September 23, 2026 | Laser Therapy, Non-Surgical Enhancement Treatments
In all the years I have been doing this, I do not think I have met a patient who regretted a tattoo at the consult. What they regret is the name in it, or the ex, or the band they stopped listening to in 2009, or an artist who turned out to be heavier-handed than the sketch on the wall suggested he would be. By the time someone is sitting in my exam chair asking about removal, the decision has been made, usually a long time ago, and what they actually want from me is a straight answer about what comes next.
So that is what this is, in roughly the order patients ask. The laser work in my practice happens at the Southwest Plastic Surgery Med Spa, on a PicoSure by Cynosure, and it is done by our esthetician and laser technician rather than by me. I set the safety rules and she runs the sessions, and I asked her to answer these questions herself because she does them every day and I do not. Her answers below are hers, word for word.
First: It Stings, and We Have Three Ways to Handle That
Does it hurt?
Our esthetician and laser technician: “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 as well, which is Pro-Nox, inhaled nitrous oxide, and we have it available at our main location.
“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.”
In practice that works out to topical numbing for everyone who walks in, the injection for most of them once they have tried both, and Pro-Nox for the patient who would rather float through the whole thing and not think about it.
Second: The Price Is Set by the Tattoo, Not by a Menu
People call and ask for one number, and I understand the impulse, but there is not one number, because the price is charged per treatment and it goes by the size of the tattoo rather than by anything else. As of this writing, the tiers are:
| Tattoo size | Per session |
|---|---|
| Extra small | $150 |
| Small | $250 |
| Medium | $350 |
| Large | $450 and up |
That is per session, so the honest total is the tier multiplied by however many sessions your tattoo turns out to need, which is the next question. Buying a package of sessions brings the per-session number down, and every so often we run a promotion on packages. The current figures live on my fees page, and since the technician has to actually look at the tattoo to size it, the exact quote is a consult conversation rather than a phone one.
Third: Four to Six Sessions, Four to Six Weeks Apart
How many sessions will I need?
Our esthetician and laser technician: “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.”
Four to six is the average, and I want to be clear that some tattoos land outside it in both directions. Between sessions we wait four to six weeks. I get asked why so long, and the answer is that I have three things to weigh for each patient: how the skin is healing, how big the piece is, and what their own life allows in terms of coming back in. She explains the healing half better than I do.
“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.”
Treating skin that has not finished healing from the last pass is a risk I am not willing to take, so no, I will not move the appointment up to fit a wedding.
The other thing that moves the session count is the color of the ink, and this is the part people who got a bright tattoo do not want to hear.
Do different ink colors matter?
Our esthetician and laser technician: “Yes. 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.”
An old black tattoo that has already faded is the easy case, and a full-color sleeve with reds and yellows in it is a longer conversation, both in sessions and in dollars.
Fourth: What the Laser Is Actually Doing
How does laser tattoo removal actually work?
Our esthetician and laser technician: “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.”
PicoSure fires in picoseconds, trillionths of a second, so the effect on the ink is a pressure wave rather than heat. The pigment shatters into smaller fragments with less collateral heat than the older nanosecond lasers, and it reaches a broader range of colors, including the blues and greens the older machines struggled with.
Then your immune system does the rest, which is why some patients feel wiped out for a day after a big piece. That is mild and temporary. A true fever or chills is not. If that happens, call the clinic, because it can signal an infection or a stronger immune reaction than we expect.
The Scar Question
Will it leave a scar, or remove the tattoo completely?
Our esthetician and laser technician: “Sometimes scarring is present after the ink is removed.”
Some of it was already there. “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.” The ink hides what the tattoo gun did.
I will not promise the laser never scars. Scarring and blistering are both possible after a session. What keeps them rare is the way we dial in the energy: 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.
Why Here
Why come to Southwest Plastic Surgery for it?
Our esthetician and laser technician: “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.”
My addition is the part she is too polite to say. This is tattoo removal inside a plastic surgery practice. I am certified by the American Board of Plastic Surgery and the American Board of Surgery, I trained 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. When a patient calls about a blister or a fever, the call reaches a practice run by a surgeon.
The full version, with the FAQ and the complete list of laser treatments we offer, is on the practice site: laser tattoo removal at Southwest Plastic Surgery.
Ready to Talk?
Bring the tattoo. We size it, quote it, and tell you the session count before the laser ever turns on.
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.
