Most people walk in assuming a tattoo removal laser works like an eraser, and I understand why, because the word “removal” is right there in the name. It is closer to a hammer than an eraser. Nothing actually leaves your skin during the session itself; what the laser does is break the ink into pieces small enough for your own body to carry off, and then your body has to go and do that part on its own time, over weeks, with no help from us.
Once you have that one fact, most of what surprises patients about the process stops being surprising: why the whole thing takes months rather than an afternoon, why you can feel a little off the day after a session, why we keep telling you to drink water, and why a scar you never knew you had can appear at the very end rather than at the beginning.
The sessions in my practice are run by our esthetician and laser technician at Southwest Plastic Surgery, on a PicoSure by Cynosure, and rather than paraphrase her I asked her to explain it the way she does when a patient sits down for the consult.
“The laser goes through the skin to shatter and break apart the ink, and then the body absorbs it and it gets removed through the waste. That’s why it’s very important for the patient to stay hydrated before and after their session. That way, the ink gets flushed out through the body a little bit faster. Sometimes patients can feel flu-like symptoms after the treatment. That is also expected with laser tattoo removal, since your body is absorbing that ink. This happens more with larger tattoo pieces than smaller ones.”
Shatter, absorb, flush. That is the entire sequence, and the only part of it we control is the first word.
The flu-like feeling she mentions is your immune system working overtime on the fragments, and in my experience it is mild, it passes on its own, and it is more likely after a large piece than after a small one. What it is not is a fever. A true fever or chills after a session is a different animal altogether, and it means you call the clinic that day, because it can signal an infection or an immune reaction that is stronger than the one we planned for.
The Count
“On average, about four to six sessions are recommended. It does depend on the tattoo itself, how old it is, and what colors were used in the tattoo.”
Anyone who quotes you one session is selling something.
I space the sessions every four to six weeks, and the spacing bends to how the patient is healing, how big the tattoo is, and what their calendar allows. The floor of that window is not negotiable.
“Some blistering is expected after a laser tattoo removal session, so your skin does need to be completely healed before we go in for the next one.”
Colors push the count up.
“Usually sunset colors, red, orange, yellow, pink, or even green, can be more stubborn. More sessions might be needed if your tattoo contains these colors.”
The Sting
“Yes, tattoo removal can be a little bit spicy, a little bit uncomfortable, but we do help the patient become more comfortable during their session. We offer topical lidocaine, which is almost always used. We also offer injected lidocaine, which is a little bit better than the topical. Patients on average are more comfortable with the injection versus just topical.”
There is a third option at our main location, Pro-Nox, which is inhaled nitrous oxide. Her description is better than mine.
“Pro-Nox is a laughing gas that makes you a little bit ditzy and makes you have a little bit more fun during your session, so you don’t think it is as bad.”
The Scar You Never Noticed
This is the part I want people to hear from a surgeon.
“Sometimes scarring is present after the ink is removed.”
“It can leave behind scarring, but since you have the tattoo present, you don’t really notice the scarring until all the ink is removed.”
Read that again. The tattoo gun that went in too deep left texture in the dermis years ago. The ink camouflaged it. Take the ink away and the texture is still there, and the patient blames the laser for a scar the artist made.
That said, I will not tell you the laser never scars. Scarring and blistering are both possible after a session. The reason they stay uncommon in my practice is how the energy is set. We start most treatments at a lower energy level and ramp up as we see how the patient’s body and skin respond to the treatment. The cautious first session is the one that protects the skin for the next five.
The Money
Per treatment, by size, as of this writing: $150 extra small, $250 small, $350 medium, $450 and up for large. Multiply by the session count and you have the honest total. Packages can bring the per-session price down, and we run occasional promotions on packages. The fees page is where the current numbers live.
Why It Is Done in My Practice
“The laser technicians are fully trained here at Southwest Plastic Surgery. Not only are we fully trained, but we also have one of the best machines on the market, the PicoSure by Cynosure. The Pico gives faster results than other machines on the market.”
I would add one thing. I am certified by the American Board of Plastic Surgery and the American Board of Surgery, I did my plastic surgery fellowship at the Mayo Clinic, I teach as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center, and I have been a Castle Connolly Top Doctor for thirteen consecutive years, 2014 through 2026. The start-low, ramp-up rule is how we run that laser, and it is a surgeon’s rule. When it is your skin, that should matter.
The full patient guide, with the FAQ, the pricing table and the rest of the laser treatments, is on the practice site: laser tattoo removal at Southwest Plastic Surgery.
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful
Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.