While most tattoos are no longer considered rebellious or extreme in today’s world, some people would still prefer to have a clean slate. In fact, survey results presented at an American Academy of Dermatology meeting earlier this year showed that 31 percent of tattooed people had some regret about their body art.1 Many times this regret stems from a change in mindset from the time the person got the tattoo (usually late teens or early 20s) to concerns about the tattoo having a negative effect in the workplace.
While we like to say, “Don’t judge a book by its cover,” that may not happen in real life. Recent research shows tattoos are something that employers take into consideration when looking at job applicants. When given the statement, “The best way to not get hired for a job is to exhibit one of the following qualities related to appearance,” nearly 61 percent of Human Resources managers surveyed by The Center for Professional Excellence at York College of Pennsylvania listed visible tattoos as a means for not hiring a potential employee.
Even so, not every person who seeks tattoo removal wants to remove all traces of artwork. Tattoo lovers also make up a big part of the tattoo removal market. Sometimes they run out of body parts to tattoo and maybe they want to remove several small tattoos to replace them with a large portrait. I see many clients who love tattoos so much, they want to get rid of the old ones so they can get new ones!

The Process of Tattooing

To understand tattoo removal, it is important to know how tattoos are created. Most professional tattoos are done with a mechanical needle that moves up and down in order to inject the desired ink pigment and stain the skin at the dermal level. The cells in the dermis are more stable than the epidermis, allowing the pigment to stay in place (if left uninterrupted).
Tattooing is regulated by state and local agencies – not the U.S. Food and Drug Administration (FDA); however, the FDA may get involved in regulation soon. The federal agency has received reports of irritation, infection and allergic reactions following some tattoo procedures, and they are investigating the common pigments used for tattooing. Another important fact to point out is that while tattoos have been around for centuries, the FDA has not approved any tattoo pigments for skin injection.
Tattoo parlors are not the only place people are being inked, and not all tattoos are done by professionals. Some tattoos you see may also be a result of amateur tattooing using India ink (a black indelible drawing ink) and a needle. There are also prison tattoos, which are done illegally behind bars. These tattoos are made with any number of improvised needles and pigments including paper clips and pen ink.

Tattoo Removal Options

To remove or fade unwanted tattoos, there are several options for the professional and even the consumer:

Faux-Removal – If your client is not 100 percent sure they want to remove their tattoo, you can suggest a number of tattoo cover-up creams or theatrical makeup options that can give them an idea of what they would look like without the ink. These creams are different from the traditional cover-up products you would typically find in the makeup aisle at the drug store. If your client likes the bare skin look, they should probably consider one of the permanent tattoo removal options.
Salabrasion – This method of tattoo removal has been around the longest. Salabrasion is a process of rubbing the tattooed area with salt and a wet gauze pad to remove layers of skin. Some people attempt this procedure at home, and as you can imagine, it is extremely painful. There is also the risk of scarring and infection. Additionally, this procedure may require a few days of downtime as the wound heals. Salabrasion typically needs to be performed multiple times to get significant results and there is no guarantee of full removal.
Dermabrasion – Dermabrasion is another tattoo removal procedure where skin layers are removed using a specialized tool similar to a sander or a metal wire (depending on the device). Oftentimes, the skin will be numbed using ice or a local anesthetic before starting the process. As layers of skin are being scraped off, there is the possibility of infection and scarring, and the tattoo may never fully fade. Additionally, dermabrasion will likely need to be repeated several times to achieve optimal fading, and there may be some downtime depending on the severity of the wound.
Surgery – Surgical excision and skin grafting are options for tattoo removal. For the excision procedure, a surgeon will remove the epidermis and dermis layers and stitch the area to enable the wound to close and heal. This procedure can cause scarring and it is best suited for smaller tattoos. To excise a large tattoo, several surgeries may be required.
Skin grafting is another surgical method that is used for tattoo removal. This procedure involves taking a piece of skin from another part of the body and sewing it over the tattoo. As the wound heals, the skin grows in conjunction with the natural skin. Skin grafting is often the most expensive procedure and requires the most downtime.
What about creams? I have never seen a cream, lotion or ointment that has been able to fade a tattoo – and neither has the FDA. The FDA has not approved any of these do-it-yourself treatments and has no clinical evidence that they work. The FDA also cautions that these items may cause unexpected reactions including rashes, burns, scars or irregular pigmentation.

Laser Tattoo Removal

Laser tattoo removal has become the gold standard for tattoo removal. It is the most commonly used treatment because it offers a low risk, highly effective treatment with minimal side effects. Laser tattoo removal works with a technique called explosive heating, which is done with a Q-switched laser. (A Q-switched laser is one where you can switch the “quality” of a resonator to produce millions of watts in nanosecond bursts.) This highly concentrated pulsing light is able to target pigment in the dermis. The light breaks up the tattoo pigment within the skin and splits it into tiny fragments that are flushed out through the body’s lymphatic system.
There are three types of Q-switched lasers: The Q-switched ruby laser, Q-switched alexandrite laser, and the Q-switched Nd:YAG laser. Each laser emits different wavelengths that work best for different tattoo pigment colors.
Q-Switched Ruby Laser – The ruby laser emits a wavelength of 694 nanometers, penetrating the skin by approximately one millimeter. The colors that are most responsive to the ruby laser are black, blue and green. Note: This laser does not work well on darker skin tones.
Q-Switched Alexandrite Laser – The alexandrite laser penetrates the skin more deeply than the ruby laser. Similar to the ruby, this laser also works best with black, blue and green ink. It emits a wavelength of 755 nanometers.
Q-Switched Nd:YAG Laser – The longest wavelength is emitted by this laser. The Nd:YAG laser has become the most widely used in laser tattoo removal today. While the 1064 nanometer wavelength is limited in its color range (it only works with black and dark blue), this laser includes a feature that allows the machine to also emit a wavelength of 532 nanometers. The shorter wavelength enables the same machine to treat red, yellow and orange tattoo pigments in a safe and effective manner.
As for the question of how long tattoo removal takes, it depends on whether you are talking about the treatment session itself or the full treatment regimen. The process of laser tattoo removal is quick. Depending on the size of the tattoo, a session can be over in a matter of seconds. However, clients must commit to a series of visits over several months to achieve the best results. Typically, the average client will need anywhere from 12 to 15 laser tattoo removal treatments to achieve significant fading or total removal, but each individual case is different. The success of the process can depend on several factors including a person’s body chemistry, overall health, the tattoo’s size and location, and the color of the ink pigments. Some people will be able to achieve full removal, while others may only receive partial fading. There is no way to guarantee 100 percent removal before starting the treatment regimen.
As for the pain involved, some clients report that the laser pulses feel like a hot rubber band snapping against their skin. Most people who have sat through the tattoo process can tolerate the laser removal process as well, but different clients have different pain thresholds. If you have a client who is not comfortable with the pain level, a topical anesthetic can be applied 30 minutes prior to treatment.
Even though the risk of side effects is low, make sure to give your clients post-care instructions to minimize any potential complications between treatments. Unlike the previous procedures mentioned in this article, the risk of scarring using a Q-Switched laser is very low – less than five percent.

Learning Laser Tattoo Removal

In most states, you do not need to be a medical professional to perform laser tattoo removal. With the proper training, anyone can learn to perform this procedure regardless of his or her previous professional experience. The industry standard for laser tattoo removal education is a course that includes classroom instruction and at least two days of hands-on training. If you would also like to learn other cosmetic laser modalities, such as laser hair removal, laser wrinkle reduction and laser vein reduction, a two-week course is typically the standard. Depending on where you live, certain hours of laser education may be required to perform these procedures – be sure to check with a national school that provides cosmetic laser training to learn about the rules and regulations where you live.

References
1 Medpage Today.

Shelley Cook is a clinical laser instructor and tattoo removal specialist at National Laser Institute school of medical aesthetics. On a monthly basis, she teaches aestheticians, medical professionals and others how to perform safe and effective laser tattoo removal treatments.