Tattoo Removal

Making Youthful Follies Disappear

Dr. Klaus Hoffmann entfernt am 31.07.2013 in der Universitäts Klinik Bochum (Nordrhein-Westfalen) mittels eines neuartigen Lasers bei Sascha Hoffmann ein Tattoo auf der Brust. Die Klinik besitzt einen neuen PicoSure Laser mit dem ein spurloses Entfernen von Tattoos möglich ist. Foto: Marcus Simaitis/dpa (zu dpa/lnw: "Neue Technik zur Tattoo-Entfernung: Wenn Laser auf Pigmente schießen ") +++(c) dpa - Bildfunk+++
Human stain? Removing tattoos is a painful business.
  • Why it matters

    Why it matters

    As tattoos increase in popularity, so too does the demand for their removal. While techniques have improved, gaps in German regulations and possible medical dangers pose concerns for patients.

  • Facts


    • Nearly 10 percent of Germans are tattooed.
    • One in 10 of people who have tattoos want to have at least one tattoo removed after 10 years.
    • Even if done correctly, the process is painful, expensive and protracted. If patients discontinue treatment before completion, the tattoo site looks worse than before.
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Fine white scars meander across Uwe Krüger’s tanned lower left arm. For a good while now, Mr. Krüger, a wiry truck driver, has been shedding what he says are the follies of his youth – tattoos on his arms and upper body.

“Ten years ago, they removed a tattoo for me at a hospital in the state of Thuringia. But they didn’t tell me beforehand that it would leave scars like this,” said Mr. Krüger, a wiry man with sporty clothing and an otherwise inconspicuous appearance. “You get them when you’re younger, and later as an adult you get to the point where you say: How dumb I was!”

Mr. Krüger is in the Berlin practice of plastic surgeon Georgios Xydias, where he will have his fourth laser treatment for tattoo removal. That’s Dr. Xydias’ specialty.

“It feels as if you were being pricked by a hundred hot needles at one little place.”

Restaurant owner, undergoing tattoo removal

Many people love tattoos. Thousands of aficionados were at the recent Tattoo Convention in Berlin’s Treptow district. The tattoo business is booming in Berlin. But for people like Mr. Krüger, the love can grow cold, and they want to get rid of the body art.

Dr. Xydias cites statistics: Nearly 10 percent of all Germans are tattooed, and for people ages 25 to 34 the figure is more than 20 percent. About 11 percent of all those with tattoos want to have one or more removed – usually after around 10 years.

Mr. Krüger’s upper right arm and chest show only the light gray outlines of former tattoos. The removal treatment lasts longer for extremely dark sections.

“There’s been a six-week pause so that the skin can regenerate itself,” he says as he settles once again in a chair in Dr. Xydias’ treatment room.

Another patient is being treated too. He and Dr. Xydias are wearing glasses to protect their eyes from the laser beams. The doctor guides the laser head to the man’s tattooed chest as a red beam of light casts a small red point on the skin. Then Dr. Xydias taps the touch screen of the equipment and gets started. A faint crackling sound can be heard, like the noise of a spark igniter on a gas stove. There is also a monotonous beeping.

“For a few picoseconds, this laser has the power of an nuclear power plant,” Dr. Xydias says. “A picosecond is one trillionth of a second. The pigments are exploded in this way.”

The patient’s affected pores emit a tiny amount of blood.


tattoo removal with a laser people dpa
Now you see it, now you don’t. Source: DPA, Marcus Simiatis


“It feels as if you were being pricked by a hundred hot needles at one little place,” says the second patient, a 54-year-old restaurant owner with a crew cut who didn’t want his name published.

He says it’s bad only in the areas “where there are only skin and bones below: at the sternum, for example.” He adds: “I’m angry at my own stupidity, because I was so naïve with the first two tattoos.”

He isn’t referring to letting himself be tattooed. He’s upset because the tattoos didn’t turn out well. He had images of his niece, mother and sister tattooed in what was supposed to be a photo-realistic manner on his chest and stomach. But two of likenesses bore no resemblance whatsoever to the actual people. Now he is having the tattoos lightened up enough so another tattoo worker can do the job correctly.

Ten years ago, Dr. Xydias removed tattoos for the first time with a laser in a hospital. The surgeon criticizes the fact that in Germany you don’t have to be a doctor in order to purchase a laser and set up a business as a tattoo remover. “That is prohibited in other countries,” he says.

Dr. Carsten Philipp agrees: “There is no uniform regulation about who can do it. Legally, it’s a gray area.”

Dr. Philipp heads the Center for Laser Medicine at the Lutheran Elisabeth Hospital in Berlin’s Tiergarten district. He’s also president of the German Society for Laser Medicine. The laser center treats congenital vascular disease, warts and pre-stages of cancers. But Dr. Philipp also removes tattoos there – though with less enthusiasm than Dr. Xydias.

“I advise everyone who comes to me to keep his tattoos. The patient has to convince me to do it,” Dr. Philipp says.

Many factors argue against removal, he says: The process is painful, expensive and protracted. Moreover, if the patient discontinues treatment before completion, everything looks worse than before.

“A shadow or light-colored areas can remain on the skin. I immediately refuse if I sense that motivation is coming from someone else. But if the patient says, ‘I can’t live with the thing any longer,’ then I do it.”

It takes 10 to 14 sessions, every six to eight weeks over two years, with a high-quality nanosecond laser. “But I don’t touch large tattoos,” Dr. Philipp says.

Why does he even offer the treatment if he has such reservations?

“The lasers are there and it’s better that we do it instead of someone who doesn’t work professionally enough. Some people cauterize tattoos with acid or salts. That leaves bad scars,” he says.

At one time, lasers with intense pulsed light sources were used, but these IPLs only heated up pigments and often left scars.

“Anyone who still does that today is a criminal,” Dr. Philipp says. “We use lasers with extremely short pulses. The flashes cause the colored particles to burst suddenly. If you’re not careful, damage can occur. For example, cellular connective tissue can be destroyed.”

Exploded bits of ink pigment can spread in the body and end up in the lymph nodes. The pigment fragments remain there and have no chance of ever being expelled from the body, he says: “The coloration remains in the body. People with tattoos have dark black lymph nodes.”

Dr. Philipp says that even though there are no studies about the consequences to health, this is one reason why he would prefer to see a tattoo remain.

“That’s easier for the body if it was able to handle the tattoo. There are things we don’t know yet. Perhaps the bursting of the pigments creates new substances in the body. We don’t know the possible reactions. But if there is a inflammatory reaction to the tattoo, then a laser can’t be used; a plastic surgeon has to cut it out,” he says.

Dr. Xydias, who is also a member of the German Society for Laser Medicine, doesn’t regard the situation with the lymph nodes as an argument against removing tattoos.

“During the tattooing, 80 percent of the ink already enters the circulation and reaches the lymph nodes. Only 20 percent remains in the dermis. In comparison to the act of tattooing, removal with the laser imposes only a minimal burden on the body.”

Dr. Xydias takes another look at the scars on the arm of patient Mr. Krüger that were caused by the removal 10 years ago: “That was definitely a dermabrasion,” definitely not a method he recommends, the doctor says.

Mr. Krüger is pleased the removal process has improved over the years.

“Even when clothed, I feel much better in my skin – now that the tattoos are almost gone,” he said.


This article originally appeared in Tagesspiegel. To contact the author:

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