 It
seemed like such a great idea at the time, having that “cute”
little butterfly etched on your shoulder for all time. A
good idea, that is, until you started shopping for your
wedding gown, and the little critter peeked above the neckline of
every dress you tried on. Fortunately, your fiancé has
politely refrained from doing more than raising an eyebrow, but
you got the message: the bug has to go.
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.”
Photos courtesy
Continuum Biomedical, Inc.
Drs. Suzanne Kilmer and R. Rox Anderson, Massachusetts
General Hospital, Harvard Medical School
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