Today, having a tattoo is all too common. And, along with throngs of tattoo enthusiasts, you’ll find plenty of people who’d love to have their tattoos removed. Below, Dr. Novick discusses the past and present techniques for tattoo removal and reveals their efficacy.
SCN: Exactly what is a tattoo?
Doctor: Tattoos are simply permanent drawings or designs made in the skin. They’re created when pigment is implanted into the middlemost layer, known as the dermis. In the past, tattoo artists — and amateur tattoo artists still today — inserted the pigment by pricking the skin with handheld needles that were coated with ink. These days, however, professional tattoos artists use an electric tattoo machine with needle tips that are coated with the chosen pigment.
There are as many as 100 different colored inks to choose from. The needles hammer up and down into the skin with a motion similar to a sewing machine and drive the pigment down into the desired locations to create what amounts to true works of art upon a canvass of skin.
SCN: How has the image of tattoos changed?
Doctor: At one time, the very mention of the word “tattoo” conjured frightening images of gang members, hardened convicts, right wing hate groups and bizarre religious cultists. In the last 20 years, however, as tattoos burst into mainstream Americana, that image has changed.
The presence of approximately 4,000 tattoo parlors nationwide attests to their enormous popularity, particularly among young people. And, it’s estimated that over 10 million Americans possess at least one tattoo.
SCN: Why do many people want tattoo removal?
Doctor: With the passage of time, not everyone remains happy with his or her foray into body art. Perhaps as many as half of all individuals sporting tattoos grow to regret their youthful indiscretion.
What appeared cool and “in” on a forearm at age 16 can prove an impediment to getting hired as an airline stewardess at age 26. And a soaring eagle with its wings spread wide and coursing up the side of the neck might look macho at 17, but altogether unacceptable to a conservative Wall Street brokerage firm at age 27. And, of course, an “I love Sally” heart-shaped tattoo replete with Cupid’s arrow spread over John’s outer arm isn’t likely to go over very well with the next love of his life.
SCN: In the past, what kinds of methods did doctors use to remove tattoos?
Doctor: It might be fairly easy to get a tattoo applied, but it’s safe to say that it’s much harder to get one removed — and also much more expensive. Prior to the introduction of light-based therapies, doctors employed a variety of removal procedures. These included dermabrasion, salabrasion, cryotherapy, chemical peeling and surgical excision.
Dermabrasion involved the use of a motor-driven wire brush to abrade the skin surface; salabrasion, the use of coarse salt crystals; cryotherapy, freezing with liquid nitrogen; and medium-depth chemical peels, the application of caustic materials.
Each of these techniques relied upon stripping away the epidermis — the topmost layer of the skin — and exposing the pigment-laden dermis. Following exposure, the ink would be extruded as part of the healing process.
Surgical excision skirted the issue of dealing directly with the embedded pigment. Instead, if the lesion were small, it was cut out entirely and the resulting wound sutured together. If it were very large or its location difficult to work with, the removal was performed in stages, allowing each surgical wound to heal before proceeding to excise another part.
In general, these methods were successful at obliterating the tattoo, but at least some degree of scarring was inevitable. It was a trade-off — an acceptable scar in place of a highly visible and undesirable tattoo.
SCN: What methods do doctors use today?
Doctor: Lasers and other light therapy devices, such as the Infrared Coagulater (IRC), are the treatments of choice today. Lasers work by emitting short, intense pulses of light that pass through the skin and target the ink. The energy from the laser light fragments the large particles of tattoo pigment, enabling the body’s natural immune system to more easily scavenge the pigment and carry it away. This process usually takes several weeks, and multiple treatment sessions are often necessary to achieve maximal clearing.
SCN: Are dark colors tougher to remove?
Doctor: Because black pigment absorbs all wavelengths of light, it’s ironically the easiest pigment to remove. Colors such as green don’t absorb as well. Also, to effectively treat a multicolored tattoo, sometimes doctors need to use a variety of lasers with varying wavelengths.
SCN: What are the possible complications and cost?
Doctor: Potential complications include permanent scarring, temporary or permanent loss of pigment or excessive pigmentation. Fees for laser treatments may range from $1,000-$3,000 or more, depending upon the number of treatment sessions required and the size, shape, colors and location of the particular tattoo.
SCN: Specifically, how effective is the Infrared Coagulater or IRC?
Doctor: IRC uses non-laser infrared light to heat the area containing the pigment. It’s quick and easy to perform and generally requires fewer treatments than lasers. Most small tattoos can be treated successfully in one to three sessions. IRC’s efficacy also doesn’t depend upon the particular color of the pigments involved. For these reasons, it’s my favorite method for dealing with small tattoos.
SCN: What can we expect during the procedure?
Doctor: IRC’s procedure is quick and simple. First, the area is numbed with local anesthesia. Next, very short pulses of infrared light are directed at the tattoo in a gridlike fashion, leaving tiny spaces between each treated site. Since each burst of energy is just a fraction of a second, an entire treatment session requires only a few minutes to complete.
It’s within the course of the next few weeks, as the wound heals, that the pigment is extruded. To complete the removal, the intervening spaces are generally treated between two to four weeks later.
SCN: What’s the price tag along with potential complications?
Doctor: Fees for a series of three sessions generally run about $1,500. As with laser treatments, potential complications include scarring and temporary or permanent pigmentary changes. Most people, however, are quite gratified and relieved after the removal.
SCN: How painful is it to remove a tattoo with light therapies?
Doctor: In most cases, the use of local anesthesia is sufficient to make the procedure painless. However, despite the anesthetic, some individuals might feel some discomfort, a stinging sensation or what’s been likened to the feeling of a thin rubber band snapping back against the skin. The skin might also feel sunburned afterward.
SCN: Does the skin look completely normal after the tattoo is gone?
Doctor: Unfortunately, at the present time, no tattoo can be removed without a trace and however minor, all tattoo treatments leave a scar. Recently, tattoo pigments have been introduced that are intended to vaporize (rather than break up into smaller fragments) upon exposure to laser light. As these become more widely used, it should be far easier in the future to remove tattoos and with much less chance for scar formation.
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To learn more about cosmetic dermatologist Nelson Lee Novick, M.D., F.A.A.C.S., F.A.A.D., please visit his bio.