Tattoo Removal

By Joshua

Chapter 40 from The Art of Tattooing
http://artoftattooing.com/

The famous Hollywood actress Angelina Jolie made the tabloid news when she had the tattoo of his name tattooed on her. She made the news again when upon ending her marriage to actor Billy Bob Thornton, she had the tattoo of his name removed from her body. When she was asked about the removal of the tattoo, her response was, ” It seemed (getting the tattoo of his name) like such a good idea … at the time.” And in another case of a romance gone wrong and additionally a celebrity tattoo mistake strikingly similar to Angelina Jolie’s situation was that of the famous actor Johnny Depp. To show his love to Winona Ryder, in 1991 he had “Winona forever” tattooed upon his arm. When he was asked about it then, his response was, “I love Winona. I’m going to love her forever…” Upon their break-up, Johnny Depp had the last two letters of his former love’s name changed from Winona to Wino, resulting in the tattoo becoming “Wino Forever.”

What those two examples goes to show is that there are a lot of people who get tattooed with a design that they’re sure will be relevant to them forever, only to find themselves in situations where that relevancy doesn’t exist anymore, and not just famous people either.  Removing tattoos is not a modern invention; tattoo removal has in fact existed for at least a thousand years. Two methods for removing tattoos were employed; the least used method was by a chemical process that caused the skin to force out the pigment and the more common method, which was by cutting the tattoo out entirely. Both of these processes were potentially very dangerous to the bearer of the tattoo because of the risk of infection and the lack thereof anti-biotic.

One of the chemical processes used was documented in the classic Medicae Artis Principes, written by Aetius of Amida, a physician to the Byzantine Court in 543 C.E. His method for removing tattoos was a mixture of both chemical and Sal abrasive steps. First he applied a mixture of nitre-saltpeter and terebinth resin-turpentine to the tattoo and then covered it up. Days later, he rubbed the area with salt (Sal abrasion), and then followed that step up by another application of the nitre/terebinth resin mix. What this process did was cause a reaction of white blood cell activity in the affected area causing the pigment of the tattoo to rise to the surface. Often the results of this process were somewhat successful, but they also resulted in serious scarring and serious skin discoloration and in many cases, led to other more serious problems.

Since those primitive and barbaric times, the methods of tattoo removal didn’t improve very much until just recently in the last twenty years or so with the advancements in various technologies. Today, there are numerous methods of tattoo removal, a couple of which leave almost no sign that the tattoo ever existed in comparison to some of the older methods of tattoo removal. The method that the physician performing the tattoo removal will use will likely depend upon a few factors such as the size of the tattoo, the age of the tattoo, the patient’s general health as well as the location on the body where the tattoo is. The methods of removing tattoos that are available today are Excision, Tissue expansion, Tannic acid removal, Dermabrasion, Sal abrasion and by Laser. Local aesthetic is required in most of these procedures.

Excision – Tattoo Removal

Excision of a tattoo is essentially just surgical removal of the tattoo, or in plain English, the tattoo is cut right out. Determining whether excision of a tattoo really is the appropriate means of tattoo removal depends upon a few factors such as the size of the tattoo, the health of the patient and the location of the tattoo. Excision is performed by first injecting a local aesthetic to numb the area after which the tattoo is removed surgically. The edges of the cut out area are then brought together and sutured (sewn up). In extreme cases involving large tattoos, a skin graft taken from another part of the body may be necessary. The Excision method can cause severe scarring.
Excision/Tissue Expansion

Another method used to remove tattoos is done by surgically placing a balloon under the flesh of the tattoo in order to stretch it. The balloon is then inflated slowly stretching the skin after which the tattoo is then cut out and then the stretched skin is used to close the area. The result in most cases is a vertical scar.

Dermabrasion – Tattoo Removal

Dermabrasion is performed by first freezing the tattooed area with a local aesthetic and then abrasively taking off the layers of skin until the area of the skin where the tattoo ink is located are removed. The abrasive agent used can be caustic acids, sale abrasion, or using actual sandpaper. Dermabrasion is somewhat ineffective since tattoo ink is in most cases, is too deep into the skin for it to be removed completely. Dermabrasion is known to cause severe scarring and/or permanent discoloration of the affected area resulting in the area becoming more unsightly than the original tattoo ever was.

Sal abrasion – Tattoo Removal

Sal abrasion is an old method that is still used today to remove tattoos. Sal abrasion is performed by first freezing the tattooed area with a local aesthetic and then by applying a solution of water and salt to the tattooed area and then an abrading instrument is aggressively used to abrade the skin until the area where the ink resides is sanded away.

Laser – Tattoo Removal

The relatively recent introduction of lasers into the medical field has been a very important advancement in many areas, including the removal of tattoos, but this method too is not without its problems. The word laser is actually an acronym for the words “Light Amplification by Stimulated Emission of Radiation.” There isn’t just one type of laser that removes tattoos, but rather several types such as the Co2, Q-switched Nd:Yag, Q-switched Alexandrite and the Q-switched Ruby; each type of laser has its pros and cons.

In order to remove a tattoo by laser, more then one treatment is usually necessary to remove the entire tattoo. To remove the tattoo, the area is first numbed prior to the treatment. The lasers work by emitting pulses of light onto the tattoo breaking up the tattoo pigment in the skin small enough to allow macrophage activity to get rid of the tattoo ink Different tattoo ink colours require different wavelengths of laser light to break up the pigment. Some tattoos need to be treated carefully so that a ghosting effect is not created, which is where the scar is the same shape as the old tattoo. Individuals with darker skin tones may be more prone to what is called post laser discoloration or ghosting where the scar is the same shape as the old tattoo. Every tattoo removal option can possibly result in the formation of keloids (thickened, raised scars) in individuals prone to this condition. Amateur tattoos may require more removal sessions than professionally done tattoos because the pigment was randomly deposited at different levels.

For both the clinician and the patient, eye protection capable of reflecting the colour laser being employed should be used to protect the eyes from damage from even diffuse laser light. Allergic reactions can occur within patients as a result of the effect the laser has upon some inks, especially with mercury (used for red colours), manganese (purples), chromium (greens), cobalt (blues), and cadmium (yellows). Also, significant and sometimes irreversible darkening of tattoo ink may occur, where the pigment is impossible to remove. This has occurred with flesh-coloured, red, tan, and white inks (colours used commonly in cosmetic tattooing.

Regardless of which method of tattoo removal is used, some scarring or colour variations are likely to remain. Healing time varies depending upon the size and depth of the tattoo, the procedure used and the patient’s healing process. A few years ago it cost approximately $10,000 to laser off a fist sized tattoo, today it costs around $500.

###END###