under scar tissue is much more difficult to remove and requires more treatments.

Layered Tattoos: Layered tattoos (which often occur when a patient tries to cover up their initial tattoo with another one) are difficult to remove and require significantly more treatments than singular tattoos. Most tattoo ink is translucent, meaning it is necessary to use darker ink tones to cover previous tattoos. Since the new layer is larger and darker (and layering increases the overall volume and density of ink), full removal can be very difficult.

Daniel Friedmann, MD

Daniel P. Friedmann, M.D. is a fellowship-trained, board-certified dermatologist and phlebologist at Westlake Dermatology and Clinical Research Director of the Westlake Clinical Research Center. He has presented nationally on photorejuvenation, noninvasive fat reduction, radiofrequency devices, up-to-date techniques in photodynamic therapy, the management of stretch marks, and the treatment of hand, chest, and facial veins.

26 Responses to “9 Factors That Determine Tattoo Removal Success”

  1. Fernando says:

    Great information! We also provide tattoo removal service in Florida uses the PicoSure and our clients have been getting excellent results!

  2. Fernando P. says:

    Nice blog! We also provide tattoo removal service in Florida using PicoSure and I can confirm its way more effective than the old q-switch machines we were using. It’s working great on large tattoos, ones with many complex colors, and tattoos that were not able to be removed with other lasers.

  3. Shane says:

    Nice blog, Thanks for sharing information about the tattoo removal treatment. I like to know why the light colored tattoos are hard to remove and is there any special process to remove this tattoos in laser treatment.

    • WD Staff WD Staff says:

      Hi Shane, the issues with removing colored tattoos can depend on a lot of factors including characteristics of your skin and the tattoo (colors, amount of ink used, size of tattoo, etc.). Please feel free to give us a call for a free consultation!

  4. Total Face Group says:

    Nice blog! I like to know why the light colored tattoos are hard to remove and why they require special process to remove by laser treatment.

    • Lynnette says:

      Light colored inks reflect the laser beam from entering the skin and pigment to facilitate removal. I am not a professional on the subject but that is my belief.

  5. Rick says:

    Thank you for the article. I just about passed your we site up in Bing but now I’m glad I clicked the link and got to go through it.

  6. Grace says:

    Nice post. This is really helpful to all tattooed guys and gals. BTW, I wrote an article on my site about the same topic, tattoo removal methods.

    Keep it up guys!

  7. Lacey says:

    The only facility in my area does not use a picosure laser. Are picosure Lasers used for colored tattoos only or black and grey ink as well? Because my Tattoo is black and grey.

    • WD Staff WD Staff says:

      Hi Lacey, sorry to hear about the lack of PicoSure in your area. It is a new (and more expensive) laser compared to old Q-switch tattoo removal lasers. We tried many different lasers and settled on PicoSure as it provided the best results in trials.

      PicoSure is extremely effective, and will work very well on your black and grey tattoo. In fact, colors are usually harder to remove then black/grey (although as you see from the above post there are a number of variables that affect tattoo success).

      I’d recommend you going to the PicoSure site (https://cynosure-locator.com/patients/) to try and find your nearest provider. Or, come to Austin for a tattoo removing vacation!

      Thanks again for reading,

      WD Staff

  8. Hannah says:

    When someone comes in for a consultation can you tell them how many treatments are needed and the total cost?

    • WD Staff WD Staff says:

      Hi Hannah, Unfortunately there is no way to pinpoint the precise number of treatments to remove a given tattoo. However, an experienced laser technician can usually provide a correct treatment range estimate (include total cost). If you want to give us a call we can provide you with a conservative estimate so you’ll know what to expect.

      WD Staff

  9. Tattoo Man says:

    Choose your colors carefully. If you do end up needing to get your tattoo removed via laser later on in life, green, blue and black inks are some of the easiest to remove. Red, orange and yellow tend to stay with you a lot.

  10. Helen says:

    Thanks for this post, unfortunately I live in new york otherwise i would come in for a consult

  11. Vic says:

    Just remember that with any form of tattoo removal there is the chance for pigmentation (discoloring) issues. Do you research and choose a professional!

  12. JN says:

    I am a smoker with professional tattooing across my fingers. I have had them for about 4 years. I have very fair skin. I have had three picosure treatments so far. However I have found the opposite of what you say to be true, I have black blue and yellow ink the yellow was the first to go after one treatment. Blue is next and is almost all the way gone after 3 treatments. But the black ink is holding on for dear life and it may take 15 or 20 treatments who knows?

  13. Cosmo says:

    Nice post, Thanks for sharing information about the tattoo removal treatment. This is really helpful to all tattooed guys and gals.

  14. Paulina says:

    Very informative post, I did not know that there are so many factors can influence how quickly the tattoo can be removed.

  15. MATTHEW says:

    I would like to make a appt HOWEVER mine are so vibrant in afraid it can’t be done. Desifilied my temple want all removed But first 1in back and both hands and both knuckles

  16. Adrian says:

    I like how you mentioned that full-color tattoo removal is a challenge in itself because of a number of factors, one of them being the colors of ink used when the tattoo was made the first time. Since green, blue, and black-colored inks are easier to remove due to being in use more often, it’s the more vibrant colors of red, orange, yellow and white that prove to be a challenge to remove safely. There’s also the factor of using equipment to safely remove the colored ink coming into play, as well as the size of the tattoo in question. If I were to have a tattoo removed, I would have to take it gradually, since the steps involved are complicated and I wouldn’t want to run into any problems during the process.

  17. Tattoo says:

    With the Pinco4 I was quoted 8 – 10 possibly 11 sessions even with a black cover up. Cost per session is 1000 dollars. Or I just wait for DTR-001 cream or CleariT both clear ink in one session and without blistering or pain. CEO emailed me the makers of CleariT and told me its going to be about a year before they bring it to the market. They need FDA approval. Cream just went through Pre-Clinical trails and now it needs to pass phase 1-2-3.

    Can’t wait until this laser / long sessions / big costs, will be a thing of the past!

  18. Tattoo says:

    Oh forgot to mention.

    looking at Laser+RAP that also looks promising. With that it seems like cover-ups with be less of a problem now. I could end up doing that while I wait for CleariT and DTR-001 Cream. But if it works fast like they say 49% ink clearance and less costs then I may end up without ink on my arm soon.

    Though I wonder how long it will take for Clinics to pick up this new shock-wave technology?

    • WD Staff WD Staff says:

      Thanks for sharing Tattoo, its great to hear about the new technology being developed. We’ll continue looking out for the best solutions and updating our tech as long as they provide better results!

      Thanks again for reading and sharing!

      –WD Staff

  19. Runprintuk says:

    Great Article its really informative. keep us posted with new updates. its was really valuable. thanks a lot.

  20. Unwanted Tattoos says:

    Great post, very helpuful as I’m considering tattoo removal. Thanks for sharing

  21. Kate says:

    It’s good to know that black inks are easier to remove!

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