Surgical tattoo removal

If the laser does not work, in some cases there is the option of tattoo removal by surgery.

How does laser tattoo removal work?

Laser tattoo removal is generally the gentlest method. The aim is to remove the tattoo in such a way that, ideally, there is no trace left at the end.

Depending on the color and the penetration depth, this is possible in certain cases. In this respect, you should seek advice and treatment from a laser specialist before deciding to undergo surgery.

As a rule, several laser sessions (3-15) are required before success can be achieved. Nevertheless, clouds of pigment or scars may ultimately remain. The scars sometimes appear as a lightening that represents the silhouette of the former tattoo.

In simple terms, the laser recognizes the colour pigments of the tattoo and shoots them with high energy while protecting the body’s own cells. In this way, the tattoo pigments are shattered. The pigments reduced in size in this way can be broken down by the body’s cells.

What does the surgical removal of a tattoo mean?

Surgical removal of a tattoo means removal without a laser using surgical means. This means that scalpels or grinding devices are used. In contrast to laser tattoo removal, anesthesia is required for such operations.

Surgical tattoo removal using a scalpel or dermabrasion are other options. These techniques make sense if the desired result has not been achieved after laser treatment, residual pigment remains or a quick removal of the tattoo is desired.

The surgical techniques are radical and involve scarring.

Skin abrasion – dermabrasion:

When is tattoo removal by skin abrasion an option? Whenever the size of the tattoo makes it impossible to cut it out.

During dermabrasion, the skin is abraded until the pigments are exposed. A deep abrasion forms, which weeps and takes several weeks to heal.

The result is a scar that resembles a moderate burn. Dermabrasion usually requires 2-3 sessions. The resulting scars can remain red for months until they slowly fade.

Cut with a scalpel:

Tattoo removal with a knife is particularly useful for elongated tattoos. These can then be cut out in a spindle shape. The skin in the vicinity is detached from the base (stretch plastic) so that the defect can be closed.

We paid particular attention to a stable multi-layer wound closure.

Image explanation: Blue is the area that is cut away. Gray is the area where the adjacent skin must be detached. The edges of the wound are then sutured in the middle (arrows), leaving a horizontal scar.

For larger, elongated tattoos, partial removal can be carried out first and then another part can be removed later when the skin has stretched. This technique is called serial tattoo removal.

Ideally, the result is a delicate linear scar. This cannot usually be achieved with the first procedure due to the increased skin tension during suturing. As soon as the scar has fully matured (usually 9-12 months), a scar correction can be performed to narrow a scar that is too wide.

Skin grafting for surgical tattoo removal:

In some situations, skin grafting to cover defects as part of tattoo removal with a scalpel can also be the method of choice.

This applies if a satisfactory result cannot be expected by moving the skin or if this is not possible.

For aesthetic reasons, a so-called full-thickness skin graft (consisting of the full layer of skin) should be used. This must be taken from a donor site. Areas of old scars are ideal for this, as it is not necessary to produce a new scar.

The skin quality should be similar, otherwise a significant pigment shift or a reduction in height may remain in the transplanted area after tattoo removal.

After removing the tattoo, the skin graft is fixed to the wound bed with sutures. The skin graft is then fixed to the clean wound surface with a stitched over-tie bandage under pressure to prevent shearing forces. The latter can be fatal for a skin graft.

In order to minimize shearing forces, it may also be advisable to immobilize operated areas with a plaster splint.

In principle, the over-bandage can remain in place for approx. 6 days after tattoo removal. After that, the dressing is changed for the first time and it is possible to determine whether the graft has completely set.

The stitches are removed after approx. 14 days, depending on the localization. Graft care with lubricating ointments (e.g. Bepanthen) is important in the follow-up treatment.

How is the aftercare carried out following surgical tattoo removal?

The aftercare for surgical tattoo removal depends heavily on the removal technique and the extent and location of the tattoo.

When cutting out a small tattoo, the stitches can be removed after 10-14 days and the wounds heal quickly.

The most time-consuming procedure is certainly skin abrasion. Dressing changes may still be necessary after several weeks. It is also important to take it easy and refrain from sport after the surgical removal of a tattoo.

If the recommendations are not followed, sutures may open, circulatory disorders may be caused and other problems may occur.

The period of restricted movement cannot be presented here in general terms, as there can be significant differences depending on the size of the tattoo.

What costs should I expect?

The costs and prices of surgical tattoo removal in Germany are highly variable and depend heavily on the size and location of the tattoo and the type of anaesthetic.

For most plastic surgeons, the cost of removing a palm-sized tattoo is comparable. Depending on the size of the tattoo, sedation or general anesthesia may be necessary. These lead to additional costs.

An inpatient stay can also be advantageous for more complex operations in order to ensure better post-operative monitoring.

For laser tattoo removal, we will of course advise you in advance about the costs involved.

Summary

No miracles should be expected with any method of tattoo removal. A trial with laser treatment is almost always recommended before deciding on a surgical procedure.

Nevertheless, even with laser tattoo removal, significant pigment disorders can remain in the form of the tattoo and scars can occur.

Even after many laser sessions, the tattoo can still be clearly visible, depending on the pigments tattooed, the laser device, …

Surgical tattoo removal is literally a drastic method that completely removes the tattoo in the operated area – but not without scars. Overall, the person affected must weigh up which method to choose and the surgeon must provide assistance.

While laser tattoo removal can be used in almost all areas, there are often limitations to the surgical technique:

• Size of the tattoo
• Localization: In the area of the upper back, even the removal of a medium-sized tattoo is difficult to impossible. The same applies to the front of the lower leg.
• The texture of the skin and the excess skin where you want to remove the tattoo are also important. The looser and more elastic the skin is, the more tissue can be removed.