The new treatment regimen may help with another problematic aspect of tattoo removal: getting patients to stick with time-consuming treatment regimens. It’s often impossible to give patients an accurate estimate of the number of treatments, the approximate cost and even what results they can expect. “There is a lot of judgment involved in assessing the tattoo and what it will take to remove it,” says Dr. Vasily. “We tend to charge by the inch and tell patients that results are unpredictable and the endpoint can’t be guaranteed.”
Most physicians charge per session and base the cost on tattoo size, ink density and the number of colors involved, as well as its location on the body. The cost per session can range from $50 to more than $500.
“We usually wait four weeks between treatments and, on average, we will do four to 12 treatments—more rather than less to ensure against scarring and pigment changes,” notes Dr. Koupaie. “We start with medium joules and find out from the patient how many days of burning and scabbing he had. If healing took two days or less, we increase the joules; three days or more and we decrease the joules. We want to irritate but not too much.”
Dr. Bernstein reminds patients that the inks used in tattoos are not regulated by the FDA, which means there’s no way of knowing the composition of the ink and how many treatments it may take to achieve complete removal. “I do add that having all three types of Q-switched lasers should allow me to remove the ink in the fewest treatments possible,” he says. And as for turning patients away? Dr. Koupaie will do this as necessary. “You need to manage expectations with tattoo removal just as you do with any other cosmetic treatment. I turn away patients who think one treatment can do the trick.”
If the proposed sequential treatment regimen and the addition of fractional lasers improves safety and efficacy, managing tattoo removal patients could become easier in the near future.


Linda W. Lewis is a MedEsthetics contributing editor.