Safety Measures and Complications of Laser Tattoo Removal

In today’s article, Prof Dr Morthy, the Course Director of the International Institute of Wellness & Aesthetic Medicine will discuss the complications in laser tattoo removal and the precautions that an Aesthetic practitioner must follow, why training in our advanced Aesthetic courses in lasers can help you in your Aesthetic practice.

Tattooing is an ancient practice that has seen a dramatic increase in popularity in recent years among both youngsters and adults as a cosmetic or body art. But the safety regulations regarding tattoos are not stringent enough to ensure that proper measures are in place. The sterility of the pigments and equipment is often uncertain, as many tattooing procedures are performed on the roadside and in makeshift salons. Hence we keep seeing an increase in reported adverse reactions after tattooing.

Physicians frequently encounter certain issues associated with unsafe tattooing procedures, although they are often unfamiliar to the general public. The most documented skin reactions resulting from tattooing, include a temporary acute inflammatory response caused by needle-induced skin trauma. Additionally, medical complications such as surface and deep local infections, systemic infections, allergic contact dermatitis, photodermatitis, granulomatous and lichenoid reactions, as well as skin conditions localized to tattooed areas like eczema, psoriasis, lichen planus, and morphea, have been reported. Additionally, clinicians have also been seeing an exponential increase in patients seeking tattoo removal services for various psychosocial or religious reasons, including employment conditions or they simply have a change of heart.

About Laser Tattoo Removal

Laser tattoo removal is a widely used non-invasive procedure to remove unwanted tattoos. The process involves using high-intensity laser beams to break down the tattoo ink particles, which are then naturally eliminated by the body's immune system. While the majority of laser tattoo removal treatments are successful, there are potential complications that practitioners need to be aware of. Any Aesthetic practitioner performing a laser tattoo removal procedure needs to be extremely careful about several important factors such as laser selection, the patient’s skin type, the spot size, the fluence and pulse duration etc. This is why at IIWAM, within our advanced Aesthetic courses in lasers and online laser training courses, we train our students in the most important safety measures to keep in mind in laser tattoo removal procedures. Let’s jump directly into what are the complications that may arise and how you can avoid them.

Complications of Laser Tattoo Removal

While Q-Switch lasers have become the standard for tattoo removal, it's important to note that complications can still occur, albeit with a relatively low incidence rate of approximately 5%.

During the laser treatment, the energy emitted by the laser is absorbed by the pigment in the skin, leading to various effects. The photothermal effect converts the absorbed energy into heat, causing the pigment to break down chemically. Simultaneously, the photochemical effect results in the disruption of chemical bonds within the pigment. Additionally, the photoacoustic effect causes mechanical destruction of the pigments. These processes collectively break down the tattoo pigments into smaller particles.

Following this breakdown, the body's natural processes come into play. Small pigment particles, unknown decomposition products, and newly formed chemical compounds are eliminated from the skin through the blood vessels or the lymphatic system. It's important to note that any pigments that remain in the skin may have different chemical characteristics compared to non-irradiated pigments, potentially triggering an immune system reaction. Furthermore, it has been discovered that a laser-induced cleavage of azo dyes can generate carcinogenic amines. These amines pose a potential risk during the tattoo removal process.

The complications associated with laser tattoo removal can be categorized as immediate and delayed. Some of the immediate complications are as follows:

Hyperpigmentation: Hyperpigmentation refers to the darkening of the skin surrounding the treated area. This complication occurs when the laser energy stimulates the production of excess melanin. It is more common in individuals with darker skin tones and can be temporary or, in rare cases, permanent.

Hypopigmentation: Hypopigmentation is the opposite of hyperpigmentation and refers to the lightening or loss of skin colour in the treated area. It occurs when the laser energy damages or destroys the melanocytes responsible for producing skin pigmentation. Hypopigmentation can be temporary or permanent and is more prevalent in individuals with darker skin tones.

Scarring: Scarring is a potential risk associated with laser tattoo removal. It can occur if the laser energy damages the deeper layers of the skin, leading to abnormal collagen production during the healing process. Factors that increase the risk of scarring include improper laser settings, aggressive treatment, and inadequate post-treatment care.

Infection: Any procedure that involves breaking the skin carries the risk of infection. Although rare, laser tattoo removal treatments can introduce bacteria into the treated area, leading to infection. Practitioners must follow strict aseptic techniques, including disinfecting the skin, using sterile equipment, and providing appropriate aftercare instructions to minimize the risk of infection.

Allergic Reactions: Some individuals may develop allergic reactions to the tattoo ink or the laser treatment itself. Symptoms may include redness, itching, swelling, and hives. Practitioners should conduct a thorough consultation and perform patch tests to identify potential allergies before proceeding with laser tattoo removal.

Delayed complications could manifest as changes in pigmentation, persistent inflammation, or other long-term skin abnormalities.

To minimize the occurrence of complications and ensure the safest possible treatment, it is crucial to have the sound knowledge and skill required to assess patients, select appropriate laser parameters, employ adequate cooling techniques, and provide thorough post-treatment care.

Also read: Q-Switch Lasers VS Pico Lasers

Precautions Needed in Laser Tattoo Removal

Patient Assessment: Before performing laser tattoo removal, it is crucial to conduct a comprehensive patient assessment. Consider factors such as skin type, tattoo characteristics, medical history, and previous adverse reactions to minimize the risk of complications.

Proper Equipment and Training: Using advanced and reliable laser systems is essential for safe and effective tattoo removal. IIWAM offers comprehensive training programs that cover laser safety, treatment protocols, and proper equipment operation. By obtaining proper education and training, practitioners can minimize the chances of complications.

Treatment Planning: Individualized treatment plans are essential to address each patient's unique needs. This includes selecting appropriate laser parameters, determining the number of sessions required, and considering any potential contraindications or risk factors.

Adequate Cooling and Post-treatment Care: Proper cooling techniques, such as cryogen sprays or cooling devices, can help minimize thermal damage to the skin and reduce the risk of complications. Additionally, providing patients with thorough post-treatment care instructions, including proper wound care and sun protection, is crucial for optimal healing and minimizing risks.

About IIWAM Training

While laser tattoo removal is a highly effective procedure, complications can occur if not performed with caution and expertise. Aspiring aesthetic practitioners should prioritize proper education and training to minimize the occurrence of complications. IIWAM offers dedicated practical and theoretical training courses in lasers designed to equip you with the knowledge and skills necessary for safe and successful laser tattoo removal treatments. By understanding the potential risks and implementing appropriate precautions, you can provide exceptional care and achieve favourable outcomes for your patients.

It is prudent that all Aesthetic practitioners undergo proper training in Aesthetic Medicine. The practitioner must balance between benefits & risks of the Aesthetic procedure and steps to mitigate complications if it occurs. At IIWAM, we call it understanding the procedure, the product, and the patient, and our trainers pay utmost attention to teaching the following subjects of various aesthetic treatment procedures under our advanced Aesthetic courses in lasers.

Apply for the best online aesthetic courses from IIWAM today.

About IIWAM Aesthetic Education

International Institute of Wellness & Aesthetic Medicine ( is a private teaching institution that provides International Aesthetic Medical Certification programs for Doctors, Dentists, Nurses, Aestheticians, and Spa Owners. Prof Dr Morthy, the course director for the Institute, is a key opinion leader for Aesthetic Medicine in the region, and a trainer for several teaching institutions.

The International Institute of Wellness & Aesthetic Medicine (IIWAM) has academic affiliations with several countries, including Malaysia, Korea, Thailand, Philippines, Myanmar, Cambodia, India and Indonesia. With our insignia of “Be Certified & Be Recognized”, the Institute develops knowledgeable, skilled, and confident aesthetic practitioners of international repute.
IIWAM is the only Institute to have its Programs certified by City & Guilds of London, CPD Standards Office (UK) and  European International University (Paris). IIWAM is also a registered CPD Training provider for Malaysian Medical Association.

IIWAM also offers Cosmetic Procedures and Stem Cell treatment at IIWAM Wellness Centre ( that are safe, effective, and affordable.