Thanks to newer technology, laser tattoo removal has become much more effective with very little risk of scarring. Laser treatment is often safer than many traditional methods such as excision, dermabrasion or salabrasion (using moist gauze pads saturated with a salt solution to abrade the tattooed area) because of its unique ability to selectively treat pigment involved in the tattoo. The side effects that may occur are rare and often temporary in nature. However, sometimes there can be long-term side effects of the same. Following are some effects that you may expect.
Short Term Effects
Immediately following the procedure you may see any or all of the following. These are temporary and disappear within several hours to several days after your treatment.
Frosting
During laser treatment, your skin will naturally turn a frosty white colour. This is caused by the carbon dioxide being 
released as a result of laser penetration and surfaces on the upper layer of the skin and usually only subsides after twenty minutes.
Blistering
During the removal process, the laser will heat up ink particles in your skin, which can cause tiny blood vessels to break around the tattoo. As a result, superficial blisters containing water and ink may appear. In fact, blisters are quite normal and an indication that the healing process has begun. They might not look too pretty and could be tender to touch, but blisters should take between 3-14 days to heal up completely, providing you don’t burst them!
Scabbing
Yet another sign that the tattoo removal is working, scabs often collect fragmented ink particles and usually appear 8 to 72 hours after the area has been treated. When the scab falls off, the top layer of ink will come with it. Picking at or peeling off scabs can increase the risk of scarring, so however tempting it might be, try to avoid this. A lot will depend on the size and location of your tattoo, but most scabs will disappear within two weeks.
Swelling
Our body’s natural defence system will react to things like illness or infection in a number of different ways. But while swelling usually occurs after being bitten by an insect or twisting your ankle, it can also happen after undergoing laser tattoo removal treatment. The heat from the laser will cause swelling, but just like any other type of swelling, this will go down once your immune system realizes there is nothing wrong. If anything, be grateful that your body is alert and aware of potential dangers.
Discomfort
While a lot will depend on your personal pain threshold, it is fair to say that the majority of people will experience discomfort to a certain degree. The level of discomfort also depends a lot on where the tattoo is located; tattoos on more fleshy areas of the body will hurt less as the flesh acts as a cushion, whereas tattoos on areas such as the wrist, feet, face and fingers could make you wince a little more than if your tattoo was on your thigh! When laser tattoo removal first came to market, it received a bad reputation for being incredibly painful. But patients who have received removals from the PicoSure laser have said discomfort levels are up to half that of alternative treatments. In general, the discomfort is commonly compared to an elastic band being slapped against your skin.
Itching
Again, this should be seen as a good sign, as your immune system is kicking in and starting to heal the affected area. An itching sensation is common, but just like any other type of skin irritation, you must try your hardest not to scratch the area. Scratching could impact on the effectiveness of removal. You may also break the skin and create a wound, which will lead to additional scarring or risk infection. Generally, you should not apply creams or lotions to the area, but if the itching is unbearable, ask your laser operator for advice.
Scarring
People often associate laser removal with scarring, but that’s not really accurate. It’s very common for a tattoo artist to unintentionally cause some scarring that goes unnoticed until the person undergoes laser removal. During a consultation, the technician can usually recognize any existing scarring and point it out to the client beforehand. Given the technological and medical advances in laser tattoo removal, permanent scarring is rare and occurs in less than two per cent of cases. If scarring does happen, it usually isn’t that noticeable and can be minimized with Vitamin E oil or over the counter silicone patches. Just make sure your skin has fully healed from the treatment before applying cosmetic products. In order to minimise the chance of scarring after treatment, drink plenty of water, get enough sleep each night and quit cigarettes if you happen to smoke. These measures will boost your body’s immune system and help the process of pigment elimination and skin repair. Also, try to avoid direct exposure to the sun, as ultraviolet radiation can harm your skin’s pigmentation and increase the risk of scarring due to greater sensitivity. Keloid scars, which are raised, thickened areas of skin can appear up to 3 to 6 months after treatment, but these are very rare.
Long Term Side Effects
The most common side effect is a darkening or lightening of the skin, known as either hyper-pigmentation or hypo-pigmentation. This usually corrects itself in 6 to 12 months after treatment.
Hyperpigmentation
With tattoo removal hyperpigmentation, the area where the tattoo was removed looks darker than the surrounding skin, similar to sunspots. Hyperpigmentation after laser tattoo removal is usually correctable—the body naturally eliminates this extra pigment over a period of time. Some people take three months to remove it; some people take six months, some people take a year to clear it. It just depends on how quickly the body can clear the pigment out, which can partly be affected by how healthy the person is.
Hypopigmentation
With tattoo removal hypopigmentation, the skin in the area that has undergone laser removal is lighter than the surrounding skin. Milder cases have a higher likelihood of clearing up, while more severe cases can be permanent—though this is usually completely preventable.
How Do I Prevent Hypopigmentation and Hyperpigmentation after Laser Tattoo Removal?
Fortunately, you can prevent these issues by taking the following steps.
- Choose a facility that specializes in laser removal.
- Speak with an expert tattoo removal specialist who can fully address your individual concerns.
- Avoid the sun before laser treatment, as directed by your technician. You don’t want to have a suntan when you come in, which can lead to pigmentation changes.
- Follow the aftercare guidelines provided by your technician.