What is tattoo removal?

Indications and Procedures

Application of a tattoo is relatively easy, although the process is painful. A design is drawn on the skin. Needles are used to push the ink down into the skin. When the skin heals from the multiple punctures, the design remains permanently in place. Attempts have been made to remove tattoos since the first one was applied. Scrubbing with sandpaper or table salt has been tried to scour the surface of the skin and remove the tattoo. The results have usually been disfigurement or scarring.

Currently, laser therapy is the most effective way of removing unwanted tattoos. The Food and Drug Administration (FDA) has approved several types of lasers for tattoo removal. The standard device now used is some form of Q-switched laser, which produces a pulsed beam with much higher power at the peak of the pulse than a continuous wave laser. When applied to a tattoo, the ink embedded in the skin absorbs the pulse of energy. The laser energy causes the tattoo ink to break up into fragments that can be removed by cells of the body’s immune system. The treatment feels like a rubber band snapping against the skin, and local anesthetics may be necessary when attempting to remove large tattoos. Immediately after the laser treatment, the treated area turns white and might swell slightly; over the next few days, blisters and scabs may form. Within seven to ten days, the skin will look normal. Several such treatments are required, spaced a number of weeks apart.

Other, significantly less popular methods of tattoo removal include dermabrasion, where the outer layers of skin that hold the ink are abraded (scraped or rubbed away) with a spinning abrasive pad, and surgical excision, in which small tattoos can be removed by cutting them out and closing the skin with stitches

Uses and Complications

The number of treatments required to remove a tattoo depends on several factors: the color of ink, the amount of ink, the depth of the tattoo, and the location of the tattoo. Professional tattoos may require more treatments to remove than those applied by amateurs, because professionals tend to use more ink and to apply the ink deeper into the skin. Ideally, treatments are spaced several weeks apart to allow the body’s immune system to remove the maximum amount of ink between sessions; this time is also necessary to allow the skin to recover fully before the next treatment.

It is more problematic to remove tattoos from areas of the body with thin skin, such as the face, genitals, and ankles. In the case of tattoo removal, laser treatments are designed to remove the unwanted buildup of abnormal pigment (ink) in the skin; however, people with dark skin have high amounts of natural pigment (melanin) in their skin. Sometimes, lasers cannot distinguish between tattoo ink pigment and normal skin pigment. As a result, both types of pigment are destroyed, leaving pale patches on the skin; these patches can fade with time. Conversely, an increase in pigmentation can be seen after treatment, causing dark patches on the skin; these patches can also fade with time. It is recommended that patients stay out of the sun before and after treatment for tattoo removal. Tattoo removal can lead to scarring, but with the modern laser methods, this is becoming rarer. The most striking side effect of laser tattoo removal is the cost, typically much higher than the cost of the original tattoo. Nonetheless, according to the American Society for Dermatologic Surgery, its members performed some 100,000 tattoo removals in 2011, up from 86,000 in 2010.

Bibliography

Ahluwalia, Gurpreet S., ed. Cosmetic Applications of Laser and Light-Based Systems. Norwich, N.Y.: William Andrew, 2009.

Camphausen, Rufus C. Return of the Tribal: A Celebration of Body Adornment: Piercing, Tattooing, Scarification, Body Painting. Rochester, Vt.: Park Street Press, 1997.

Graves, Bonnie B. Tattooing and Body Piercing. Mankato, Minn.: LifeMatters, 2000.

Hewitt, Kim. Mutilating the Body: Identity in Blood and Ink. Bowling Green, Ohio: Bowling Green State University Popular Press, 1997.

"Inked and Regretful: Removing Tattoos." U.S. Food and Drug Administration, January 30, 2013.

Kirby, William, Emily Holmes, Alpesh Desai, and Tejas Desai. "Best Clinical Practices in Laser Tattoo Removal." Dermatologist (June 2012): 23–28.

Miller, Jean-Chris. The Body Art Book: A Complete, Illustrated Guide to Tattoos, Piercings, and Other Body Modifications. Rev. ed. New York: Berkley, 2004.

Wilkinson, Beth. Coping with the Dangers of Tattooing, Body Piercing, and Branding. New York: Rosen, 1998.

"Unwanted Tattoos." American Society for Dermatologic Surgery, 2013.