Tattoo Removal

During the entire history of tattooing, various tools and methods have been used to perform tattoo removal. Tattoo removal was once considered extremely implausible and tattoos were thought to be permanent, but treatments now exist for the removal of tattoo, both partially and completely.

Removal of tattoos with laser treatment is the latest development.

Statistics and Motives

According to a survey conducted in 2012, 14% of adults who have tattoos regret getting them. The reasons for it were varying. 20% said that they were too young when they got the tattoo, 20% regretted that it was permanent, 19% said that they were marked for life, while 18% of the people said that they simply didn’t like it anymore.

Percentage of Britons who suffered regret with regards to their ink was higher i.e. 19% while this ratio in Italians was lower i.e. 11%.

The most common age groups of people who regretted their tattoo and got rid of them were late teens and early twenties. More than 50% of people getting tattoo removal treatments said that they suffered embarrassment. Fashion problem, workplace discrimination and significant life events were other common causes for removal.

The most common issue related to the regret of getting a tattoo is the end-of-history illusion. It means that adults and teenagers of different age groups believe that their tastes and choices have matured and will not continue to change in the future. Therefore, they believe that a tattoo will continue to appeal to them with the passage of time.

Old Methods of Removing Tattoos

Earliest practices of tattoo removal through laser were performed using continuous wave lasers. During the early 1990s, Q-switched lasers took their place and are still being commercially used. However, the practice of tattooing has been done for centuries now.

Be it the Ancient Egypt or Roman Empire, tattoos have been continuously used. Different methods have been used for removal but most of them were invasive procedures which required getting rid of the skin filled with pigments and then allowing it to heal. The process is far more painful and also carries huge risks of infections and skin diseases.

Some of the common methods before the development of laser treatments were:

  • Dermabrasion: It was a common procedure before the advent of laser. Dermabrasion is a surgical, invasive procedure, in which upper and mid layers of the skin are treated with strong abrasive devices.
  • Treatment with TCA: TCA stands for Trichloroacetic acid. TCA is used to remove the top layers, including the layer in which tattoo pigments are present.
  • Salabrasion: In salabrasion, skin is gently scrubbed with salt for a long time.
  • Cryosurgery: Tissue is destroyed by treatment with extreme cold. Normally liquid nitrogen is used.
  • Excision: Removal by surgery is still in practice for large tattoos, performed alongside skin grafts.
  • Some ancient methods of tattoo removal include application of lime, wine or garlic.

Laser Tattoo Removal

Laser breaks down particles of tattoo ink present in the layers of skin. These smaller particles are then absorbed by the body. This process resembles natural fading that can be caused by time or sun exposure.

Every tattoo pigment has a specific light absorption spectrum. Lasers emit adequate energy that is within the absorption spectrum of that particular pigment. This causes the pigment particles to be broken down.

Pigments such as bright yellows, greens and fluorescent inks are harder to treat with lasers because their absorption spectrum falls outside the spectrum of laser or lies on the edge of it. Dark blues and blacks are easier to treat. Pastel colored inks are also very difficult to remove because of the presence of titanium dioxides. These metal oxides are highly reflective and therefore absorption of laser is difficult compared to other pigments.

Latest technology of Q-switched lasers is believed to be the ideal treatment by National Institutes of Health. The scarring is rare and these lasers are used after the application of topical anesthetics so pain is not experienced by the patient.

There are different types of Q-switched lasers. Each of them is effective at removing different ranges of pigments. Most recent modification in Q-switched lasers occurred in 2006 which provides multiple wavelengths and is able to treat a broader range of pigments as compared to previous technologies.

Laser removal treatments require multiple sessions for complete removal of inks. These sessions are normally spaced at seven weeks or more to avoid adverse effects. Reducing the gap between sessions does not necessarily improve the rate of removal and can lead to severe scarring and dischromia.

At every session, some of the tattoo pigments are fragmented which are then absorbed by the body in the gap between consecutive sessions. As a result, the tattoo lightens over time.

Number of sessions and time gap between them depends on the size of the ink, skin color and part of the body on which tattoo is present. Tattoos located on ankles take the longest time. Time required and success of removal depends on each individual’s healing system and skin type. If scarring and layering doesn’t occur then the treatment becomes more effective.

Risks and Side Effects

After the treatment, white discoloration occurs which may or may not be accompanied by bleeding. Since the application of laser is sterile, there is no need for antibiotics. Moreover, antibiotics may cause allergic reactions.

The most common side effect is transient change in skin pigmentation. It occurs in almost half of the patients. Mostly these changes resolve in a year or so but in some rare cases they can be permanent.

Hyper-pigmentation occurs mostly in darker skin tones. Hypo-pigmentation is also a common risk in which skin develops light patches.

Some of the tattoo pigments contain metals. These pigments when broken down by laser treatments may convert into toxic chemicals when exposed to light and may absorb into blood.

Blood vessel rupture can also occur if Argon lasers are used, which are very rare these days.

Textural changes are also noted but are not long term and mostly resolve in a few days.

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