The Art of Tattoos

Tattooing is an art dating back to ancient times. Today, researchers estimate up to 20 million Americans have at least one tattoo. Among adults, 26 percent of men and 22 percent of women have a tattoo. Roughly 23 percent of college students have one or more tattoos. Even younger Americans are getting in on the act. More than 13 percent of adolescents have one tattoo.

A professional tattoo artist typically uses a needle attached to an electric gun. The needle places tiny amounts of ink into the upper area of the dermis (the layer of skin beneath the outer layer, or epidermis). Tattoo art may follow a pre-designed pattern or be a free-flowing design.

Professional tattoo artists generally use good hygiene and safe practices to reduce the risk of complications from the procedure. However, if the needles are not sterilized, the equipment can be contaminated and viruses and bacteria can be passed from one client to another. Tetanus, tuberculosis, hepatitis B, hepatitis C and HIV have all been reportedly transmitted from unsterilized, contaminated tattoo needles. The CDC reports several cases of Staphylococcus aureus (bacterial) skin infections among several people receiving a tattoo from an unlicensed artist who didn't follow proper infection control practices. In addition to infection, clients are at risk for bleeding, excessive scarring or, on rare occasions, allergic reaction to substances in the ink.

Removing Tattoos

There are many reasons people get a tattoo. Some want to fit in with the rest of their friends. Some want to make a statement or use body art to express their feelings or set themselves apart from others.

No matter what the reason for the tattoo, some people eventually have a change of heart and decide they no longer want the body art. One survey found 17 percent of people with a tattoo have considered having it removed. However, getting rid of a tattoo isn't easy. While the outer layer of skin (the epidermis) constantly sheds and renews itself, the dermis, where the tattoo inks reside, doesn't change. Thus, tattoos are considered to be permanent markings.

Many years ago, the only options for tattoo removal were surgical removal of the affected layer of skin or dermabrasion. Today, the most common way to remove tattoos is with a laser. The Q-switched (quality-switched) lasers deliver ultra short laser pulses to the targeted pigments in the tattoo ink. The laser energy produces a photo acoustic effect: the intense heat causes the granules of ink to shatter, breaking the walls of the skin cells holding the ink. The body then sends special scavenger cells to carry away the debris.

Laser removal of a tattoo is a long, costly and painful process. A single treatment session lasts from 15 to 30 minutes and is repeated about every two months. The American Academy of Dermatology estimates many amateur tattoos can be removed in three to six sessions. Professional tattoos (which often contain more then one color) may take six to 10 sessions. Side effects of the laser treatment can include scarring and loss of natural pigmentation.

Erasing the Evidence

Some tattoos are very difficult to remove, despite many treatments. Black, dark blue and red respond best to the laser treatment. However, Dermatologist/Cosmetic Laser Surgeon, David Vasily, M.D., says some of the more unusual tattoo colors, like dark green, yellow and aqua-blue are stubbornly resistant to laser treatment. Many of the newer tattoos contain a lot of ink and thus, are more difficult to erase. Sometimes doctors can remove most of the tattoo, but residual ink remains, leaving behind an image of the tattoo or a "stain mark."

Vasily has developed a tattoo removal approach that combines two technologies - the traditional Q-switched laser and the Palomar Lux1540™ Fractional Laser handpiece. The Lux1540 delivers infrared light to remodel scars (replace the damaged tissue with healthy tissue.). Patients with treatment-resistant tattoos often have a lot of scarring in the affected area of skin - both from the trauma of the original tattoo and the efforts to remove it. Vasily first uses the Lux1540 to reduce the scarring. Then he uses the Q-switched laser to target the remaining ink in the skin.

Vasily has had very good success with his combination attack on tattoos. But it still takes a long time to erase the design - often at least two years. He says people who are thinking about getting a tattoo need to consider if they will still want to show it off twenty, thirty or even forty years from now. If a person has any doubt about permanency of the artwork, he/she should not get a tattoo. For those who've already gone that route and now regret the decision, Vasily recommends seeking the advice of a physician who has a significant amount of experience in tattoo removal.

For general information on tattoos or tattoo removal: American Academy of DermatologyFood and Drug Administration, Center for Food Safety and Applied Nutrition