Removing Tattoos–and Regrets

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We’ve all been told that the only constant in life is change. However, that may not apply if you’ve gotten a tattoo. By design, they are meant to be permanent.

Tattoos have exploded in popularity during the last two decades. Thirty-six percent of young people between the ages of 18 and 25 have at least one tattoo. Overall, nearly a third of all Americans sport one. Fifty-eight percent of tattoo wearers are female, and, not surprisingly, tattoos are most popular among young people. The number of adults over 65 with tattoos is only five percent.

But many people, due to a change in outlook, a relationship or circumstance, later come to regret them. In the next decade or two, dermatologists and cosmetic surgeons will likely have a heyday removing these vestiges of another time.
Methods have been used to remove tattoos over the years, and almost all have some drawbacks. Today, the state-of-the-art method is to use high quality Q-switched lasers, which are able, through various frequencies of light, to “shatter” the ink used in the tattoo, with the smaller ink particles then being absorbed and removed by the body.

Dr. Robert Burke, a dual board certified cosmetic surgeon who practices in Michigan, has been removing tattoos for more than 23 years. He explains, “Tattoo removal is all about the wavelength of laser light that is used to remove the tattoo. Tattoos are made of various colors. Each color interacts with a different wavelength of light. The wavelength of light hits a specific color target, causing that color to disappear by breaking up the color pigments into many microparticles that are taken away by the body’s cells.”

The process takes from 3 to 12 office visits, and it can be painful and costly; it is not perfect. Some patients report that the process burns, and some report that the pain is about equal to that of getting a tattoo. The difficulty of removing a tattoo is based on several factors: the age, color, ink density and location of the tattoo. The easiest tattoos to remove are those with high contrast, such as black ink on light skin, older tattoos and tattoos with “shading” or less dense ink. Colored tattoos are most stubborn. The location matters because areas with less circulation will take longer to absorb and dislodge the ink. A faint image may remain; some patients have a scar or skin discoloration after treatment is completed.

Dermabrasion sands off tattoos with sandpaper, acids or salt and a rotating brush. Drawbacks are that it can only be done on certain tattoos but not on facial ones. Green and white ink are particularly resistant to lasers, and so dermabrasion might be a second line of treatment for this ink, but it leaves scarring. Other side effects are pain, skin discoloration and infection during the healing process.

Cryosurgery uses liquid nitrogen and a directed light to freeze-burn the tattoo and prompt skin peeling. Side effects can be bleeding, blistering, edema, pain and damaged hair follicles. With tattoo excision, a scalpel is used to actually remove the top layer of skin. The resulting wound is then sutured. This removal process must be performed by a surgeon and is recommended only for smaller tattoos. But these methods leave scars, and results may depend on the individual’s ability to heal and regenerate tissue.

Cost of tattoo removal can depend on variables such as the location of the tattoo, the individual’s skin tone, the quality of the ink and how old the tattoo is. Since the success rate can be affected by the rate of blood flow to the skin, the closer to the heart the tattoo is, the more successful the removal is likely to be. Cost may be based on total number of treatments or a per-square-inch basis, and some providers offer financing plans.

Look for a dermatologist or plastic surgeon who has good before-and-after photos. The newest lasers, such as PicoSure® or the Enlighten™, which uses dual wavelengths and dual pulses to remove stubborn ink of many colors, are more effective and also may be more expensive. Some states require a doctor to supervise laser treatments, since the process requires an understanding of the biology of the skin around it.

For those without the fortitude or patience for permanent removal, makeup such as Dermablend®, originally designed to cover scars, can be used to camouflage the ink. Tattoo fading creams contain chemical irritants that are meant to cause the skin to peel and allow the natural healing process to kick in dissolving ink as the skin rejuvenates. But dermatologists advise being careful with home removal; the effectiveness of these products will not equal the results from treatment by trained professionals.

Think before you ink; removing that memoir can be much more painful and time consuming than having it put on to begin with. ■

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