Tattoo Removal

Written by Shabir

It is estimated that close to 10% of the U.S. population has some type of tattoo on their body and the numbers are increasing exponentially. After a few years, close to 50% of then want to have laser tattoo removal. There is good news for those who have a bad tattoo or are not please with what they have. Newer laser tattoo removal techniques are now available which can eliminate your tattoo with minimal side effects. There are numerous types of lasers- but they all work by breaking up the pigment colors of the tattoo with a high-intensity light beam. Black tattoo pigment absorbs all laser wavelengths, making it the easiest to treat. Other colors, such as red, selectively absorb green laser light. Various colors can only be treated by selected lasers based upon the pigment color.

Tattoo removal is an old age problem and various methods have been described in the past. The majority border on techniques which are many times worse than the tattoo itself. For the past 3 decades, tattoo removal was done using unsophisticated surgery techniques, all of which left individuals with a lot of scarring and empty pockets. From ripping the skin, to scrubbing the skin with sand paper, we now have evolved through a century of chemical, mechanical, light cold and thermal methods of tattoo removal- and today the gold standard for tattoo removal is LASER.
 
With the recent advances in medical technology, laser therapy has become the gold standard for removal of tattoos. If you have a tattoo that you wish to have partially or completely removed, you should first consider your options and decide which method might be best for you. 
 
Can All Tattoos Be Removed?
 
Not all tattoos can be removed completely, but the majority can be partially removed. Tattoos are meant to be permanent and with recent improvements in ink technology and professional tattoo artists improving their skills, tattoos imprinted on in the last decade are very difficult to remove. Even with the best technique, some residual scarring remains in a few cases.
 
What are other methods of tattoo removal?
 
There are other methods of tattoo removal, but most of them are painful and ineffective. Today laser therapy has replaced most of them. The other methods include dermabrasion, camouflage and excision of the tattoo. These methods cause a lot more damage to the skin and also result in scarring. These techniques are only used when laser is not an option.
 
Salabrasion: this is a physical tissue destruction of the superficial skin with some chemicals, like salt, or a piece of gauze or tissue. This is a poor’s man version of tattoo removal.
 
Dermabrasion: Dermabrasion is the primary method of mechanical tissue destruction. The skin is scrubbed with various devices ranging from a rapidly spinning diamond fraise wheel, a wire brush or even a metal scrapper. The skin is usually frozen with a coolant to make it rigid prior to the procedure.  As the name suggests, the procedure can be bloody and unsightly even painful. Rarely pieces of skin tissues break off and will result in a scar. Not a recommended method for tattoo removal as it causes severe scarring. Today, the technique is refined with novel methods of skin abrasion, but nevertheless, the results are poor at best.
 
What are disadvantage of Mechanical tissue destruction?

The main disadvantages with mechanical destructive methods are the high risk of scarring; hypertrophic scars and even infection. For those who have deep tattoos, the risk of scarring is even higher with the above techniques. Often, the technique causes the tattoo pigments to imbed even deeper into the tissues. These methods are only used for very small areas of the skin with very superficial tattoos.
 
Surgery: In the old days, tattoos were simply excised together with the skin. This is sometimes done for difficult tattoo which are deep and located in unusual places. Areas of the body with lax skin are best suited for excision as the incision can be closed without any tension. However, surgery for removal of tattoos is very rare and the last modality of choice.
 
Chemical tissue destruction: Various caustic chemicals (tannic acid and silver nitrate) have been used to treat numerous skin conditions including tattoo removal. The chemicals are applied on the skin and often combined with superficial dermabrasion. Sometimes the chemicals are injected superficially underneath the skin. The chemical method of treating any skin lesion is now relegated to the history books. The procedure always results in scarring, deformity, and pain and skin discoloration. Many individuals have had to undergo skin grafting other plastic surgery procedures to correct the defects caused by the chemicals. This was a technique used when there was nothing available in the past. Unfortunately, some of these chemicals are available and still used for home use. If you come across any cosmetic clinic or tattoo parlor which still uses chemicals to treat tattoos- just run away.
 
Liquid nitrogen: In dermatology, liquid nitrogen (-196 °C) is commonly used to treat numerous skin lesions and once was attempted to remove tattoos. There have been a few reports of successful removal of tattoos, but in general, the technique is not effective and can destroy surrounding normal tissue. It can only be used for the very superficial and very small tattoos. Liquid nitrogen is best left to treat anal warts and not tattoos.
 
Thermal tissue destruction: Tattoo removal has even been attempted with heat. Thermal injury via fire, hot coal and metals and cigarettes has been applied on the skin for centuries to try to remove unwanted tattoos. As one can imagine, the results were obvious and anyone who has ever been burnt with a cigarette, will known exactly how great it feels.  Electrocautery and electrodessication were widely used in the past and caused significant scarring. Most thermal products to remove tattoos are not used today. However, technology in the use of thermal products has led to the best methods of tattoo removal- the laser. 
 
How do Lasers Remove tattoos?
 
Lasers work by generating concentrated beams of light energy. The heat generated from the laser breaks up the ink particles- which are later cleared by the body’s normal scavenging system. Different lasers have different ability to penetrate the skin. Depending on the size and complexity of the tattoo, several sessions may be required to remove the tattoo. The laser is selective for the tattoo and does not harm the normal skin or tissues. In general, superficial tattoo are easily removed and deeper tattoos may take some time. The laser does generate heat and there is some pain and blistering in some cases. Despite all the bragging about Lasers and their potential uses, the chance of scarring is always present.
 
Who is a Candidate for laser tattoo removal?
 
Those individuals with fair skin and superficially placed tattoos on the arms, chest, buttocks or legs are the best candidates. Dark skinned individuals with tattoos placed on the ears, ankles or the fingers are some of the most difficult to treat. Results of tattoo removal in dark skinned people, in general, is difficult and the results are mediocre at best.
 
What determines the success of tattoo removal?
 
The size, location and how deep the tattoo is placed affects the results. Because of better ink technology and improved skills of tattooer, the newer tattoos are more difficult to remove compared to the older ones. 
 
Does Tattoo Removal Hurt?
 
Yes, nothing in life is painless and the same goes for tattoo removal. If you thought that it was painful applying a tattoo, then you will feel the same or slightly more pain when the tattoo is removed. The laser is basically a heating source and stings when it touches the skin. The pain is like a needle jab, but many times over. To decrease the pain, the physician will recommend taking a few over the counter pain medications before the procedure. Aspirin like products are not recommended because they have a tendency to increase the bruising.  To further decrease the pain, the physician may apply a local anesthetic ointment on the tattoo 30 minutes before the procedure. In some cases, the physician may inject a local anesthetic into the tattoo before the procedure. One can only imagine how much pain there may be if one goes to a tattoo parlor which does not have access to any of these pain medications. 
 
How long does each procedure take? 
 
Laser treatment usually does not take more than a few minutes. However, multiple sessions are required to remove most tattoos. The multiple sessions are split over 4-8 weeks, depending on the size and complexity of the tattoo
 
What happens at the physician’s office?
 
Once you arrive, your eyes will be covered by eye shields to protect against the laser rays. The doctor will test your skin’s reaction to the laser to set the right amount of energy. A pen like laser device is then activated and the laser is fired along the tattoo. Each burst of laser feels like a needle sting. Depending on the size of the tattoo, 10-30 pulses of the laser may be required in one session. For those who hate needle stings, this is real fun.
 
What happens after each treatment?
 
Once the treatment is completed, ice is applied immediately on the treated tattoo to minimize the swelling. After about 30 minutes, a topical antibiotic ointment is placed on the tattoo followed by a sterile dressing. The skin site should be left dry for a few days. It should be treated just like sunburn.
 
How long is each session?
 
On average, each laser treatment takes from ten to twenty minutes. Most individuals require at least several treatments for the best result
 
What are side effects of laser treatment?
 
Side effects of laser procedures are generally few but may include:
 
Depigmentation: Some individuals may develop fading of the skin (hypopigmentation). This hypopigmentation usually resolves in 2-3 months. Others may develop darkening of the skin. However, these dark spots are difficult to resolve and require some of drug therapy
 
Texture change: Often an individual will feel changes in the texture of the skin. These textural changes usually resolve in a few months. However, in some cases the changes may be permanent. Skin textural changes resolve over 6-8 weeks in most cases. Tattoos of the face and the neck respond faster but are also more sensitive to tissue damage.
 
 Allergic reactions: Some individuals may develop a localized allergic response to some of the tattoo pigments after laser treatment. However, these allergic responses are more common with some lasers only. The allergic response can be treated with steroids.
 
Ink darkening: Sometimes cosmetic tattoos with red or flesh colored tattoos can darken with laser treatment. This is usually a chemical reaction from the heat generated from the laser. Therefore, a test will be conducted by the physician to determine how things will work out. Some individuals may use this ability of the laser to darken the eyeliner tattoos. This is a permanent reaction.
 
Miscellaneous: Many of the dyes are supplied by a variety of sources, some unlicensed. Fortunately, complications are rare. Some complications may include localized swellings underneath the skin (granuloma), loss of hair and even permanent scarring. The area may appear like a sun burn for a few months and ultimately the skin will become normal.
 
Can lasers remove all colors equally well?
 
No, different lasers may remove different colors. In general, blue, black, green and red colors fade way the fastest. Yellow is the most difficulty color to remove. Most lasers are only capable of putting out one wavelength, which significantly limits their ability to treat colors selectively without causing scarring or pigment changes. Some colors may require more treatments, but they can be usually removed.
 
Can the pigmentation changes seen during pregnancy be removed with laser?
 
Yes, but melasma is a physiological change of pregnancy and will disappear after birth. There is absolutely no need for a pregnant female to undergo an expensive laser procedure during this time period. Plus, one can’t tell what may happen to the fetus
 
What care is required of the laser treated area?
 
There may be some pinpoint bleeding but one should keep the area clean and dry. One can take a shower the next day but not scrub the treated area.
 
Can laser remove permanent make up?
 
The majority of permanent makeups have metallic bases and when they come into contact with laser, the make up is usually darkened. Once this darkening occurs it is not possible to remove the discoloration
 
In addition, most physicians do not like to use the laser near the eye. You never know what can happen.

What is the cost for tattoo removal with laser?
 
Tattoo removal is considered cosmetic and is a big business. No insurance covers the cost of applying or removing a tattoo. Tattoo removal is much more expensive undertaking than tattoo placement. Laser tattoo removal can range from several hundred dollars up into the thousands of dollars, depending upon the size, type and location of the tattoo and the number of visits required. The fees may vary but usually start at $ 3-400 per session. However, this is a very conservative estimate. So before you embark on this therapy, sit down and get the cost. In some cases the costs may be quite prohibitive, you may be better off wearing suitable clothing to hide your tattoo. For those who do not have suitable clothes, learn to like your tattoo.
 
How many laser sessions are required?
 
Most simple tattoos are removed in 2 - 4 treatments scheduled about 4-8 weeks apart. Removing complex and deep tattoos requires a series of treatments spaced approximately 8 weeks apart or longer. Professional tattoos usually require 6-10 treatments for complete clearing. A large, professional tattoo in color can cost thousands of dollars to remove, and the success of the procedure still can not be guaranteed. The more superficial the tattoo pigment and the less the total volume of pigment, the fewer the number of treatments necessary to remove the pigment. 
 
Cream Removals
 
The best advice on cream removers is they do not work. Numerous dermatologist and cosmetic parlors sell creams for everything and some even claim that they remove tattoos. The only thing they remove is your finances. Avoid them and go and see a reputable physician (and if he recommends a cream-run). It will save you a lot more money in the long run.
 
Final Advice
 
Because laser surgery is a medical procedure inherent with all the possible complications and costly, it is recommended that one go and see a professional physician who is experienced and understands the procedure. Avoid going to back street tattoo removal parlors because tattoo removal is a complex procedure which is best done by professionals. Find a reputable dermatologist or cosmetic surgery center to ensure proper treatment and care. If possible, you should obtain a recommendation from your family physician for a physician who specializes in tattoo removal.