Tattoo removal has been performed with various tools during the history of tattooing. While tattoos were once considered permanent, it is now possible to remove them with treatments, fully or partially. Before the development of laser tattoo removal methods, common techniques included dermabrasion, TCA (Trichloroacetic acid, an acid that removes the top layers of skin, reaching as deep as the layer in which the tattoo ink resides), salabrasion (scrubbing the skin with salt), cryosurgery and excision which is sometimes still used along with skin grafts for larger tattoos. Some early forms of tattoo removal included the injection or application of wine, lime, garlic or pigeon excrement. Tattoo removal by laser was performed with continuous-wave lasers initially, and later with Q-switched lasers, which became commercially available in the early 1990s. Today, “laser tattoo removal” usually refers to the non-invasive removal of tattoo pigments using Q-switched lasers. Typically, black and other darker-colored inks can be removed completely. Two alternative removal methods are in development. Dalhousie University PhD student Alec Falkenham has developed a cream which promises to remove tattoos safely and painlessly. US Stemcell Inc and ClearIt LLC are collaborating on a product called ERASER.
A poll conducted in January 2012 by Harris Interactive reported that 1 in 7 (14%) of the 21% of American adults who have a tattoo regret getting one. The poll didn’t report the reasons for these regrets, but a poll that was done 4 years prior reported that the most common reasons were “too young when I got the tattoo” (20%), “it’s permanent” and “I’m marked for life” (19%), and “I just don’t like it” (18%). An earlier poll showed that 19% of Britons with tattoos suffered regret, as did 11% of Italians with tattoos. Surveys of tattoo removal patients were done in 1996 and 2006 and provided more insight. Of those polled, the patients who regretted their tattoos typically obtained their tattoos in their late teens or early twenties, and were evenly distributed by gender. Among those seeking removals, more than half reported that they “suffered embarrassment”. A new job, problems with clothes, and a significant life event were also commonly cited as motivations.
Tattoo removal is most commonly performed using lasers that break down the ink particles in the tattoo. The broken-down ink is then absorbed by the body, mimicking the natural fading that time or sun exposure would create. All tattoo pigments have specific light absorption spectra. A tattoo laser must be capable of emitting adequate energy within the given absorption spectrum of the pigment to provide an effective treatment. Certain tattoo pigments, such as yellows, greens and fluorescent inks are more challenging to treat than darker blacks and blues, because they have absorption spectra that fall outside or on the edge of the emission spectra available in the tattoo removal laser. Recent pastel coloured inks contain high concentrations of titanium dioxide which is highly reflective. Consequently, such inks are difficult to remove since they reflect a significant amount of the incident light energy out of the skin.
Widely considered the gold standard treatment modality to remove a tattoo, laser tattoo removal requires repeat visits. The newer Q-switched lasers are said by the National Institutes of Health to result in scarring only rarely and are usually used only after a topical anesthetic has been applied.
Multiple factors contribute to the success of laser tattoo removal, one of which is a patient’s own immune system. The Kirby-Desai scale parameters qualify the factors that can dictate tattoo removal success. Moreover, treatment on certain patients with immune system problems is contraindicated.
Laser tattoo removal is uncomfortable – many patients say it is worse than getting the tattoo on. The pain is often described to be similar to that of hot oil on the skin, or a “snap” from an elastic band. Depending on the patient’s pain threshold, and while some patients may forgo anesthesia altogether, most patients will require some form of local anesthesia. Pre-treatment might include the application of an anesthetic cream under occlusion for 45 to 90 minutes prior to the laser treatment session. A better method is complete anesthesia which can be administered locally by injections of 1% to 2% lidocaine with epinephrine.
Immediately after laser treatment, a slightly elevated, white discoloration with or without the presence of punctuate bleeding is often observed. This white color change is thought to be the result of rapid, heat-formed steam or gas, causing dermal and epidermal vacuolization. Pinpoint bleeding represents vascular injury from photoacoustic waves created by the laser’s interaction with tattoo pigment.
Although laser treatment is well known and often used to remove tattoos, unwanted side effects of laser tattoo removal include the possibility of discoloration of the skin such as hypopigmentation (white spots, more common in darker skin) and hyperpigmentation (dark spots) as well as textural changes.