Biology 103
2002 Second Paper
On Serendip

Everyone makes decisions that they regret later in life. Some people make bad financial decisions, others bad relationship decisions, and most make bad fashion decisions. If you're lucky, the mistakes you make have only temporary repercussions. If you're not lucky, one of your mistakes was getting a tattoo. Not much can be done for those who outgrow their body art. The only procedures available cause so much trauma to the skin that they leave scars that are as large and offensive as the original design. That is, until laser therapy.

In order to understand how tattoo removal works, it is necessary to know something about the tattooing process. A needle attached to a hand-held "gun" is used to inject the desired pigment. It vibrates several hundred times per minute and reaches a depth of about a millimeter. The ink must penetrate past the top layer of skin, the epidermis, because its cells divide and die very rapidly. The dermis, or the second layer, is much more stable so the design will last with only minor fading and dispersion. The ink is insoluble and will not absorb into the body. Typically, a scab forms over the design and the wound has healed within 3 weeks. (1)

The most popular procedure for removal is laser surgery, but several other methods are still available. Salabrasion has been practiced for centuries and is somewhat antiquated. It involves numbing the area with a local anesthetic then applying a solution of tap water and table salt. An abrading surface, which can be as basic as a wooden block wrapped in gauze, is used to scrape the area until it turns a deep red color. Then a dressing is applied. Essentially, this is a primitive dermabrasion. (6) It works by shaving off the epidermis and then the areas of the dermis containing pigment. Dermabrasion is a more modern version of salabrasion. A rotary abrasive instrument is used to peel off the pigmented skin. It is called cryosurgery when the area is frozen with a special solution prior to abrasion. (2) Since these are rather traumatic procedures, bleeding is likely to occur. Scarring is significant and a virtual certainty. Until the development of laser surgery, dermabrasion was the most effective and convenient means of tattoo removal.

Tissue expansion is a less common procedure. A balloon is placed under the dermis of the patient and slowly inflated. This stretches the skin and forces cells to divide more rapidly. Then, the tattoo is cut out and the new skin is used to cover the excised flesh. If it is performed properly, tissue expansion only leaves a linear scar. (3)

Perhaps the most invasive option is staged excision. First, the area is numbed with local anesthetic. Then, a dermatologic surgeon uses a scalpel to cut into the skin and actually remove the pigmented sections. The area is closed with stitches and leaves scarring wherever an incision was made. This technique works best on small tattoos. (3) For a larger are, a skin graft is necessary. (2)

Since the scarring and pain associated with each of these procedures is often more offensive than the tattoo itself, the option of laser surgery is extremely desirable. As early as the 1960's, scientists began exploring the medical uses of lasers to correct birthmarks such as port-wine stain. Eventually, researchers determined lasers are effective in tattoo removal because heat generated from the beam breaks pigments in the cells of the dermis into small particles which can be absorbed by the body's immune system. The epidermis is "transparent," meaning that the laser travels through it and focuses on the exact level of the pigment. This chars the ink and it breaks down. The tattoo subsequently fades as immune cells attack the foreign particles. Patients liken the sensation of the laser to having hot grease splattered onto the skin, or being snapped with a rubber band. (2) One man reported that his skin smelled like pork chops following the procedure. (7)

The first lasers used for tattoo removal were the Argon and the CO2. They broke down the ink, but at the cost of the other layers of skin. Just as with abrasion and excision therapies, scarring was left in place of the design. (8) Only three lasers have been proven effective in breaking down ink without damaging the surrounding skin- the Q-switched Ruby, Q-switched Alexandrite, and most recently the Q-switched Nd: YAG. They are referred to as "Q-switched" because of the short, high energy pulses of light used in the procedure. (2) The Q-switched Ruby is the most commonly used laser for tattoo removal. However, the Q-switched Nd: YAG has been recently discovered to be more effective on colored tattoos and darker pigmented skin. The beam of light penetrates deeper which increases the amount of damage done to the epidermis. As a result, the surface layers of skin sometimes retain a permanent "frosted" appearance. (6) Research is still being conducted on which lasers are most effective, although it is generally acknowledged that a combination of all three Q-switched beams is necessary in most cases. (10)

The color of the ink and the quality of the tattoo also play a role in laser removal. Black ink absorbs all laser wavelengths which makes it the easiest to treat. Blue is also fairly easy while green and yellow are the hardest. (5) If a tattoo is done by an amateur artist, the ink particles are larger and may be contained on several layers of dermis. This increases the amount of exposure to the beam needed to produce the charring effect. A professional artist will typically have better control over the tattoo "gun" and distribute the ink more evenly and with more precision. (2) No matter what condition the tattoo is in, laser removal is a bloodless, low risk alternative. It is usually performed in several sessions on an outpatient basis.

Redness and swelling are common immediately following the procedure and the site may scab. (2) Side-effects are generally mild. There is a possibility of hyperpigmentation, an abundance of color in the skin at the treatment site, hypopigmentation, a lack of color at the site, or lack of pigment removal. The chance of permanent scarring is only 5 percent. (5)

Typically, having a tattoo removed is more expensive than getting one put on. The cost will range from several hundred dollars to several thousand based on the size, location, pigment color, and number of visits required. Medical insurance will not usually cover the expense because it is considered a cosmetic procedure. (2) However, there are a number of programs available to those who want to get rid of gang tattoos for free. (9)

The advent of laser removal in recent years has made more invasive techniques virtually obsolete. It is more effective, less painful, and results in less long-term skin damage. There is still some controversy surrounding which beams and wavelengths are most effective in different situations, but laser removal is unanimously regarded as the most expedient procedure..

References

1)www.howstuffworks.com, How Tattoo Removal Works

2)www.howstuffworks.com, How Tattoos Work

3)no-tattoo.com, Tattoo Removal, The Things You Did as a Kid, Cleaning up the Mistakes

4)www.topdocs.com, FAQ on Tattoo Removal

5)American Academy of Dermatology, Tattoo Removal Made Easier With New Laser Therapies

6)www.patient-info.com, Article on Tattoo Removal

7)www.thesite.org, Health and Fitness article on Tattoo Removal

8)Skin Laser Center, Article on Tattoo Removal

9)free tattoo removal programs offered to gang members

10)MedScape from WebMD, Abstracts on Tattoo Removal (note: I had to set up an account on MedScape to view these articles so the link might not work on all computers)


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