Decorative tattoos have been part of the culture for thousands of years. No longer is it limited to military personnel and athletes. We’re seeing many younger patients, especially women, getting exotic tattoos often in multiple locations. In the United States, it’s estimated that 25% of women between the ages of 19 and 35 have a tattoo.
Although many choose to have a small tattoo placed on their body in an area that’s easy to cover with clothing, we’re seeing more patients with tattoos on their lower arms and necks. These are obviously difficult places to cover with clothing. The reasons for removing the tattoo include “outgrowing the usefulness or novelty,” “my job prohibits me from having a tattoo that can’t be concealed” or “I’m no longer married to or dating the person whose name is on the tattoo.” The Harris County Medical Society, of which I’m a member, offers a “De-Tag” program for juveniles who are in custody to remove gang tattoos. Members of the Medical Society donate their time and the laser companies donate lasers and technicians to spend a few hours on a Saturday to help these young men and women try to get a new start on life.
A few tattoos can be covered with a heavy concealer, on a temporary basis, but most patients want the tattoo removed. Over the years there have been a number of techniques to expunge the dye. This includes using coarse salt and a sponge to scrub the ink out, or abrasion to sandblast the dye, freezing the tissue, and using creams to try to leech out the dye.
With the development of lasers, including Q-switched lasers in particular, physicians are able to target specific colors in the tattoo to selectively fracture the pigment granules so that they can be absorbed with less scarring.
Tattoo removal is a multi-treatment process, even with a simple black tattoo. Because of the multiple colors in many tattoos, it is necessary to use different lasers or filters. The laser light has to be specific to that color so it’s absorbed at a maximum rate. Each of the colors has a different wavelength. A green laser beam such as in the 532 nm range, will be absorbed by red pigment, and a red laser beam will be absorbed by green pigment such as in the alexandrite 755nm laser. The 1064 NdYAG laser light is absorbed by water so it is not color specific although this laser frequency works well on black or dark blue tattoos.
When I see a patient with a single color dark tattoo, I explain that it will take at least five sessions to treat the area. The goal is to burst the tattoo pigment into small enough pieces that the body will absorb it. Unfortunately, the area where there was a laser is now left lighter in color than the surrounding skin. This is fine for someone who’s fair-skinned but in a darker-skinned individual, this can leave a noticeable remainder of the tattoo that was. I also explained that the tattoo removal generates heat and treatment may end up causing hypertrophic scarring.
Some patients do not want to go through the time and expense of multiple laser treatments and would prefer to have the scar removed surgically. This can be done in a single session with small enough stars that the world could be closed without significant tension. Unfortunately, many patients have large stars that require multiple excisions of small areas of the tattoo until the tattoo is totally removed.