During a recent virtual course on laser and aesthetic skin therapy, dermatologist Omar A. Ibrahimi, MD, PhD, said doctors “don’t really know what’s in a lot of these ink residues” when they are targeted by various laser tattoo removal machines. “We know they’re getting mobilized and some of it’s going into the lymphatics. What’s happening with these ink particles? We don’t fully know. We don’t fully understand how tattoos are removed today, but the working models include some of the residual ink coming out through transepidermal elimination, some of it being removed via lymphatics, and some of it being removed by rephagocytosis. (According to Merriam-Webster, phagocytosis is the engulfing and usually the destruction of particulate matter by phagocytes that serves as an important bodily defense mechanism against infection by microorganisms and against occlusion of mucous surfaces or tissues by foreign particles and tissue debris.)

Laser tattoo removal comes with greater hazards for tanned or darker, and often more sensitive skinned individuals as the extra melanin contributes a competing chromophore during the removal procedure which complicates the treatment.

Dr. Ibrahimi also went on to advise clinicians to “address the expected healing time and the risks such as hyper- and hypopigmentation, blistering, and scarring” and to “set the expectation that this is not going to be a one and done procedure. Laser tattoo removal takes a series of treatments, often more than what we think – sometimes in the range of 15-20. And you may not get complete clearance. I liken it to breaking it up enough so that if somebody sees it, they won’t be able to recognize what the tattoo is. But you won’t be able to erase it 100%.”

We are informed that “the clinical endpoint to strive for during tattoo removal is a whitening of the ink. That typically fades after about 20 minutes.” However, when the whitening does not fade, then the patient is left with permanent hypopigmentation for which there is not good treatment.

Other common adverse side effects from laser tattoo removal also include prolonged erythema, blistering, hyperpigmentation, and scarring. Less frequent complications include ink darkening, chrysiasis (a permanent slate-gray discoloration of the skin), and transient immunoreactivity.

In contrast, the nonsurgical and non-laser tattoo removal process that’s especially suitable for removing cosmetic tattoos on delicate and conspicuous areas of the face delivers its results exclusively via transepidermal elimination without all of the common or less frequent adverse side effects associated with successful laser tattoo removal. While manufacturers of laser tattoo removal devices have been continually developing and refining their techniques for tattoo removal, their limitations still make it a poor option for removing facial cosmetic tattoos in light of the safety and efficiency of non-laser cosmetic tattoo pigment removal.