Does laser tattoo removal hurt?
Tattoo removal has long been thought of as a painful treatment; this dates back to ancient times, when quite barbaric methods such as Salabrasion (scrubbing the skin with salt) and Microdermabrasion (an intense exfoliation) were used in an attempt to remove ink. However, lots of innovation in tattoo removal means, these days, the stigma of ink removal as very painful is no longer justified.
Although the first lasers used back in the 1960s were very damaging to the skin, and more often than not required general anaesthetic, modern advancements mean that today there are relatively pain-free laser tattoo removal options available. Here we’re going to cover what tattoo removal feels like, how painful it is across a whole range of different tattoo removal options, as well as how different treatment methods impact the skin.
What does tattoo removal feel like?
Generally, feelings of pain vary hugely from person to person. What some may describe as stinging or tingling others may describe as burning or jabbing. While some will perceive a pain as a stabbing, sharp sensation, others may experience it as a deep aching, cramping feeling. This is due to the complex interactions taking place between your nerves and your brain, as well as the fact that we sometimes perceive pain differently - where one person would used the descriptor ‘ache’; others would describe a ‘jab’.
Much like the feeling of getting a tattoo varies by person (and by different area of the body), laser tattoo removal feels different for everyone too. There are, however, some commonly used descriptors which come up time and time again.
Generally, higher energy lasers like different Q-switched and picosecond lasers (which can cause some damage to the skin) feel different to more advanced techniques (which use less energy). It’s worth noting, though, that most clinics now offer various pain management and numbing techniques (read more about that here) so the following descriptions explore what treatments feel like without pain relief.
High energy laser tattoo removal (Q-Switch, Picosecond)
A lot of people describe high energy laser treatment as akin to a very tight rubber band being repeatedly snapped against the skin, creating a burning, stinging sensation that is certainly not comfortable, but is still bearable.
Some people find the treatment more extreme, with less flattering descriptions including: ‘It’s like if you touched something like a burning stove, but then you had to leave your hand there and stay still and just get burned’ and others saying it feels as though ‘hot specks of grease [from a pan]’ are ‘hitting the skin’. Other people have likened the treatment to a muscle spasm or cramp, much like being hit with some kind of taser.
In a video interview of his tattoo removal experience, Mark Wahlberg noted that he could smell his own skin burning.
It isn’t surprising that clinics use numbing creams (which you can often buy over the counter) or a more intense pain relief in the form of lidocaine with epinephrine injections. This approach numbs the area meaning you’re unlikely to feel anything at all. Make sure you check with your doctor before opting for any form of pain relief, be it topical or injected.
The pain that occurs after the treatment is described differently: a tight, severe sunburn, and sometimes the treated area can feel itchy and raw. Others are left with even more damage to the skin, with bullae (fluid filled blisters) being quite commonplace. Those with fluid filled blisters, unsurprisingly, find this extremely painful and unpleasant. The tattoo removal documentary D’Inked does a wonderful job of revealing the challenges associated with tattoo removal treatment when using high energy devices.
Lower energy tattoo removal (NAAMA)
Generally, newer technology is seen as being less painful. NAAMA's very low energy tattoo removal technology uses far less energy than traditional high-energy devices. Those who have undergone treatment, without any pain relief, have likened it having a blunt fork pressed into the skin just until it’s a little unpleasant (but not a piercing pain). Others say it feels like a more tender part of the skin is being scratched hard enough so that it feels uncomfortable, but not so intensely as to cause extreme pain.
NAAMA also use a Zimmer Cryo; an advanced piece of kit which applies air (-30 degrees Celsius) to the area being treated, which is found to be very effective at both relieving pain, and speeding up the recovery of the skin. Most people find their treated area to be entirely numb, dulling any sensation.
After around 20 minutes, most people don’t even know they’ve had treatment, whereas others might feel as though they have a mild sunburn - the treated skin might be a little tender or red, or 'slightly raised', as Dr Worsnop, a consultant dermatologist has observed.
"In a video of his tattoo removal experience, Mark Wahlberg noted that he could smell his own skin burning"
"With NAAMA, after around 20 minutes, most people don't even know they've had treatment"
Is tattoo removal painful?
Pain really varies from person to person - what one person finds mildly unpleasant, another will find unbearably painful. Pain is often measured on the Wong-Baker pain scale: a way of rating pain from ‘no pain’ to ‘hurts like the worst imaginable pain’ developed by Donna Wong and Connie Baker. Many people will refer to a ‘pain threshold’; essentially the maximum amount of pain that person can handle. While the pain of laser tattoo removal differs between people, there are some factors which really influence the level of pain you’ll experience.
Different methods of tattoo removal
More dated methods of tattoo removal (like ‘Tissue Expanderin’, Cryogenics and Salabrasion) have largely been relinquished because of their ineffectiveness, but also because they’re very painful. The earlier forms of laser tattoo removal (like the CO2 laser) are still used, although less widely. Most people opt for general anaesthetic, since this is regarded as a very painful form of tattoo removal.
Generally, traditional laser methods which use higher amounts of energy result in more heat being trapped in the skin, which can induce pain. More recent technology uses much less energy and is much less damaging to the skin, therefore causing much less pain (with most people finding it only mildly uncomfortable).
Different pain management techniques
There’s lots you can do to manage pain throughout the laser tattoo removal process. You can take paracetamol or ibuprofen half an hour before your session - which can kick in at the right time, relieving pain during your treatment. Before taking any medication, including OTC pain relief, always check with a doctor.
You can also request a local anaesthetic numbing cream, or, since they’re available over the counter, bring your own with you. Most reputable clinics use a Zimmer Cryo system or similar. The Zimmer Cryo is a piece of kit which applies very coolair (-30 degrees Celsius) at the area being treated and is found to be very effective at both relieving pain, and speeding up the recovery of the skin. It works by relaxing the muscles, reducing swelling, and numbing the area to ease the sensation.
Make sure you speak with your laser therapist about your concerns, and ask to take regular breaks during the session. And remember - with lower energy technology, the discomfort will only last as long as the treatment - you’ll feel fine afterwards because your skin won’t be left damaged.
The location and size of your ink
Just as having a tattoo applied is more painful on certain parts of the body, removing it can also differ. Generally, people find treatments on the inner arm, inner thigh, ankle, spine and back of the neck to be the most painful areas, which might be due to the skin being thinner in these places.
"Most reputable clinics use a Zimmer Cryo or similar system"
Will tattoo removal leave a scar or blisters?
Possibly. The amount of damage to your skin is mainly dependent on the technology being used, your skin type, and the aftercare programme you follow.
Q-switched lasers work by repeatedly transferring energy to the ink molecules, typically pulsing at just over 1 nanosecond (one billionth of a second). The particles heat up extremely rapidly, expanding as they do, and eventually break apart. This heat exchange causes heat to get trapped within the skin, which can result in blistering. Often this blistering will heal, but sometimes you’ll suffer with some long-term damage like scarring.
Picosecond lasers produce faster laser pulses, though most often only a bit faster than nanosecond devices. . The faster the light energy is applied to the ink molecules, the more effectively it can be absorbed. Picosecond lasers create localised shockwaves in the skin which shatter tattoo ink (also called a photoacoustic effect), breaking the ink apart into small enough pieces to be cleared away by the immune system. This effect can result in heat being trapped inside the skin (albeit slightly less heat than older, slowerlasers), with a slightly lower likelihood of scars and long-term damage.
NAAMA is an ultra-low energy femtosecond laser technology which breaks down tattoo ink using up to 1,000X less energy than other laser devices on the market. This low use of energy works because of the speed at which energy is being delivered to the tattoo ink (which is much faster than conventional q-switched and picosecond lasers used today). The pairing of ultra-low energy and ultra-fast pulses is a really effective combination: ink molecules are broken apart before heat can escape into surrounding skin tissue, resulting in no lasting damage to the skin. Dr Worsnop, consultant dermatologist comments: 'That's the beauty of NAAMA - it’s extremely unlikely you’ll get any scarring'.
"NAAMA is an ultra-low energy femtosecond laser
The NAAMA tattoo removal difference
NAAMA is widely regarded as the least painful tattoo removal option currently available. This is largely due to the fact that NAAMA is ultra-low energy, so doesn't cause lots of damage to the skin. 100% of those who have been treated with NAAMA say it’s less painful than getting a tattoo in the first place, and Dr Gintas comments “less pain, less side effects, you’re comfortable after the procedure with absolutely no damage to the surrounding skin”.