Tattoos, of course,  have been around for centuries.  People have poked inks and dyes into the skin for everything from labeling slaves and prisoners to creating permanent eyeliners and beauty marks.  The practice has crossed ethnic and societal boundaries, and has been used by widely diverse cultures since ancient times.  Traditionally, in this country, tattoo parlors haven’t exactly made the “A” list of places nice people frequent -- at least that is what generations of children have been told. 

For the last twenty years, however, the old macho reptiles and daggers tattoos have taken a back seat to the more contemporary flowers, unisex Celtic designs, and unicorns.   Men found out that while they might always love “Mom,” the other names on tattooed hearts had a way of changing over time, and a series of X-ed out names down an arm became increasingly hard to explain to the latest conquest.  And, what about the band you loved -- the only place their logo will appear in the future will be on your shoulder.  Today, it is no longer surprising to see tattoos on both men and women who come from all walks of life.   There has been an organized effort to “clean up” the shops where tattoos are done, and to improve safety for those on both sides of the needle.  One thing has remained constant over the years, however: professionally created tattoos are intended to be permanent.  They don’t wash off, and until the invention of the medical laser, removal was an iffy, painful thing.

For those who want to make a tattoo disappear, plastic surgeon Michael V. Kelly, II, M.D. advises research and patience.  “Tattoos take a lot longer to get rid of than they did to create, and we invite people who want to have one removed to schedule a consultation to discuss just what the process might involve in their specific case.  Just like the ‘artist’ might have promised a one-of-a-kind design, each person’s skin has its own characteristics and accepts the ink differently, so there are no stock answers.” 

Dr. Kelly believes that it is just as important that the discussion about this procedure deal in realities as it is for conversations about other cosmetic surgery techniques.  Tattoo removal is an elective procedure and there are no guarantees that the “art” will completely disappear.  It is important that the person understand exactly what will be involved and -- after a careful inspection of the design they want removed -- to discuss what might be expected in terms of time to accomplish the removal and the anticipated level of success.

The Laser As A Cosmetic Tool
 

It has only been within the past decade that the laser has become such a versatile medical instrument.  Laser is not actually a word but an acronym for Light Amplified by Stimulated Emission of Radiation.  There are many different medical lasers in use today, but the development of the Q-Switched, YAG laser is the one best suited for removing tattoos, with the Alexandrite laser -- affectionately called “Alex” in our office -- being used to remove some colors.

“The Q-Switched laser uses very specific wavelengths of light to target the desired area,” explained Dr. Kelly, “while passing through the surrounding skin without damage.  It is the absorption of the rapid, short, high-intensity bursts of light that causes the tattoo inks to “self-destruct” --  break up into tiny particles -- and is especially effective on black, blue and red inks.  Green and yellow are the two inks most resistant to fading and require another laser.  Purple is probably the most difficult color to remove.”

“It strikes me as somewhat strange,” Dr. Kelly continued, “that people who were willing to undergo the pain of getting a tattoo in the first place are concerned about the small amount of discomfort associated with having one removed.  Perhaps their initial ‘personal art experience’ was a valuable teacher.  Some people say the removal process feels like being splattered with a small drop of hot bacon grease and others compare the sensation to being snapped with a little rubber band.  While people tend to measure pain according to their own individual standards,” the doctor said, “the laser does not cause a serious level of pain.  The sessions usually last only a few minutes, so the discomfort is minimal.”

Most people who have tattoos don’t realize that there are more than 100 different inks that can be used in the process, and none of them are regulated by the US FDA.  This complicates the process of estimating the success of a specific removal attempt, which is determined to some degree by the kind of ink used, the size and location of the design, how much ink was used to create it, and how deeply the skin was penetrated.  Generally speaking, at least 95 percent fading of the tattoo may be possible.

“We perform the laser removal treatments in our office,” explained Dr. Kelly, “and aim to remove the tattoo as completely, comfortably and as quickly as possible.  The particular kinds of laser are safe and reasonably gentle,  targeting only the tattoo ink in the skin, not the surrounding tissue.  If the design was done by an amateur, we might only need three or four treatments, maybe less.  If it was created by a professional, it will probably take a little longer.”

After each treatment, the skin will be slightly discolored, and it is perfectly normal for the area around the target to be a little swollen and red, but this will disappear over time.  The tattoo will continue to fade as the body removes the pigment during the four to six week healing interval between treatments and, if instructions for using an antibacterial ointment and dressing and for keeping the area clean are followed, the potential for success is significantly increased.  The good news is that the skin in the target area will return to its normal color and texture after the treatments are complete, and the design will be as close to gone as possible.

“The best advice I would offer about tattoos,” said the plastic surgeon with a smile, “is to make sure it’s something you’re going to want to have around for a long, long time...or try one that washes off first.  We have safe, effective technology to remove them today...all you need are the will, the financial resources, the time and patience to have it done.  For the opportunity to be ‘art free,’ however, most people think it’s worth it.”