Tired of tattoos?

by Mary Mihaly

Remember that oh-so-cool tattoo you just had to have that summer at the beach? Used to be that you were stuck with it, even after the coolness wore off. But thanks to advances in plastic and laser surgery, even the most recalcitrant tattoo can be removed.

There was a time when tattoos were the epitome of style--James Dean style, that is. They were the symbol of rebellion, a rite of passage for young men who wanted to strut and impress people. Bikers had tattoos, sailors had tattoos...even actress Demi Moore sports one. Angels, lions, eagles, sweethearts and yes--even Mom--are just a few of the artistic creations displayed on tattooed arms, thighs, butts, backs, or fronts.

Such permanent expressions of loyalty or love are hardly new; archaeologists have found tattoos on mummies thousands of years old. The imprint is made by injecting colored ink into the skin, one tiny hole at a time, until the holes gradually form a design. Some tattoo artists have undergone formal training, even serving a lengthy apprenticeship with an experienced tattoo expert; others, known as "scratchers," are self-taught and may or may not adhere to accepted hygienic practices of the industry.

For many, tattoos are no longer fashionable. "Supposedly, there are 20 million people with tattoos in this country," says Kenneth Arsham, M.D., medical director of the Meridia Laser Center in Cleveland, Ohio, "and half want them removed."

But it isn't only bikers and soldiers who want tattoos removed. Arsham sees college students who come to him a week after being tattooed, immediately regretting the decision. Another one of his patients was a concentration camp survivor who wanted his Nazi identification number removed. "It's not that he wanted to forget," Arsham says. "People kept asking him: 'what was it like?' He just wanted not to be asked anymore."

J. Sheldon Artz, M.D., Arsham's colleague, commented in Vim & Vigor magazine on the diversity of patients who want tattoos removed. "I sometimes treat [former] prisoners," he said, "now rehabilitated. They've found that by enhancing their self-image, they do better in the outside world. For example, if they have to play golf with the boss and expose a tattoo, they are embarrassed; they feel their professional credibility is diminished."

Almost every method of tattoo removal leaves at least a faint blemish on the skin; scarring depends on the tattoo's colors, size, depth and age. An experienced artist's tattoo is sometimes easier to remove because the ink was injected at a relatively consistent depth throughout the design. Blue, black and red inks leave the least residue in the skin. Purples and oranges also remove well, but green and yellow pigments may not disappear altogether.

More than 100 tattoo inks are available to artists--none of which are regulated by the Food and Drug Administration--so a physician's attempts to "erase" any person's body art always involves some educated guesswork. "With amateur tattoos, you don't know if the dyes are iron-based, titanium-based or what," Dr. Arsham says.

Until recently, getting rid of an unwanted tattoo was an ordeal, too painful for even the toughest to tolerate. Thanks to laser technology, however, tattoos are no longer permanent--for anyone.

The great cover-up

"If you like being tattooed but just don't like the particular tattoo(s) you have, consider getting a cover-up," writes Michelle Delio in her book, Tattoo--The Exotic Art of Skin Decoration. Years ago, artists routinely used larger, darker tattoo designs--black clouds with lightning, black panthers, even peacocks--to "cover" old tattoos. Today, for those who want to keep a tattoo, lighter alternatives to those dark designs are available.

Cut it out.

Excision--or surgical removal--works best with small tattoos. The surgeon injects a local anesthetic to numb the immediate area and literally cuts out the tattoo. The edges of skin are then pulled together and stitched. Bleeding is minimal and is controlled by cauterizing the blood vessels. When a person chooses excision for removing a large tattoo, it may be necessary to graft skin from elsewhere on the body to cover the wound.

Rub it off with dermabrasion.

The word means "abrasion of the skin," and that's the actual process: the physician "freezes" part of the tattoo with a spray anesthetic, then "sands" the tattoo with a rotary abrasive gadget that peels away the skin, layer by layer. This method of removal generally causes more bleeding than other techniques.

Salabrasion--ouch!

This centuries-old procedure sounds brutal--and probably is. After a local anesthetic is provided, a solution of ordinary tap water and table salt is applied to the tattoo. Then, an abrasive machine such as the rotary "sander" used with dermabrasion--or even a simple wooden block wrapped in gauze--is used to vigorously rub the tattoo until the skin rubs away.

Lose it with lasers.

Lasers have been used to banish birthmarks and other blemishes for decades, but it's only recently that new lasers have been able to recognize specific colors in skin so they could be selectively obliterated without leaving a scar.

Several varieties of lasers are used for tattoo removal. The most common is called a "ruby laser;" another, called Medlite, is popular for removing red inks. "On the average, professional tattoos require six to 10 treatments [for complete removal], while amateur tattoos require three to four treatments, all spaced approximately six to eight weeks apart," writes Jeffrey Rapaport, M.D., of Fort Lee, New Jersey, on his "Laser for Tattoos" web site. Professional tattoos require more treatments because the ink is less concentrated and has been injected deeper into the skin.

During each treatment, which can last from 15 to 45 minutes, the laser delivers light in very short, high-intensity "pulses" onto the skin, heating and literally breaking up the inks until they are carried away by the body's immune system. The sensation from the laser is a little like a rubber band snapping against the skin, Dr. Arsham says, or like tiny bacon splatters. He knows exactly how it feels because he treated himself with the same lasers to remove his own sunspots. Occasionally, physicians use a local anesthetic, especially when the tattoo is located in a sensitive area.

A thin scab typically forms on the treated area. Afterwards, the treated area feels like it is slightly sunburned, but the discomfort should disappear after a day or two. In darker-skinned people, melanin--the skin's natural pigment--also absorbs laser energy, and the treated area becomes temporarily lighter than the surrounding skin.

Health insurance rarely covers tattoo removal, which, using lasers in a hospital setting, can cost up to $500 per treatment. Michelle Delio, contributing editor to Tattoo Magazine, has the best advice: "Check with a plastic surgeon for a more in-depth discussion of your options... Of course, if you remember to think before you ink, you'll never have to worry about the expense and pain of getting rid of an unwanted tattoo!"