By SHARON CHAYRA
VIEW ON HEALTH
Think about it: you’re young and in love and getting “Tanya loves Jason” on your hip doesn’t seem like such a big deal. That is until Tanya doesn’t love Jason anymore. Now you’re left with an embarrassing reminder of your youth and an impulsive and fleeting love affair. Despite the fact that certain things last forever, tattoos aren’t one of them. Tattoo removal used to be a permanent adornment to one’s skin but that is no longer the case. In recent years dermatologic surgeons have developed safe and effective techniques to successfully remove unwanted tattoos.
Patients request removal of a tattoo for a variety of reasons, whether it be social, cultural or physical. Former gang members who want to leave behind their previous lives also get in line for this procedure. There are also rare cases in which the patient develops an allergic reaction to a tattoo several years after the initial application. Because each tattoo is unique, removal techniques must be tailored to suit each individual case. For example, professionally applied tattoos tend to penetrate the deeper layers of the skin at uniform levels.
It is estimated that close to 10 percent of the U.S. population has some sort of tattoo. Some of the motivations behind these removals range from embarrassment at what was a youthful impulse; dissatisfaction with the tattoo as it fades and loses its shape, feeling that it would prevent him/her from being promoted in their chosen career. Some reported that restrictions in their ability to get the job they wanted also influenced their decision for removal.
Nicole is a prime example. She got her tattoo at the age of 20, only to realize 10 years later that she had grown tired of it. Now a mother, she found it just didn’t suit her anymore. Her tattoo, which covered her upper back shoulder-to-shoulder, is in the process of being removed. She has had 10 sessions so far and expects a few more to rid of it completely. When asked why she wanted to remove it she replied: “Life in general.”
But what is tattoo removal specifically? It’s the removal of a tattoo sure, but how is it actually done? There are several procedures that are available. The most common is laser surgery. This procedure requires the surgeon to remove the tattoo by selectively treating the pigment colors with a high-intensity laser beam. Lasers have become the typical treatment because they offer a “bloodless,” low risk, highly effective approach with minimal side effects. The type of laser used generally depends upon the pigment colors. In many cases, multiple sessions may be required.
Plastic surgeon Dr. Julio Garcia, who has been doing tattoo removal since 1993, says the number of sessions needed depends on the size and color of the tattoo. He says treatments vary and it is hard to predict how many treatments a given patient might need. He is clear about one thing: After laser surgery, the same area cannot be treated again for 4-6 weeks to avoid burning the skin.
There are drawbacks to this method as it is physically painful as well as painful to your bank account.
Location is the biggest component in removal. Tattoos on areas of the body that have thick skin hurt less while areas with skin and bone in close proximity, such as the wrist, hurt more. Depending on your tattoo, you may require anywhere from one to 10 sessions, each costing in the range of $250-$850 per session.
Some doctors like Dr. Garcia charge by time. He feels it is the fairest way for a patient. A large, professional tattoo in color could cost thousands of dollars to remove, and the effectiveness of the removal isn’t guaranteed.
The success of laser tattoo removal relies mostly on the patient’s own immune system. A healthy patient will get the best results. Adequate hydration, eight hours of sleep a night, maintaining a healthy weight, eating a well balanced diet, exercise, and non-smoking provide the best results.
While generally accepted as a safe treatment and the gold standard method to remove a tattoo there are risks. They include the possibility of discoloration of the skin as well as textural changes. Very rarely, burns may result in scarring. Rarely, “paradoxical darkening” of a tattoo may occur, when a treated tattoo becomes darker instead of lighter. This seems to occur more often with flesh tones, pink, and cosmetic make-up tattoos.
The color of the ink also proves to be important when thinking about removal. Dr. Garcia says turquoise and green are the hardest to remove. This is because we contain pigments of blue and green in our skin. Black is the easiest as that color does not exist in our skin.
Dermabrasion requires the surgeon to “sand” the skin, removing the surface and middle layers of the tattoo. The combination of surgical and dressing techniques helps to raise and absorb the tattoo inks. For a few days, the skin will feel as though it has been severely brush-burned. Medications may be prescribed to alleviate any discomfort the patient may have. Healing usually occurs within seven to 10 days.
The newly formed skin, which is pink at first, slowly develops a normal appearance. In most cases, the pinkness largely fades by eight to 12 weeks. Make-up can be used as a cover-up as soon as the crust is off. Most people can go back to work in seven to 10 days after dermabrasion. Patients are usually instructed to avoid unnecessary direct and indirect sunlight for three to six months after the procedure and to use a sunscreen on a regular basis when outdoors.
Another form of tattoo removal is surgical incision although this option is extreme and rare. The surgeon removes the tattoo with a scalpel and closes the wound with stitches. This technique proves highly effective in removing some tattoos and allows the surgeon to excise inked areas with great control.
Some find tattoo removal severe and look for a less drastic way to hide the tattoo. Opting to cover an unwanted tattoo with a new tattoo is the most common method. An artfully done cover-up may render the old tattoo completely invisible. It should be noted however that this would depend largely on the size, style, colors and techniques used on the old tattoo. Covering up a previous tattoo requires darker tones in the new tattoo to effectively hide the older unwelcome piece.
Products like Derma-Blend are found at high-end make-up counters and can conceal a tattoo for an important job interview or a special event such as a wedding. For 32-year-old Mike McFarlane, covering his tattoo with cosmetics gave him the confidence he needed when interviewing for a job in sales. He explains, “One day I’d like to get this off my arm but I don’t have the money. For sure I needed the job. So the make-up stuff worked.”
McFarlane did get the job and it may have been due in part to concealing his body art. Despite the fact that tattoos are more commonplace, there remains a bias about ink in the workplace. Fair or not, with jobs scarce, employers can now choose the cream of the crop and sometimes the cream has no visible ink.
In East Los Angeles where gangs are rampant, there is a project called Homeboy Industries that offers free tattoo removals to former gang bangers who have completed a program getting them off the streets.
Still, tattoos remain very popular and local parlors report brisk business. In addition to the hula dancer or raging dragon, women have used tattoos as permanent makeup for their eyes, brows, lips and cheeks. The FDA considers the inks used in permanent makeup to be cosmetics. Local jurisdictions govern how these tattoo parlors ensure client safety.
However, dermatologists are formulating new inks that are biodegradable and bioabsorbable. The dyes are encapsulated in microscopic polymethylmethacrylate beads suspended in solution. They can be designed to disappear after three months, six months or one year.
Tattoo removal is a very extensive procedure and should only be done by a reputable physician. You want to make sure you find a highly regarded dermatologist or cosmetic surgery center to ensure proper treatment and care. If possible, you should obtain a recommendation from your family doctor for a dermatologist or skin surgery center that specializes in tattoo removal. Dr. Garcia insists that only a physician or a nurse should perform tattoo removal. This will ensure safety comes first for the patient.
Many patients wonder what to expect at a tattoo removal session. When the patients arrives he/she is given protective eye shields. The skin’s reaction to the laser is then tested to determine the most effective energy for treatment. The session itself consists of placing a hand piece against the surface of the skin and activating the laser light.
Patients have told Dr. Garcia that each pulse feels like the snapping of a rubber band against the skin. The patient will then be asked to apply a topical antibiotic cream or ointment. A bandage or patch will be used to protect the site and it should likewise be covered with a sun block when out in the sun.
It should be noted that since tattoo removal is a personal option in most cases and is considered a cosmetic procedure, most insurance carriers would not cover the process unless they deem it medically necessary.