Having a tattoo you hate used to be a real problem. Until lasers became widely accessible, it was very difficult to remove them.
How tattoos are done
To understand tattoos, you have to know about the structure of your skin. It has two layers.
The outer layer is the epidermis. This is the layer that is constantly being shed and renewing itself. The new cells are formed deep in this layer. They then take about 14 days to move gradually to the surface, pushed upwards by even newer cells forming beneath them. They remain for about another 14 days at the surface before being shed. So it takes roughly 1 month for the epidermis to renew itself completely.
The under layer is the dermis. This contains elastic tissue, blood vessels, sweat glands, nerve fibres and hair follicles. The dermis is relatively static, and does not renew itself like the epidermis.
Tattooists use a machine with one or more needles connected to tubes containing dye. As the tattooist guides the machine over the skin, the needles move up and down, penetrating the skin by a couple of millimetres and depositing particles of dye in the under layer of the skin (dermis). Over time, the body seals the dye particles with a protective wall of collagen protein. Because the dermis does not renew itself, the dye will remain there forever.
‘Five-year tattoos’ are offered by some hairdressing salons and market stalls. (Professional tattoo studios will not have anything to do with them.) They claim that they place the ink only in the epidermis, and that they will be shed in 3–5 years.
It is unlikely that they will disappear in 5 years. If the ink really was only in the epidermis, it would be shed in a few weeks and the tattoo would be gone. In fact, some of the ink will be placed in the more static tissue of the dermis like any other tattoo, and is likely to be permanent.
‘Black henna tattoos’ are popular in South East Asia, especially among tourists. They are not really a tattoo. They temporarily dye the skin using henna dye, which has been made darker by adding a chemical called PPD (paraphenylenediamine). PPD is in many fabric dyes and some hair dyes.
Problems with tattoos
Allergy. Very occasionally, an individual is allergic to one of the pigments used. There will be swelling and itching, often in the red part of the tattoo. Allergy may not occur immediately and may develop months or even years after the tattoo was done.
The dyes used in tattooing are industrial pigments that were originally produced for other purposes, such as car paints and writing inks. Their safety in skin has never been properly investigated.
Deep damage. A deep tattoo is actually similar to a full thickness burn. The British Medical Journal reported a case where a tattoo around the arm contracted like a tourniquet within a few hours, and prevented circulation in the arm (British Medical Journal 2006;333:52).
Cases of hepatitis B infection as a result of tattooing have been reported. Theoretically, HIV and hepatitis C
could be caught if contaminated needles were used. This is why, in the UK, you cannot donate blood for 1 year after having a tattoo.
If you have to go into hospital a tattoo can sometimes be a problem. For example, an epidural (for painless childbirth and other procedures) involves an injection in the lower back. Doctors worry about giving this injection through a tattoo in case the ink gets into the fluid around the spinal cord, and so they usually have to cut the skin first.
Wishing you had not had it done. There is now a greater appreciation of the real distress that an inappropriate tattoo can cause – having an obvious tattoo can be a real disadvantage in the job market.
When doctors in Wales questioned patients who wanted tattoos removed, they found that a quarter had regretted their tattoo within a month of having it. Over 70% had been below the legal age of 18 when it was done and, on average, they had endured 14 years of embarrassment before deciding to get it removed. The journalist Carol Midgley points out that having a tattoo is saying you will always be the same person that you are today, and that it is ‘like never being able to remove the Bay City rollers scarf that you wore in 1977 aged 11 even when you are 63’.
Researchers in France questioned 150 people who wanted their tattoos removed, and asked them why. There were many reasons: they no longer liked the look of the tattoo; social and employment reasons; pressure from family or partner; change of lifestyle or partner; and the tattoo not fitting in with present attitudes and values (Journal of the European Academy of Dermatology and Venereology 2010;25:181-7).
Ways of removing tattoos
In some areas of the UK, you cannot have your tattoos removed under the National Health Service (NHS). In a few parts of the UK, the NHS will remove tattoos if they are on exposed skin (such as the hands and face), and are interfering with your chance of getting a job. Private treatment is most likely. As with all cosmetic procedures, take care when you choose a private clinic.
Laser removal of tattoos breaks the ink down into tiny particles that scavenger cells in the skin can digest. A special type of laser that emits light energy in very brief pulses, each lasting only nanoseconds, is used. This keeps heating of the surrounding skin to a minimum, making scarring less likely. Each session will take 15–45 minutes, depending on the size of the tattoo. Afterwards, the area may ooze some blood for several hours and needs to be covered with a dressing. Treatments are usually given every 6–8 weeks, and more than 20 treatments will usually be needed if the tattoo was done professionally. (Amateur tattoos can often be removed with only one or two treatments.) The cost is likely to be several hundred pounds.
It is quite rare for the tattoo to be completely removed by laser treatment and traces of it will probably remain. Successful removal depends partly on the colour of the tattoo – complicated multicoloured tattoos are more difficult to deal with.
The ‘ruby laser’ works best against blue-black and green tattoos, but is not much help against red, yellow and orange.
The ‘Nd-YAG’ laser is used against blue-black and red tattoos, but green and light blue colours do not respond well.
The alexandrite laser is used for blue-black and green tattoos.
Tattoo-removing-cream injections are offered by some private clinics. A special cream (Rejuvi) is applied with an injection machine, in a similar way to the original ink. The cream contains deionized water, zinc oxide, magnesium oxide, calcium oxide, isopropanol, triethanolamine and benzoic acid. It is said to bond to the colour pigments in the skin, and both are rejected by the healing process of the skin to form a scab, which peels off after 10–20 days. Any colour tattoo can be treated. It has to be done by a skilled person, to ensure that the skin is not punctured too deeply. Several treatments are needed, with several weeks between each, so the cost is likely to be several hundred pounds (British Journal of Dermatology 2004;151:1282–3).
Excision involves cutting out the area of skin that bears the tattoo. It may be the only way of removing a deep, clumsy tattoo not done by a professional tattooist. Surgery for large tattoos is likely to cause scarring and may need skin grafts.
In some cases, the surgeon may use a technique called ‘tissue expansion’. Inflatable balloons are placed under the skin to stretch it before removing the tattoo. This procedure can take several months (Pulse 2004;63(5):48–9).
Salabrasion. A salt solution can be rubbed into the tattoo to damage the skin, until the pigment is extruded. This technique is seldom used nowadays. It sounds homely, but do not try it yourself – it must be done by someone experienced in the technique.
Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Sunday, September 4th 2011
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