The Body: Tattoo Removal

Tattoo removal presents a difficult scenario to the treating physician. Tattoos may be accidental, caused by dirt or foreign material being driven into a wound, or they may be purposely applied in either an amateur or professional setting by using a varied number of inks and techniques. Successful removal of the latter type of tattoo is dependent upon its cause, size, method of placement, and type of pigment.

Very small tattoos that seldom "show" are often best treated by simple excision and closure. A scar will result, but the scar is often less objectionable than the tattoo itself.

Historically, physicians have treated larger, multicolored, purposely applied tattoos in two ways:

• Dermabrasion--sanding the skin down below the level of the tattoo ink
• Carbon dioxide laser vaporization of the entire tattooed area

In most patients, these treatments result in objectionable scars.
Today, Mayo physicians remove tattoos with a type of laser known as a Q-switched YAG laser. This laser fires a very intense beam of light, either invisible or green-colored, into the tattoo in a very rapid burst. This heats the pigment within the tattoo and triggers its eruption from the skin. The laser color is chosen dependent upon the color of the ink--certain colors, like fluorescent yellow, are extremely difficult to remove.

The procedure time varies from 15 to 45 minutes, depending on the tattoo size and the area treated. Topical anesthesia is occasionally used depending on tattoo location, size and the patient's tolerance for the brief burning discomfort associated with each laser burst. Oral or intramuscular sedation can be used at the patient's request.

Following treatment, the wound may ooze small amounts of blood for several hours. The wound must be covered with a dressing for 24 hours and maintained in a moist environment for seven to 10 days.

The risks of scarring with this treatment are quite low. However, complete eradication of the tattoo is quite rare. Although multiple treatments are usually required to obtain successive lightening of the tattoo, final results are dependent upon the depth of the tattoo pigment within the skin. On rare occasions, certain uncommon tattoo inks react with the laser to form a darker-colored chemical which is untreatable.

While some small amounts of pigment may remain, the average patient is quite happy with the improvement obtained. Although multiple treatments are required, the risk of the procedure is quite low.