Tattoo removal using lasers means no scars, but process still isn't easy

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Tattoo removal using lasers means no scars, but process still isn't easy
April 26, 2011
By Evelyn Theiss
Cleveland.com

Tattoo rue.

That's the term for how you feel when your tattoo has become passe -- either because fashion changed, or more likely, your lifestyle has -- as did one young, local mom, who wanted a marijuana leaf tattoo removed before her child learned to talk and ask questions about it.

Typically in the past, about 4 percent of the population had tattoos, but in recent years, that number has risen to 15 percent. And that group skews young: About 40 percent of people younger than 40 have them.

To remove a tattoo, it used to be that you would have to have it sliced or abraded off, which meant, yes, pain, followed by oozing, then a scar. Since the early 1990s, though, lasers have become the biggest weapon in the tat-removal arsenal.

But that doesn't mean tattoo erasing is an easy process.

Dr. Lydia Parker, a Beachwood dermatologist, has become an expert in tattoo removal, which she's been doing since her practice bought a quality-switched, or Q-switched, laser in 1993. This type of laser emits short, high-power pulses, and it has become recognized as the gold standard. The pulses are effective at breaking the ink into particles, which are then eliminated by the patient's immune system.

Here's what Parker has learned since beginning to remove tattoos: "The majority of people who get a tattoo put on are eventually going to want it off."

Usually people want the markings removed because they're looking for a job or promotion to a position where visible tattoos become a problem. Perhaps they want to enter the military, become a police officer or acquire a higher-status job in a place that frowns on tattoos.

Parker says she suggests to those considering getting a tattoo to have it placed somewhere on their body where it's easy to hide when appropriate.

She cautions against putting someone's name on your skin, "unless it's someone you are permanently attached to, like a mom or child. And then, make sure the tattoo artist knows how to spell the name!"

Above all, Parker says, know this: The smaller the tattoo, the easier and less expensive it is to remove.

"You want to make sure the laser will address the colors in your tattoo," Parker says.
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Read all of The Plain Dealer's Tat Chat features

Removing black ink is not difficult because lasers are particularly effective on dark hues.

"Pretty colors -- turquoise or yellow -- can be difficult to get rid of," Parker says. Each color requires a different wavelength of the laser.

When it comes to who applies your tattoos, the Ohio Department of Health requires that the artist be trained in first aid and in dealing with blood-borne pathogens (training can be acquired through the Red Cross). The state also requires artists to have graduated from either a tattoo school or an apprenticeship to show they can perform the job.

Tattoo artists need city permits to open a parlor and must provide proof of training. And they're subject to inspection. Local health department requirements may vary, so you need to find out a city's specific regulations.

Scarring is gone, but discomfort remains
Thinking of a tattoo?

Application

To maximize safety and artistic appeal, seek out a professional tattoo artist. Reputable artists use sterile needles, disposable gloves and antiseptic creams. One thing to know: Tattoo dyes aren't regulated.

The discomfort of application depends on your pain tolerance. Tattoos in areas with thin skin (for example, near the ankle) or on soft skin (inner arms or thighs) tend to be more painful.

1. Each needle injects ink one drop at a time, 1 to 2 millimeters below the skin's surface.

2. The dermis is the target for the ink. If the needle reaches subcutaneous fat or muscle, there's a problem; it will spread and blur.

3. The epidermis, the skin's outer layer, is like a tinted window over the tattoo.

The equipment

The electric tattoo needle, which hasn't changed much since the 1920s, can puncture the skin up to 3,000 times per minute.

Small groups of needles (often three) draw the sharp outlines of the design.

Larger groups of up to 32 needles splay out like the bristles of a paintbrush to provide shading and coloring.

Removal

Tattoo removal isn't cheap, easy or fast. The removal method used by dermatologists has evolved greatly over the years; most use lasers now.

Surgery

The image is cut from the skin. This remains the only option for ink that has penetrated the subcutaneous fat layer. Scarring will occur.

Abrasion

Skin is sanded down using salt or a rotating brush. Or a chemical peel is employed. Scarring is likely.

Lasers

Short flashes of high-intensity light break up the ink so that it is absorbed by the body. Because of this, doctors ask patients to wait a month between treatments.

Dr. Philip Bailin has been removing tattoos since the early 1970s. Back then, his clients were mostly military veterans or gang members.

"Today, it's high school and college kids who want them off," he says.

When Bailin started, "surgical removal of tattoos was the only option, through excision, or using dermabrasion or salt dermabrasion, all of which left a lot of scarring."

Then came the first lasers, which vaporized the skin and got the tattoo out, but still left a scar.

Today, scarring is not much of an issue, says Bailin, who is a surgeon at the Cleveland Clinic's Dermatology and Plastic Surgery Institute. But there's discomfort and even pain during the laser process; it's been compared to being pinged repeatedly by a rubber band. Patients tell him it's more painful than when they got the tattoo.

But, Bailin says, "Usually, people don't remember getting the tattoo anyway," so they don't recall the pain in that process. They may have been under the influence of alcohol when they got the body art.

Take care in choosing who applies your tattoo, says Bailin and other doctors. While any process involving needles might, if proper precautions aren't taken, lead to the transmission of disease, the other possible complication in tattoos is infection. Allergic reactions can happen, too.

Part of the problem is the diversity of inks.

"Even tattoo artists and parlors that have been in business for years and are very reputable don't know what the ingredients are in the ink they use," Bailin says. The dyes don't come with detailed information, and "the FDA doesn't really control it. There's a big problem with no homogeneity of inks."

Removal process can be lengthy, costly

tattoo-salvatore-brdar.JPGAllison Carey, The Plain DealerSalvatore Brdar is a tattoo artist who has done his own tattoos. He was featured in The Plain Dealer's Tat Chat feature last year.

But once you have a tattoo, it's permanent -- until you decide you want it off.

Tattoos applied amateurishly are, surprisingly, often easier to remove because they're mostly black and not inked as heavily or deeply. "Three to six treatments can get rid of them," Parker says. "Professionally applied tattoos can take up to two years to remove."

Once people decide they want a tattoo gone, they usually want it gone in a hurry. But the best way for removal is to have a laser treatment, then let the tattoo fade -- say, for a month or so -- before the next laser treatment.

"That way, you don't see where it was, and you don't see a scar or discoloration," Parker says.

And, as in any specialty, make sure the doctor (by Ohio law, only medical doctors are permitted to use lasers for tattoo removal) treating you with a laser is using the appropriate kind: a laser designed for tattoo removal, not hair removal.

Costs for laser removal of tattoos vary, but $150 a session is about average, and even for a small tattoo, a minimum of three sessions might be required. For a large one? A dozen sessions or more, because only small portions can be treated at a time.

Either way, doctors say, there's more discomfort than actual pain.

"We like to see little or no bleeding," says Parker, "so that the skin will heal without a scar."

Given the time and money involved to remove them, consider a tattoo anything but temporary.