New Year, New You, No Tattoo!

Laser tattoo removal by a dermatologist is your best option


Tattoos can be metaphors for aegis, love or belief.  Or, tattoos could be drunken mistakes.  You may no longer feel attached to your old tattoo.  In celebration of the New Year and resolutions to erase synthetic pigment, this one is for you.

The stats behind tattoo removal

Twenty-one percent of Americans have tattoos.  Although most of us are proud of our tattoos, 17 percent of us want an old tattoo gone.

  Of these people, 8 percent consider and 5 percent eventually pursue further tattooing to mask previous work especially when the art is faded.   

Many people who receive tattoos at a young age later desire tattoo removal for several reasons:

  • enhancement of self-esteem
  • social reasons
  • domestic reasons
  • family reasons

How have tattoos been removed?

People have wanted to remove tattoos ever since tattooing was invented.  According to the American Society for Dermatologic Surgery (ASDS), in 2011, dermatologists attempted to remove about 100,000 tattoos--up from 86,000 in 2010.  Over the years, there have been several tattoo removal methods proposed and used--some quite gruesome.  For the most part, these tattoo removal methods are only partially effective and leave scarring and pigmentary changes.

Here are some tattoo removal methods which have been tried:

  • In 543 AD, a Greek physician named Aetis proposed salabrasion.  With salabrasion, an abrasive surface, water, and salt are used to rub away the tattoo.  
  • Surgical excision of the tattoo with the resulting wound closed (primary closure).  Alternatively, once the skin containing the tattoo is removed, enzymes can be used to separate the epidermis or top layer of skin from the dermis or bottom layer--the dermis contains the pigment.  This top layer is then grafted onto the wound site.
  • Cryosurgery where very cold solid carbon dioxide, nitrous oxide, liquid nitrogen or so forth are used to remove tattoos.
  • Application of caustic chemicals to dissolve the tattoo like phenol, trichloroacetic acid, tannic acid or so forth.
  • A rotatory hand-held unit is used to abrade or rub away the tattoo.  This skin is abraded to the reticular dermis or bottom layer of the dermis.  The unit rotates at thousands of rotations per minute (rpm) and uses wire brushes, serrated wheels or diamond fraises.  Alternatively, sterile sandpaper has been used.  
  • A superficial micro tattoo process punctures the skin over the tattoo, and, in this way, a remover paste is introduced into the pigmented dermis.  This remover paste is made of deionized water, zinc oxide, benzoic acid and more.  Subsequently, the area becomes inflamed and tattoo pigment is oozed out or extruded.

Of these tattoo methods, only surgery is a gold standard treatment.  Moreover, the Internet is rife with tattoo-removal ointments and creams which aren't approved by the FDA and according to the FDA can cause scarring, rashes, burning or pigmentary changes.

Laser removal of tattoos

The best way to rid yourself of a tattoo is to let a dermatologist do the job with an FDA-approved laser.  Argon and carbon dioxide lasers of old left significant scarring and thermal damage.  Today, Q-switched lasers emit nanosecond pulses with a high peak power.  These pulses approximate the thermal relaxation time of a pigment, meaning that the pigment will take in heat from the laser without spreading it to surrounding cells void of pigments. 

Essentially, lasers explode pigment particles into smaller particles which are then sucked up by macrophages and cleared by the lymph system.  Some of these pigments may also be extruded through the skin.  Of note, some released pigment particles may be allergenic (allergy-causing) or even carcinogenic (cancer causing).

The easiest tattoos to remove are blue and black in color.  Lighter colors like red, green and yellow are harder to remove.  Because every color of pigment absorbs a different wavelength of light, different types of lasers need to be used to remove multicolored tattoos. Tattoo removal is a long process; depending on the size and color of your tattoo, you can expect 6 to 10 dermatologist visits to remove a single tattoo with a few weeks of healing punctuating treatments.

The pain of tattoo removal varies but is usually described as a mild discomfort.  A skilled dermatologist will adjust the procedure as to minimize pain and discomfort.  Adverse effects from the procedure include scant bleeding, redness or soreness, all of which are typically transient.

If, for whatever reason, you've made a resolution to bid adieu to an old tattoo, and laser removal is possible, please have a licensed dermatologist who specializes in tattoo removal perform the procedure.  Tattoo removal is a tricky procedure which should be performed by a specialist physician who can effectively manage the process, pain, and potential adverse effects. 

You should never let an unlicensed person (cosmetologist or tattoo artist) remove your tattoo. In recent years, in addition to a variety of dubious and potentially dangerous do-it-yourself tattoo removal methods, unregulated and cheap Chinese lasers have flooded the market.  Keep in mind that just because someone has procured such a questionable and likely dangerous device doesn't mean that she should be using if for anything including tattoo removal. 

For a list of dermatologist surgeons who remove tattoos check out the American Society for Dermatologic Surgery (ASDS) website.    If you have a medical problem with a tattoo or tattoo removal product or procedure, contact FDA Medwatch.

Selected Sources

"The risks of do-it-yourself and over-the-counter devices for tattoo removal" by N Kluger from the International Journal of Dermatology published in 2014.  Accessed from PubMed on 12/29/2014.

Laumann A. Chapter 101. Body ART. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. eds. Fitzpatrick's Dermatology in General Medicine, 8e. New York, NY: McGraw-Hill; 2012. Accessed December 30, 2014.

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