Problems after Tattoo Removal: Blisters, Skin Lightening, Scarring and Paradoxical Darkening — What Can Be Done?

What is normal after tattoo removal?

A tattoo removal laser breaks up ink particles with very short, high-energy pulses of light. Immediately after a pulse, whitening appears on the tattoo that goes away within minutes. This may be followed by redness, swelling, tenderness and pinpoint bleeding.

Blistering in the first days, followed by crusting, is also common and can be part of healing; it usually goes away within a week or two. For the general features of the procedure, the number of sessions and which colours are difficult to remove, see our article “Laser Tattoo Removal”.

How long do blisters and crusts last after tattoo removal?

Blisters usually appear within hours or days of the procedure, go down within a few days and leave a thin crust behind. When the crust falls off on its own, new pink skin can be seen underneath. This process usually takes a week or two.

Very large, tense and painful blisters may be more common after treatments carried out with unsuitable settings or when the area is irritated after the procedure. Bursting blisters and picking off crusts increase the risk of infection and scarring. Show blisters that are growing, inflamed or very painful to a physician.

Why does the skin become lighter or darker after tattoo removal?

Laser light can affect not only the ink but also the skin’s natural pigment. As a result, the treated area may stay lighter (hypopigmentation) or darker (hyperpigmentation) than the surrounding skin. Darkening is more common especially in darker skin and in areas exposed to the sun. Lightening may become more noticeable with a large number of sessions or high energy.

Most of these colour changes fade within months; however, some may persist for a long time or may not resolve completely. If there is a colour change, the physician may suggest lengthening the interval between sessions or pausing treatment. For pigmentation problems with laser and light treatments, see our article “Burns and Pigmentation Changes after Laser and IPL”.

Does tattoo removal leave scars?

With appropriate settings and in experienced hands, the risk of scarring is low; but it is not zero. Burns, infection, picking off crusts, sessions that are too frequent and a tendency to keloids (excessive scarring) increase the risk of scarring. Some tattoos may already have caused scarring in the skin when they were done; this scar may become more visible as the ink is removed.

If you notice a scar that is becoming raised, hardening, itching or steadily growing, see a physician. Treatments started early may be more effective for raised scars. If a scar has developed, the physician may suggest postponing the next sessions or changing the treatment plan. Changes in skin texture (roughness, shininess or thinning) can also occur rarely and may partly decrease over time.

What is paradoxical darkening? Which tattoos does it affect?

Paradoxical darkening is when ink that the laser is expected to remove suddenly turns grey, black or dark brown instead of fading. It can occur with skin-tone, white, pink, some red and light-coloured inks, and with some pigments used in permanent make-up on the eyebrows, lips and around the eyes. Some of these pigments contain metal compounds whose chemical structure is changed by laser energy.

Darkening is usually noticed immediately after the first pulse. Darkened ink may fade in later sessions, but this process is long and uncertain. This is why a test on a small area first is a common precaution with such tattoos. If needed, the physician may consider other laser methods that do not target the ink colour.

Can tattoo removal cause an allergic reaction?

Some people are allergic to tattoo ink; this is most common with red ink and appears as an itchy, raised, persistent reaction on that colour of the tattoo only. When the laser breaks up the ink, these particles may become more exposed to the immune system. Rarely, allergic reactions after laser treatment have been reported that were local or spread over the whole body.

If you have previously had itching, swelling or a raised reaction on one colour of your tattoo, be sure to mention it before the procedure. In this case the physician may consider a different method or additional precautions. For signs of a severe allergy, see our article “Allergic Reactions in Aesthetic Treatments”.

What should be considered when removing permanent make-up from the eyebrows, lips and around the eyes?

Because the pigments used in permanent make-up are often skin-tone, brown or red shades, the risk of paradoxical darkening is higher. Around the eyes, suitable eye protection must be used; treatments close to the eyelid require special experience. Around the lips there is a risk of a cold sore flare-up; if you have a history of cold sores, mention it beforehand.

In the eyebrow area, the laser can cause temporary lightening or loss of the eyebrow hairs. This is why, when removing permanent make-up, the decision is made together with the result of a small test area and the physician’s assessment.

How can you recognise an infection after tattoo removal?

Open wounds, blisters and crusts can make it easier for germs to enter the skin. Increasing redness, warmth, swelling, pain, yellow-green discharge and fever may be signs of infection. If an infection is suspected, the physician will assess the area and plan the appropriate treatment; do not use leftover antibiotics you have at home on your own. For general information, see our article “Infection after Aesthetic Treatments”.

If there is a problem, what should you do at home, and what should you avoid?

1. Note the symptoms and when they started; take photos at regular intervals in the same lighting.
2. Follow the dressing and aftercare instructions your physician gives you; keep the area clean and dry.
3. If you have any of the warning signs, call the physician who performed the procedure the same day; say which laser was used and which session it was.
4. During healing and afterwards, protect the area from the sun with clothing or as your physician recommends.

• Do not burst blisters, pick off crusts or scratch.
• Do not try tattoo removal creams, acids, rubbing with salt or similar methods at home; these can cause burns, infection and scarring.
• Do not apply steroid or antibiotic creams you have at home on your own.
• Avoid hot baths, saunas, steam baths and swimming pools until healing is complete.
• If a colour change or a scar has developed, do not go ahead with the next session without talking to your physician.
• Do not try to speed up the process by having sessions closer together; this can increase the risk of side effects.

What are the treatment options? What can the physician do?

The physician will first assess whether the symptom is part of the expected healing or a complication such as a burn, infection, allergy or pigment change. For large blisters, draining under sterile conditions and wound care may be planned; for infection, appropriate medication; and for allergic reactions, treatment according to the severity of the reaction.

For skin lightening or darkening, protection from the sun and time are often the first approach; the physician pauses treatment if needed. For raised scars and paradoxical darkening, different treatment methods may be considered. For the general process, see our article “What Should You Do If a Complication Occurs after an Aesthetic Treatment?”.

What can be done to reduce the risk?

• Have the procedure done under the responsibility of a physician who can assess your skin type and the features of the tattoo, in a licensed healthcare facility. An increased risk of burns and allergy has been reported with laser treatments carried out by people without medical training.
• If your tattoo contains skin-tone, white, pink or red ink, or if permanent make-up is to be removed, ask whether a small test area will be done first.
• Mention beforehand if you have previously had itching or a raised reaction on your tattoo, or if you have a tendency to keloids, a history of cold sores or take medicines that make you sensitive to light.
• Protect the area from the sun in the weeks before the procedure; do not have the procedure on tanned skin.
• If there is a mole inside or around the tattoo that changes colour or shape, ask for an assessment by a physician first.
• Keep to the interval between sessions that your physician recommends.

Limits of the evidence: how often complications of tattoo removal occur varies greatly depending on the colour and composition of the ink, the skin type, the type of laser and the practitioner. Because the composition of tattoo inks is often unknown, it is not possible to say in advance with certainty which tattoo will darken or cause an allergy. This page is for general information and does not replace an examination.