Losing That Tattoo Is Harder Than You Think

May 21st, 2012 · No Comments ·

The biggest improvements in technique came just in the last decade, about eight or nine years ago, thanks to the invention of a new type of laser, Chess said. Prior to that, there were three options, all of which could create significant scarring:

Excision — A plastic surgeon cuts out the skin where the tattoo is located and either stitches the skin back together or puts a skin graft in. This leaves a permanent scar and the skin where the graft was placed may have an abnormal appearance.

Dermabrasion — The skin is mechanically abraded, or ground down. “It’s almost like using a sanding wheel to disrupt the surface of the skin and cause enough irritation so that the body reacts and expels the foreign material,” Nadler said. Dermabrasion is done repetitively over a period of many months and as the ink oozes out, the tattoo slowly fades. It doesn’t always get rid of all of the ink and commonly leaves a scar. The process needs to be done with anesthesia, such as an injection of Novocain in the area to be treated. Otherwise, “it’s extremely painful — like being flayed,” Nadler said.
Older lasers — These lasers burn off skin and ink, Chess said, and can create severe burn scars. The only time this type of laser should be considered now is if a person is allergic to a dye in the tattoo and use of the newer laser might create a more severe reaction, a fairly rare exception.
What’s made the difference in tattoo removal is the invention of the Q-switched laser. “It’s different from all previous lasers in a very simple way,” Chess said. “The pulses of light from these lasers are measured in billionths of seconds, nanoseconds. All other lasers have pulses that are either a thousand or a million times longer.”

The result is that these new lasers deliver a high peak of power in an incredibly short period of time, he said, creating “a photo-acoustic shock-wave effect that shatters ink particles.” Those tiny particles are then cleared though the body’s lymphatic system.

It’s a treatment that usually needs to be repeated a number of times. At the extremes, which are rare, you might be able to get rid of the tattoo in one or two sessions. In some cases, more than 20 treatments spread over two to four years may still not be sufficient. “Some ink may never disappear,” Chess said.

There are three different types of Q-switched lasers — the ruby, Nd/YAG and alexandrite — and four wavelengths of light they emit in order to treat the skin. You should expect a physician who does a lot of tattoo removal to have at least two of these three laser types.

For example, a patient recently came to Chess to remove a tattoo of the Italian flag that contained two large green and red rectangles, and a third that was flesh-colored. “Depending on the color of ink you’re dealing with, you need to use a Q-switched laser that emits the appropriate color or wavelength of light that will interact with that color of ink.” With a color like purple, which is a combination of red and blue, you need to alternate the use of two different Q-switched lasers, he said.

The process “stings smartly,” Chess said, but is generally tolerated well by adults without an anesthetic. “Most patients say it hurts about as much as getting a tattoo,” he said. Aftercare includes washing the wound gently every day, and putting on antibiotic ointment and dressings for about a week until the scabs are gone.

Regulations on tattoo removal vary by state. In some cases, only a physician can do it. In others a technician in a doctor’s practice can perform the procedure. Chess recommends consulting with a doctor first to make sure you select someone who has in-depth knowledge of tattoo removal and has the right equipment available. This may require checking out more than one doctor or facility.

Doing careful research is all part of the process of deciding whether and how you are going to have a tattoo removed. Given the risks and the challenges, it’s not a decision to be taken lightly.

Nor is the decision to have a tattoo put on in the first place. “I think the main thing people have to remember is the permanency of it,” Nadler said, especially relative to other things in life. “Where I had my tattoo put on,” he said, “there was a big sign in the waiting room, ‘Tattoos last longer than relationships.’”

Tags: Health