Removal of Unwanted Tattoos

John Klear describes his recent laser treatments this way: “It’s like a really hot Exacto knife slicing through your skin.”

Still, it’s worth it to him to have his tattoos removed. He got them when he was in the Navy, a rite of passage but also a lasting reminder of “the folly of youth,” he says. Later, after deciding he didn’t like the way they looked, he researched tattoo removal on the Internet and decided to go to the University of Michigan Health System for treatment.

His dermatologist, Jeffrey Orringer, M.D., sees many patients who want their tattoos to disappear. Indeed, he says, nearly 20 percent of people with tattoos are thinking of having them removed – and other estimates are even higher. “The most common reason,” he says, “would be to remove a name of someone who is no longer involved in the patient’s life.”

Orringer treats patients with laser technology that allows for a fairly precise removal of the ink without damage to the surrounding skin and, in most cases, without a scar. The technology is far superior to the techniques of the past, which typically resulted in scarring.

Current technology allows the physician to choose certain wavelengths of laser light and shine them on the skin. The wavelength of light from the Q-switched (or quality-switched) laser targets the ink in the skin; the ink heats up when absorbing the laser light, and the balls of ink “pop like popcorn – but on a microscopic basis,” says Orringer, assistant professor of dermatology at the U-M Medical School. The body responds by sending in white blood cells that chew up the altered ink and lighten the tattoo.

For typical, professionally applied tattoos, Orringer orders six to 12 treatment sessions that will clear most tattoos. And it’s not an easy process. “Some patients tell me that having it removed with a laser is somewhat more uncomfortable than acquiring it in the first place,” he notes. The cost also tends to be greater than the price of having the tattoo applied, he says, and can add up to a few thousand dollars for the most complex tattoos. Simpler tattoos cost less than that.

Some tattoos are easier to remove than others. Those that are older, simpler, contain fewer colors are easier to remove, while those located on arms and legs tend to be tougher, Orringer notes.

“I’d say it’s most difficult to remove a tattoo from the ankle area,” he says. “The hands, fingers and other areas at the end of extremities are also more difficult because of a difference in blood flow.”

Counterintuitively, darker colors, such as black, are easier to remove; vivid, bright colors can be more difficult. When tattoo artists mix colors – such as dark blue with white to create sky blue – it can pose difficulties during the removal process. The white ink acts as a shield that reflects much of the laser light, protecting the blue ink and making it more difficult to eradicate with lasers.

For Robert Kelley, 48, the process of having his tattoo removed is a chance for him to teach his son about the potential downside of getting a tattoo. He is pleased that he has the option to have the tattoo removed, but it hasn’t been easy.

“I’ve been able to show my son after my surgeries what the healing process looks like,” says Kelley, who has required more than a dozen laser sessions for the removal of a skull tattoo on his arm, which he got when he was a teenager. “If my son wants a tattoo when he’s older, I’m going to remind him of the process I went through.”

Thinking of having a tattoo removed? 7 things you should know
1. Laser technology can reduce the appearance of tattoos so they are no longer visible. Unlike past treatments, present-day lasers rarely cause scarring or damage to the surrounding skin.
2. It will take more time to remove a tattoo than it took to have it applied. Often, six to 12 sessions are required to erase all of the ink.
3. Areas of the body where it is more difficult to remove a tattoo include ankles, hands and fingers.
4. Older, simpler tattoos that contain few colors are easier to remove.
5. Treatment options include lasers, one of the most common of which is the Q-switched, or quality-switched, laser; surgical excision; and dermabrasion, the “sanding” of the skin.
6. Risks of laser removal of tattoos are similar to those associated with small wounds. The treatment itself can be uncomfortable or even painful as it creates small breaks in the skin. Some crusting or bleeding may occur in the area after treatment. Small risks of scarring, infection and discoloration of the skin also exist.
7. And if you don’t have a tattoo yet – buyer beware. By some estimates, one-fifth of people with tattoos are thinking of having them removed.

For more information, visit these Web sites:

Laser removal of tattoos at the University of Michigan Health System: http://www.med.umich.edu/derm/patient/cdlctreatment.shtml#lasrem

American Academy of Dermatology: http://www.aad.org/public/Publications/pamphlets/tattoo.htm

American Society for Dermatologic Surgery: http://www.asds-net.org/Patients/FactSheets/patients-Fact_Sheet-tattoo_removal.html