Tattoo Removal The history of tattooing is a long and varied one. "A tattoo is a permanent mark or design made on the body when pigment is inserted into the dermal layer of the skin through ruptures in the skin's top layer." ("How Tattoo Removal Works," 2004). A more recent development in this area, however, is the issue of tattoo removal. Only recently have advances in technology made it possible to effectively remove a tattoo. The process of tattooing, which inserts ink deeply into the layers of the skin, has traditionally made it very difficult to get rid of a tattoo once it's been applied. Modern techniques for tattoo removal include; dermabrasion, salabrasion, excision (surgical removal) and laser removal. There are also less thorough methods for covering a tattoo such as scarification or tattoo modification. Currently, the most favoured method of tattoo removal is laser removal, as it leaves little scarring and is very effective, although multiple laser treatments are often required.

There is evidence of tattooing throughout many cultures across the world and through history. The word "tattoo" itself comes from a Tahitian word for "marking something." ("Tattoo History," 2004). The practice of tattooing dates back at least to the Egyptians, and probably earlier. There is evidence of tattooing around the time of the construction of the Great Pyramids and Egyptian mummies show signs of bearing tattoos. ("Tattoo Removal," 2000). Women in Borneo used to tattoo their skills, such as "weaver" on their arms. In ancient Greece, tattoos were used to mark spies, and in Roman civilization, criminals and slaves were marked with tattoos for identification. Polynesian communities used to use tattoos to indicate family membership and rank. This tattooing made its way to New Zealand, where a distinct style of facial tattooing ("Moko") still exists among the aboriginal community today. In western civilizations, tattooing was part of certain ceremonies and was used in Britain until 1066, when the Norman invasion effectively ended the practice. "The Normans disdained tattooing. It disappeared from Western culture from the 12th to the 16th centuries." ("Tattoo History," 2004) (Although Pope Hadrian banned the use of tattoos in 787 AD, they were still around until the 11th or 12th century).

While the practice of tattooing waned in the west, in Japan it became extremely popular. This was a result of a royal edict that said only royalty could wear ornate clothing. Tattooing surged among the middle classes in response to this decree. ("Tattoo History," 2004).

The exploration of the South Pacific, where tattooing was still an important part of the culture and ritual, reintroduced tattoos to the west. The first electric tattooing machine involved a pen-like instrument which rapidly penetrated the skin and injected the tattoo ink into deeper skin layers. This device received a patent in 1891, and made tattooing easier, less expensive and less painful. ("Tattoo History," 2004).

Today, tattooing in North America is primarily to denote gang or other group affiliations, or just for body decoration. Since both these reasons are subject to changing tastes and circumstances, there has developed a demand for a reliable way to remove tattoos. It is also a fairly popular phenomenon, as some estimates say that one in seven North Americans have a tattoo. ("Tattoo History," 2004). The process of tattooing involves injecting dye or pigment into deep punctures made into the skin. Because the tattooing process is relatively permanent, the ways to remove tattoos are fairly invasive. Results of tattoo removal attempts can also be quite variable. For most tattoos that a person tries to have removed, some scarring or pigment retention will remain.

Various factors affect how successfully a tattoo removal may be. Some individual factors can't be predicted, such as healing ability. If the tattoo artist was more experienced, the removal may be more successful, as it is likely that the dye will have been injected to the same skin depth. If the tattoos have been in place for quite a while, removal may be easier than for new ones. Other things may also influence the result, such as tattoo size, colours used, and where on the body the tattoo is located. There are currently around a hundred different tattoo inks available, with yellow and green being the most difficult to remove.

One technique used for tattoo removal is complete surgical removal, or excision. Excision involves the cutting out of the skin that has the tattoo and removing it completely. For this reason, excision is used when the tattoo is relatively small. This method offers the advantage of removing the...

However, the surgical excision of a tattoo can be painful, and the scarring is often more pronounced than for other methods.
Excision may also be used for larger tattoos, however this must be done in stages. The surgeon begins by removing the centre of the tattoo. When this has healed over, the sides of the tattoo may be removed, usually in several more steps.

The surgical removal of a tattoo begins by the surgeon injecting a local anaesthetic into the area to be excised. The tattoo (or portion of a tattoo) is cut out with a scalpel and the skin edges are sutured together. Since the incision is not very deep, tattoo excision doesn't bleed a lot. What bleeding there is, is controlled with cauterization.

Excision is a popular method to remove smaller tattoos, although larger segments of skin, as mentioned, may have to be removed in stages. For a very large excision, the surgeon may use a skin graft to speed healing.

Another method that is used by physicians to remove tattoos is known as dermabrasion. In dermabrasion, the skin is sanded, and the tattoo is effectively rubbed out of the skin.

Dermabrasion is also usually done in several physician visits, since the process is quite precise and the abrasion process time-consuming. (Although, like excision, smaller tattoos may be done all at once.) In this technique, the doctor begins by (usually) spraying a freezing solution onto the area to be sanded. A surgical rotary sander is then used to abrade the surface and remove the upper layers of skin. This makes the pigmented area more accessible. Dressings are applied and the combination of abrasion and dressings serves to remove the tattoo ink from the flesh.

Dermabrasion, like excision, carries more risk of scarring, and since the procedures are more invasive, infection must be considered as well.

Salabrasion is a related technique, where the skin is abraded and then a dressing is applied. Like dermabrasion and excision, the physician first applies a local anaesthetic to the tattooed area. After the area is frozen, a solution is applied that is made up of water and table salt. This solution aids the abrasion process. The doctor may then use the same tool used for dermabrasion, a rotary sander, to rub off the outside layers of skin. This makes the lower skin layers more accessible, where the tattoo ink is located. Dressings are applied and changed regularly until the area heals, and, if necessary, more treatments are performed.

Salabrasion is an old technique for tattoo removal. Historically, a wooden block with a sterile cloth wrapped around it would be used to abrade the area. The use of salt in the solution would help fight infections before more modern antiseptic ointments were available.

All the above methods, however, may result in scarring of the tattooed area. A popular method for tattoo removal that minimizes scarring is the laser treatment.

Laser stands for Light Amplification by the Stimulated Emission of Radiation. "Pulses of light from the laser are directed onto the tattoo breaking up the tattoo pigment. Over the next several weeks the body's scavenger cells remove the treated pigmented areas. More then one treatment is usually necessary to remove all of the tattoo." ("Tattoo Removal," 2000).

The permanence of tattooing is based upon the fact that the tattoo pigment molecules are too big to be carried away by the body's systems. Lasers work by making smaller ink molecules, so the body may carry them away.

A specialized laser technology was developed, known as Q-switching, for the removal of tattoo ink. This Q-switching refers to the light pulses that are emitted by the laser. Today, laser tattoo removal is mostly done with three types of specialty lasers; the Q-switch Ruby, the Q-switch Alexandrite, and the Q-switch Nd:Yag. Research has been done to determine the appropriate wavelength for the laser to maximize absorption by the pigment. The laser emits pulses of high-energy light. These light waves pass through the upper layers of the skin without damaging it, and target the tattoo ink molecules. By absorbing this high-energy light, the ink molecules break apart into much smaller fragments. These smaller fragments then stimulate the body's immune system to remove what remains of the tattoo.

Laser tattoo removal is done with or without an anaesthetic, as it is much less invasive that other methods. If aspirin is taken prior to laser treatment, extensive bruising may occur. For this reason, Tylenol is recommended for any pain relief required in the days prior to laser treatment.…