Dragons and Fairies: What is the Most Effective Way to Remove an Old Tattoo?

It happened quite some time ago, but it continues to accompany you to this day. A decision made at a specific moment, prompting you to tattoo something on your body: the name of a loved one, an image of a favorite singer, or perhaps just a meaningful quote or seemingly innocent drawing you liked.

The reasons for this vary: youthful indiscretion, societal pressures, or simply wanting to appear "cool" to peers.

Since then, you've experienced a lot, and if you've been fortunate enough to connect with the light of Judaism, you've learned that the Torah strictly prohibits the creation of tattoos of any kind on the body, as precisely stated: "Do not cut your bodies for the dead or put tattoo markings on yourselves" (Leviticus 19:28).

Today, that tattoo continues to bother you, reminding you of things you'd prefer to forget, or revealing a past period long left behind. So, what are the options? Nowadays, there are several solutions developed for tattoo removal, using various methods. What, then, are the implications of each method, and is there a recommended one?

First, a bit of theoretical explanation: A tattoo is the insertion of pigment into the subcutaneous layer, binding to proteins until it becomes permanently visible on the skin. The materials used in tattooing are so strong that the body cannot remove them, which is why tattoos remain enduringly.

Unlike other countries where a great deal of consideration is required before getting a tattoo or age restrictions apply, in Israel, by law, parental consent is needed for those under 16, and beyond that, the sky's the limit.

Easy to Tattoo, Very Hard to Remove

While creating a tattoo is simple and quick, its removal is much more complex and often cannot be resolved with a single treatment, requiring a series of sessions.

Dr. Monica Elman, a dermatologist who opened a network of clinics, is well-acquainted with the field. In an interview with Ynet, she discussed the topic extensively. According to her, "A tattoo is an emotional deep imprint. Sometimes people tattoo around a birthmark or existing moles and later feel uncomfortable with their appearance. I even had a patient whose husband threatened to leave her because of a tattoo."

Similarly, Prof. Yaron Har-Shai, head of the Plastic Surgery Department at Carmel and Lin Hospitals of Clalit Health Services, stated in a Ynet interview that "Making tattoos is easy, but removing them is very difficult. The removal also depends on the technique used to make the tattoo. In a machine, the pigment is usually inserted at a consistent depth in the skin, but with manual tattoos, there might be different depths, making deeper pigment harder to remove. Additionally, as the tattoo covers a larger area with more colors, it becomes harder to remove."

(Illustration Photo: shutterstock)

So is it possible to ensure complete removal of a tattoo without any marks or scars? Prof. Har-Shai argues not always. "I've seen many tattoos where removal attempts left color marks indicating a tattoo was there, though the drawing was no longer recognizable. Removal is complicated and may involve complications, so it's important to think very carefully before getting a tattoo and consider concealing it as much as possible."

Dr. Elman shares a similar viewpoint. "Once a person tattoos their body, they can't expect to regain 100% smooth skin. The skin has a memory, and it often remembers things we'd rather forget," she explains. "The tattoo trend today is massive, but there's no quick fix. If someone has a tattoo covering their entire back, the process cannot be rushed, and even excellent results may include some scars or white spots on the skin."

Currently, the main methods for tattoo removal are skin sanding, surgery, and laser. Each has its advantages and disadvantages, and each is suitable for removing specific types of tattoos depending on their size, location, and colors.

First Method: Surgery

This is a one-time procedure where the tattoo is excised from the skin, and the remaining skin is stitched together. The process is considered a surgical operation and involves local anesthesia. Consequently, according to Dr. Elman, it is suitable only for small tattoos in concealed places.

"Surgery always leaves a scar," explains Prof. Har-Shai, "and it's not always possible to completely remove the tattoo. If it's large and there's not enough skin to cover it, that's a problem. In such cases, slightly more sophisticated surgical methods, like expanding healthy skin around the scar, could be used, resulting in a two-stage operation. It's hard to know in advance who will specifically need the surgery, but if the tattoo is very small and can be removed in one procedure, that's typically preferable."

Dr. Elman agrees. "Sometimes it's just a small blemish," she says, "and to complete the process in one go, surgery is better. A scar will remain, eventually becoming white. I recommend the surgical method for at least 10% of tattoo removal requests."

Second Method: Laser

In recent years, laser use has expanded for various applications, including hair removal, eyeglass removal, and yes, tattoo removal. It helps break the bond of pigments in the sub-skin, separating them from proteins, enabling tattoo removal. Additionally, the method can also apply to various skin marks and colors, including permanent makeup. However, its notable disadvantage is that not all colors can be removed with it. Typically, aesthetic results are better in darker tattoos.

"To break the tattoo link with the laser, you need to know what type of color was injected into the tissue," describes Dr. Elman. "There is a higher chance of removing tattoos in colors like blue, dark green, black, and gray, as their breakdown and protein separation capabilities are higher. On the other hand, tattoos in yellow, red, white, or pink have lower breakdown capabilities, so dark tattoos typically yield better aesthetic results compared to light tattoos."

The removal process includes numbing the area, followed by laser irradiating the tattoo area, breaking the protein-color bond. The treatment duration ranges from a few minutes to an hour, depending on the tattoo size, with no significance to the tattoo's location in the process.

(Illustration Photo: shutterstock)

Afterward, the skin requires several weeks to heal from the remnants of the burn left by the procedure, thus needing a minimum six-week interval between treatments. "The skin does not like being burned," Dr. Elman explains, "and time is needed for the skin to self-recover."

And what about the number of treatments? Generally, between five to ten treatments are needed, with several restrictions during the removal process, including prohibiting sun exposure or hair removal until the skin heals. "It's important not to cause any inflammatory or additional sensitivities that would delay the healing process," explains Dr. Elman.

Alongside these aspects, laser treatment also has disadvantages. "Sometimes, only the center of the tattoo can be removed, not its border, due to the tattoo's depth and colors," describes Dr. Elman. "In certain cases, skin pigmentation changes may occur, with the appearance of white spots that could be lightly concealed with natural tanning. In any event, even if the procedure is done by a skilled nurse, a doctor must be on-site, as an anesthetic is injected."

The cost of such treatment isn't especially low and may reach several thousand shekels, mainly depending on the tattoo's size.

Third Method: Skin Sanding

Yes, just as it sounds. This method involves "sanding" the skin using a drill equipped with fine-grit sandpaper. The drill removes layers of skin as it passes over the tattoo, requiring between one to three treatments.

Sound classic? Yet Dr. Elman is very skeptical of this. "This is an old technology, and in my opinion, the aesthetic result is unsatisfactory. I don't believe in this approach as the skin can remain heavily scarred, depending on its color, and it shows evidence of trauma. There's no turning back from such skin damage."

Prof. Har-Shai shares the same discomfort with the idea. "The option to use sanding depends on the pigment's penetration depth. If it's a very superficial penetration, sanding might help, but if sanding crosses the epidermal-dermal boundary, a scar will remain. If it's a relatively large tattoo, the scar will be large as well."

Removed a Tattoo Already? Important Information

After tattoo removal, the skin is particularly sensitive, and you must act accordingly:

1. No Tanning Allowed - "As soon as the sun causes tanning," says Prof. Har-Shai, "the skin's pigment cells rise to the surface and might remain there. In such a situation, rather than making the scar area paler, it becomes darker, and it's very difficult to treat this." This means no sun exposure for about half a year, and use of sunscreen with SPF 15-30 is recommended.

2. Proliferative Scar - A few months after tattoo removal, a raised scar may develop, requiring treatment. This scar is firm and itchy and may appear after tattoo removal, regardless of the method chosen.

But the best advice? Not to tattoo at all. Today, it's known that tattoos may cause serious medical complications. "There are also individuals who suddenly discover they're allergic to tattoo pigment colors and then have to cope with lifelong allergies. There are known cases where people have been treated with steroids due to severe allergic reactions to tattoos," describes Prof. Har-Shai. And that's just the mild response. Studies already show that tattoos may cause infertility, fertility problems, harm to the fetus for pregnant women, and even cancer.

However, for those who have already done so, there are even charitable options. One such option is Asa Paz's charitable initiative, specializing in this area and charging a particularly symbolic fee. For those who need it, we can only wish you good luck.