Difficult Tattoos Even Dermatologists Struggle With: How To Remove Them

Hello, I am dermatologist Jung Ji-in. Many people who decide to get a tattoo removed might wonder if their tattoo will be easily erased. Recently, with a significant increase in patients visiting for tattoo removal, we are encountering various cases. Among them, there are particularly challenging cases. Today, I will take some time to explain in detail the cases that are a bit more difficult for tattoo removal.

Tattoos that cover existing tattoos or scars with ink are called cover-up tattoos. Especially for cover-up tattoos meant to hide scars, the existing scar tissue is often tough and thick, which can slow down the removal effect.

• Increased Ink Volume: There is significantly more ink than in regular tattoos, which is likely to increase the number of treatment sessions.
• Risk of Hypertrophic Reaction: There is also a slightly higher chance of developing a raised, hypertrophic reaction.

In such cases, delicate treatment tailored to the skin condition is required, so we recommend that you receive removal treatment from an experienced dermatologist. However, if the scar is not severe and the cover-up tattoo is applied over a thin scar, it may be possible to remove it without much difference from other tattoos.

Keloids are a unique constitutional reaction that can occur even without severe injury. It cannot be definitively stated that tattoo removal itself causes keloids, and if the tattoo is on areas prone to keloid scars, such as the shoulders or collarbones, or if the patient is in their 20s or 30s, it may be slightly more affected.

However, even if one has a keloid tendency, if the keloids are not severe, they often show a similar response to those with a normal constitution. Even if a scar occurs, it is more often a slightly raised mark like a hypertrophic reaction rather than a keloid.

Conversely, even if one does not have a keloid tendency, if the tattoo has a particularly large amount of ink or diverse colors, or if it is located in an area of the body where scars tend to form easily, changes in skin texture (hypertrophic reaction) may occur in the tattooed area.

The colors that respond least to lasers are flesh tone, white, and yellow. This is because there are almost no specific laser wavelengths that react to these colors. Generally, more sessions are required than for black and white tattoos, and after removal treatment, the color may temporarily darken before brightening again after repeated sessions. Overall, it is somewhat more difficult to achieve satisfactory results compared to solid black tattoos.

If Considering Flesh Tone, White, or Yellow Tattoos

It is advisable not to get flesh tone, white, or yellow tattoos, even in anticipation of future removal.

Skin tone is known to somewhat influence the number of tattoo removal sessions. This is because in darker skin, melanin pigment reacts excessively, hindering laser penetration. Additionally, side effects such as hyperpigmentation or, conversely, hypopigmentation after laser treatment may occur more frequently in darker skin.

However, generally, the difference in skin tone among Koreans is not so extreme, so you can consider that it is not a difference that makes tattoo removal impossible.

If Undergoing Tattoo Removal, Avoid Sun Exposure

During the treatment period, it is crucial to pay special attention to sun protection to safeguard your skin.

Today, we discussed challenging cases in tattoo removal. Since tattoo removal results can vary depending on various factors, it is essential to consult thoroughly with an experienced dermatologist to establish an optimal treatment plan tailored to your tattoo condition. If you have any further questions, please contact Yonsei Star Dermatology's KakaoTalk channel. Thank you.