Something to think about BEFORE you get that tattoo is the fact that having a tattoo removed is much more expensive than having one put on. Laser tattoo removal can range from several hundred dollars up into the thousands of dollars, depending upon the size, type and location of the tattoo and the number of visits required. More bad news is that medical insurance generally doesn’t pay for tattoo removal, since it is considered aesthetic or cosmetic in nature. (Traumatic tattoos, which result from accidents or injury, are a different matter.)

Because this is a medical procedure, make sure to see a dermatologic surgeon who specializes in tattoo removal. Check with the American Society for Laser Medicine & Surgery or the American Society of Dermatologic Surgeons for a referral or ask your own doctor for the name of a specialist in your area. (Some tattoo parlors also provide tattoo removal services. Before you sign on, make sure the person doing the removal is a medical doctor who specializes in laser surgery! Tattoo removal, like tattoo application, carries with it the risk of infection and must be handled with extreme care.)

If you’re a young person trying to escape gang life and you don’t have the money to get those tell-tale tattoos removed, your tattoo doesn’t have to last forever. Check this out: Some generous doctors, hospitals and local governments and civic groups around the nation are offering free tattoo removal to give teens like you a new chance at life. These links discuss several of these efforts:

The unfortunate thing about tattoos is that both getting them and having them taken off can be uncomfortable. The impact of the energy from the laser’s powerful pulse of light has been described as similar to getting hot specks of bacon grease on your skin or being snapped by a thin rubber band. (Compare these descriptions to those of how it feels to get a tattoo in How Tattoos Work.) Because black pigment absorbs all laser wavelengths, it’s the easiest to remove. Other colors, such as green, selectively absorb laser light and can only be treated by selected lasers based on the pigment color.

In preparation for a laser procedure, doctors recommend that non-aspirin products, like Tylenol, be used for minor aches and pains prior to the procedure, because aspirin and nonsteroidal anti-inflammatory agents such as Ibuprofen can produce pronounced bruising after treatment.

Further pre-treatment steps might include the application of a prescription anesthetic cream two hours before the laser session. It is wiped off just before laser surgery begins. (Some patients say they don’t need this. Others prefer to have a local anesthetic injected into the tattoo prior to laser therapy. Pinpoint bleeding is sometimes associated with the procedure.) Then pulses of light from the laser are directed onto the tattoo, breaking up the pigment. Over the next few weeks, the body’s scavenger cells remove pigment residues.

More than one treatment, which actually only takes minutes, is usually needed to remove an entire tattoo — the number of sessions depends on the amount and type of ink used and how deeply it was injected. Three-week intervals between sessions are required to allow pigment residue to be absorbed by the body.

Following treatment, the doctor will apply an antibacterial ointment and dressing to the area, which should be kept clean with continued application of ointment as directed by your doctor. A shower or bath the day after treatment is okay, but the treatment area should not be scrubbed. Your skin might feel slightly sunburned for a couple of days and the treated area may remain red for a few weeks. The site might also form a scab, which should be handled gently. After healing, the site will gradually and continually fade.

Side effects of laser procedures are generally few but may include hyperpigmentation, or an abundance of color in the skin at the treatment site, and hypopigmentation, where the treated area lacks normal skin color. Other possible side effects include infection of the site, lack of complete pigment removal and a 5 percent chance of permanent scarring.

Before lasers became popular for tattoo removal starting in the late 1980s, removal involved the use of one or more of these often-painful, often scar-inducing surgeries:

• Dermabrasion, where skin is “sanded” to remove the surface and middle layers;

  

• Cryosurgery, where the area is frozen prior to its removal;

  

• Excision, where the dermatologic surgeon removes the tattoo with a scalpel and closes the wound with stitches (In some cases involving large tattoos, a skin graft from another part of the body may be necessary.).

  

Although the procedures above are still used in certain cases today, lasers (Light Amplification by the Stimulated Emission of Radiation) have become the standard treatment for tattoo removal because they offer a bloodless, low risk, effective alternative with minimal side effects. Each procedure is done on an outpatient basis in a single or series of visits. Patients may or may not require topical or local anesthesia.

As early as the 1960s, lasers had been developed for industrial uses. When researchers developed lasers that emitted wavelengths of light in short flashes called pulses, medical use became viable. These lasers can effectively remove tattoos with a low risk of scarring, according to the American Academy of Dermatology . The type of laser used to remove a tattoo depends on the tattoo’s pigment colors. (Yellow and green are the hardest colors to remove; blue and black are the easiest.)The three lasers developed specifically for use in tattoo removal use a technique known as Q-switching, which refers to the laser’s short, high-energy pulses:

• the Q-switched Ruby,
• the Q-switched Alexandrite,
• the Q-switched Nd: YAG, the newest system in this class of lasers and particularly advanced in the removal of red, blue and black inks

Most dermatologic surgeons caution that complete tattoo removal is not possible. Tattoos are meant to be permanent, so removing them is difficult. Few surgeons guarantee complete removal. Having said that, there are several methods of tattoo removal which have proven effective. The degree of remaining color variations or blemishes depends upon several factors, including size, location, the individual’s ability to heal, how the tattoo was applied and how long it has been in place. For example, a tattoo applied by a more experienced artist may be easier to remove since the pigment was evenly injected in the same level of the skin. New tattoos may also be more difficult to remove than old ones.

Doctors say they can’t predict the exact degree of removal because they generally don’t know which of the 100 tattoo inks available today were used. (The U.S. Food and Drug Administration currently lists tattoo pigments as “color additives,” which are intended only for application to the top layer of the skin.) Consult with a removal specialist — be sure to take a list of questions along

If you decide to get a tattoo, begin with the end in mind. you may want it forever, or you may hate it a month from now. certain colors are tough to remove such as greens and blues so you want to be 100 percent sure you want this tattoo. This may mean thinking about your career goals, family life (pregnancy, children, etc), personal style and taste flucuations and see if the tattoo you are considering today would still fit into your life 10-20 years from now.

Do your research before you choose a tattoo artist – make sure they use safe materials and ask your friends if they’ve had a good experience with them. Ask to see photos of previous work and ask how long the artist has been a tattoo artist. Make sure the artist is willing to spend some quality time with you and your design so that you both know exactly what you are wanting. getting a tattoo removed because the job was not done to your satisfaction isn’t as good as getting it right the first time around.

Do your research before you choose a tattoo parlour- make sure they use sterile products for tattooing. Ask if they have an autoclave to sterilize their tools and make sure the shop looks very clean and professional. consider whether or not the other clients in the shop appear to be having a good experience. Ask how long they have been in business. Stay away from the shops that tend to herd people in and are more interested in mass production of tattoos versus quality work.

Understand that Tattoo Removal Isn’t Overnight

Tattoo removal doesn’t magically make a tattoo disappear. Laser tattoo removal is a highly-effective procedure that is the only proven method of removing a tattoo. Most tattoos will need three to ten treatments to remove. A number of factors affect the number of sessions (generally spaced four to six weeks apart) that will be needed to remove a tattoo:

The age of the tattoo: older tattoos are easier to remove than new tattoos. Over the years, the ink in a tattoo with fade from exposure to sunlight as well as the body’s attempts to remove ink particles, albeit mostly without success.

When you consider removing a tattoo, look for a clinic or medical practice that either specializes in laser tatto or does a high volume of these procedures such as a dozen a day. Some clinics may add laser tattoo removal to their practice as an after thought and only do a handful of treatments a month and may not be able to give you the quality results you deserve.

Ask how long the clinic or medical practice has been in practice. Ask how long they have offered laser tattoo removal. Some clinics may have recently added this procedure to their list and may not have as much experience in the one important laser treatment you are interested in.

Make sure the clinic uses a Q-switched laser and that it looks modern and somewhat sleek vs. huge and old. This type of laser delivers the energy quickly and allows for the best results for tattoo removal. Q-switched lasers are the only lasers that should be used for laser tattoo removal.

Ask questions about the type of Q-switched laser and what colors they are able to remove. Nd:YAG is the industry standard. Alexandrite and Ruby lasers are great for some common colors, but weak at other common colors.

Make sure the clinic asks for your medical history and be cautious if you have certain conditions. Tattoo removal should not be undertaken by women who are pregnant or breast feeding, people on chemo or radiation therapy, people taking medications that may cause sensativity to light such as accutane, or people who have immune system conditions.

Ask about what side effects you’ll experience before you start your procedure. Knowing these ahead of time and preparing yourself mentally makes the experience better. If you know that your skin will be somewhat swollen and possibly blistered after your procedure, you are less likely to be so concerned that you won’t attend your next treatment.

During your procedure, be sure to wear eye goggles to protect your vision. The medical clinic should have these available at the office for your use. You do not need to purchase or bring your own.

Your tattoo removal clinic should give you a list of aftercare instructions to take home with you after your laser treatment, or at the very least review in detail these instructions at your office visit. The aftercare instructions should include details such as: for how long should you keep the area covered, how long and what kind of antibiotic ointment should be used, guidance on how to care for the area in water and sun, and many other issues.

These aftercare instructions will provide the guidance and clarity that the patient will appreciate – if you aren’t surprised after having a medical or cosmetic procedure, you are much more likely to return for future treatments and achieve your goals of removing your tattoo completely.

There are three main layers to the skin: the epidermis, dermis, and subcutaneous layer.

Epidermis – the outermost layer serves as the first layer of defense against the outside world. Cells at the surface are dead, and they fall off and away as upward pressure is applied by continuously multiplying cells in the lower epidermis

Dermis – provides the skin’s structural integrity, elasticity, and resilience; includes fibroblasts, capillaries, lymph nodes, sweat glands, hair glands, but only a few nerves and muscle cells

Subcutaneous tissue – the thickness varies greatly; mostly fat or adipose cells, protects the body from cold and mechanical trauma

Our skin contains three major chromophores that absorb the wavelengths of light that are used in laser tattoo removal.

Melanin: gives skin its tone or color. Darker skin has more melanin. Patients with darker skin types (Types IV-VI) may experience some destruction of melanin when the 1064nm light is absorbed, but it will re-generate by itself.

Hemoglobin (blood): absorption of energy especially by 532nm may lead to purpura (redness, bruising)

H20 (water): absorption low for 532nm, very moderate absorption for 1064nm

Previous laser used for tattoo removal (inc. CO2 lasers operated at a wavelength that led to massive absorption of energy by H20 and vaporization (and scarring) of the skin.

How q-switched lasers interact with tissue

When energy absorbed by tattoo pigment or shattered by photo-acoustic effect, there is a fragmentation of ink particles to 10x to 100x smaller.

Laser-induced optical property changes: particles change from clear to black.

Release of pigment particles into the extracellular dermal space.

Partially elimination of ink in a scab form but greater elimination into the lymphatic system.

Re-phagocytosis of laser-altered residual tattoo ink particles.

When laser light reaches the stratus corneum and epidermis, a number of paths are available to the light. Some reflects off from the outmost layer of skin; other penetrates into the epidermis and dermis and then is reflected. One technique used in all laser treatments is to hold the laser handpiece is such a way that minimizes this wasted energy lost to reflectance.

Other laser energy penetrates into the epidermis and dermis and reaches chromophores such as tattoo ink particles and is absorbed. It is this absorption that excites the particles leading to a rapid increase in temperature and the shattering of tattoo ink.

Phagocytes are cells found in the blood, bone marrow, and other tissue that ingest pathogenic and infectious agents in the body.

Phagocyte comes from the Greek word phagein, meaning to eat or devour

Many sub-categories (inc. neutrophils seen in the picture to the right devouring anthrax) that perform different tasks but in general these helper cells will help to flush away shattered tattoo particles.

Stimulating phagocytes may be possible with powerful immune-modifying topical drugs such as Imiquimod, but with potentially serious side effects that make it a poor choice for a cosmetic procedure such as laser tattoo removal.

Skin type matters because darker skin (Types IV or higher) may be more likely to experience hypo pigmentation or keloid scarring.

These patients will want to start with lower fluence (energy) levels than other patients with subsequent evaluation to see how skin reacts to treatment.

Hypo pigmentation with few exceptions is a short-term side effect, with full pigmentation returning within a few months, potentially necessitating a delay of future treatments to allow these re-pigmentation.

Type I: Always burns; never tans

Type II: Burns easily, tans minimally

Type III: Burns moderately; tans gradually to light brown

Type IV: Burns minimally; always tans well to moderately brown

Type V: Rarely burns; tans profusely to dark brown

Type VI: Never burns; deeply pigmented

Redness: the body’s immune response involves blood and its components arriving at the site of a stimulus

Tenderness

Swelling

Bruising

Blistering: likely the most significant side effects; blisters can be raised and cover up to the entire area of the tattoo; part of the normal healing process. These blisters are only an expansion of the very outermost layer of skin and will not lead to scarring. They can be filled with fluid that can take the color of the ink being removed. Helpful to the healing and tattoo removal process.

Scabbing: can occur is there is any pinpoint bleeding or blistering encounterd. These scabs should be kept on the skin for as long as possible because they will draw out ink from the tattoo.

Hypopigmentation: loss of color in skin because of destruction of melanin; a temporary condition that resolves itself within weeks or months as melanin is reproduced and skin color returns; somewhat prevalent in Skin Type V and VI (especially those of African descent)

Hyperpigmentation: over-production of melanin as system over-responds to the absorption of energy by melanin; rare but possible in Skin Type IV and V (especially those of Hispanic descent)

Patients that should not be treated

Pregnancy, or a patient trying to become pregnant. There is an unknown but possible risk of transfer of ink to fetus. Additional slight risk of miscarriage due to stress of procedure.

Breast feeding, again because of unknown but possible risk of transfer of ink to baby.

Chemotherapy within last 6 months because of sensitivity to light and compromised status of immune system.

Accutane within last 6 months.

Sunburned skin in area of tattoo

Patients to exercise extra precautions or care with

Allergic reaction to ink, primarily red tattoo ink, may lead to increased chance of anaphylaxis. Either should not be treated or patient should take Claritin or Benadryl prior to treatment and for at least 3 days while they are healing.

Skin types IV or above because of increased chance of hypo or hyperpigmentation and scarring.

History of keloid scarring because of increased chance of further keloid scars.

History of hyper or hypopigmentation

Antibiotic use may cause an increase sensitivity to light.

Other Conditions to Consider

Chronic disease (ex. Diabetes> because of delay in healing. These patients may need longer between treatments to heal fully.

Older clients may also take longer to heal.

Immuno-comprised patients (ex. HIV, AIDS, Arthritis, Allergies) may take longer to heal or not flush out ink as well as other patients.

In general, a patient’s first few treatments will result in more significant side effects that later treatments. Once the amount of ink in the tattoo has decreased, the immune response associated with the treatment will be less obvious. Additionally, the patient will be more conditioned to the treatment.

Cover area with bandage for three days

Apply antibiotic cream (Neosporin or triple antibiotic ointment) every 8 hours for three days

Let area dry out after three days so that it will heal faster

Do not soak in water until all blisters and scabs are completely healed

Okay to shower but patient should keep treated area out of water as much as possible

Patient should return for follow up treatment after 4 to 6 weeks.

Laser is an acronym: LASER

Light

Amplification

Stimulated

Emission

Radiation

LASER means “Light amplification by the stimulated emission of radiation”, which means spatially coherent light emitted after the simulation of something.

The substance (lasing medium) that is stimulated ranges widely from gases to solids to liquid. The light that is emitted can be a range of visible colors or invisible wavelengths. Lasers are diverse in their application, power, and sophistication. Some may be purchased for a few dollars (a laser pointer). Tattoo removal lasers generally cost around $100,00 for a new, top-of-the-line system. Scientific lasers can be as large as a room, mounted on an aircraft, or tiny components of a cutting-edge research project.

A device that emits light (electromagnetic radiation) through a process called stimulated emission

Laser light is usually spatially coherent so that the light is emitted in a narrow, low-divergence beam

Typically, lasers emit light with a narrow wavelength spectrum (”monochromatic light”)

Gain Medium (material with properties that allow it to amplify light created by the flashlamp, examples include dye, gases, solids such as crystals, and semiconductors; the gain medium determines the wavelength of light that will be emitted by the laser)

Pump Source/Flashlamp (provides energy to the laser system; they discharge high current pulses and are filled with Krypton gas, Xenon, or a combination)

High Reflector (used to reflect light through the gain medium to amplify this light)

Output Coupler (a partially reflective mirror allowing for extraction of a portion of the laser beam)

Laser Beam (the “business-end of the laser”; this will be used to create an effect in the skin)

Extremely high peak powers can be achieved by allowing the photons inside a laser cavity to build by using fully reflective mirrors at both ends.

A mechanically, optically, or electronically-gated mirror within a laser cavity can release photons in a fraction of a millisecond.

This process is called Q-switching and can generate a high energy pulses with pulse widths in the nanosecond range.

Keeping the energy input constant, a shorter pulse allows greater power to be delivered.

A continuous wave or millisecond laser are not able to generate the peak power that can be condensed into a nanosecond (billionth of a second)

These ultra-short pulses can produce 300 degree centigrade tissue temperatures in nanoseconds.

This causes a rapid thermal expansion that shatters the target (e.g. tattoo pigment) into extremely small particles that can be removed by macrophages in the patient’s tissue.

The shock wave to tissue that results from this rapid thermal expansion is also referred to as the photoacoustic effect.

PhotoAcoustic Effects

The photoacoustic effect is a conversion between light and acoustic waves due to absorption and localized thermal excitation.

When rapid pulses of light are incident on a sample of matter, they can be absorbed and the resulting energy will then be radiated as heat.

This heat causes detectable sound waves due to pressure variation in the surrounding medium.

One the key ways tattoo removal lasers break up tattoo ink is through shattering the ink through these high-intensity waves.

Selective Absorption of Chromospheres

Chromophore: the part of a molecule responsible for its color

The human skin has many chromophores, including melanin, hemoglobin, etc.

When using a tattoo removal laser, one of the goals is the have the tattoo ink absorb wavelengths of light that will destroy the ink, but leave other chromophores undamaged.

Remember, color is reflected wavelengths that were not absorbed by a substance. An red apple absorbs all colors except red, which is reflected to the viewer. A black tire absorbs all colors. A white piece of paper reflects back all colors.

Certain laser wavelengths are used that can be absorbed by tattoo ink that we are removing.

We are seeking to shatter ink in the skin but leave the skin as undamaged as possible.

The Theory of Selective PhotoThermolysis

One of the goals of laser therapy is to confine damage to microscopic sites of selective light absorption in the skin, such as blood vessels, pigmented ink, and unwanted hair with minimal damage to adjacent tissue. To achieve this selective effect, laser would need to fulfill three requirements:

They should emit a wavelength that is highly absorbed by the targeted structure

They should produce sufficiently high energies to inflict thermal damage to the target

The time of tissue exposure to the laser should be short enough to limit the damage to the target without heat diffusion to the surrounding tissues. This is known as the thermal relaxation time (TRT).

Q-switched Nd:YAG Lasers (532nm and 1064nm)

The Q-switched Nd:YAG laser system overcomes the obstacle of excessive melanin absorption and is used to remove blue and black ink and tattoos in darker skin types (1064nm), or red pigment (532nm).

The clinical endpoint following laser treatment is whitening of the skin with occasional mild pinpoint bleeding. Current models offer a spot size range of 1.5 to 8mm.

Pulse length as low at 5ns up to 20ns, which allows significant power while meeting Thermal Relaxation Time constraints – damaging tattoo ink particles while minimizes damage to the skin.

1064nm

The long 1064nm wavelength has the deepest penetration and carries the least risk of hypo-pigmentation; however, it is also the least effective in removing brightly colored pigments.

Of all the laser systems, it is the preferred system for use in darker skin types. This wavelength may also be useful when residual, more deeply placed ink particles are all that remain.

532nm

The 532nm wavelength (green light) is absorbed by hemoglobin, and as a result, purpura lasting 1 week to 10 days frequently occurs after treatment.

This wavelength is also effective for red, orange, and occasionally yellow ink.

Some reports have detailed the paradoxical darkening of red tattoo pigment as well as other skin-toned, yellow, and pink tattoos.

This occurs as the laser pulse reduces ink from rust-colored ferric oxide (Fe2O3) to jet black ferrous oxide (FeO).

Similarly, bright colors may contain white ink made up of titanium dioxide (TiO2, T4+) that is reduced to TiO2 or blue Ti3+ upon laser treatment.

Alexandrite lasers (755nm): Designed with goal of removing blue and green tattoos that are difficult to completely remove with 1064nm and 532nm wavelengths from Nd:YAG lasers. Alexandrite lasers can be highly effective at removing darker colors such as black and blue, have some difficulty with green tattoos, and do a very poor job addressing red, yellow, and other lighter colored ink. Also, these lasers often operate at a slower rate that makes treatments take longer and may discourage their use.

Ruby Lasers (694nm): The earliest lasers used a Ruby crystal. Early tattoo removal lasers were ruby lasers, but were associated with significant scarring. Newer q-switched Ruby lasers are uncommon, but they are very effective at removing green ink, as well as a range of other colors. Of course, ruby lasers are ineffective at removing red ink tattoos because the red ink is a reflection (rather than absorption) of the wavelength of light associated with red. Without the required absorption of energy, shattering the tattoo ink is almost impossible.

Hypopigmentation occurs in many patients with Ruby lasers, which resolves within 3 to 4 months of treatment

A recent study from Lawrence-Livermore labs sought to discover the optimal process to break up tattoo ink. It investigated by computer simulation the actual mechanism of the breaking up of tattoo ink.

It found that if the laser pulse length is sufficiently short, the strong acoustic waves created were able to exceed the fracture threshold for graphite tattoo pigment. The shorter the pulse the better.

Although the tattoo particles would never reach the melting point, a cavitation bubble would be formed. The steam generated would get into the cracked particle and cause a stream-carbon reaction.

Found that the optimal pulse length was 10-100 picoseconds to minimize laser fluence and collateral damage.

New research is focused on the optimal pulse duration for fragmenting tattoo particles. This is thought be to 10 picoseconds to 100 picoseconds.

Picosecond: one-thousandth of a nanosecond; Fetosecond: one-thousandth of a picosecond, one-millionth of a nano-second.

Manufacturers of tattoo ink aren’t required to reveal their contents – the ink is not regulated by the FDA or other agencies. Many professional tattoo artists mix their own ink from dry pigments, but contents might not be revealed to a client for competitive reasons.

Tattoo “inks” aren’t really inks – they are pigments suspended in a carrier solution. Most inks are made of metal salts. Some are plastics, some might be vegetable dyes.

One concern with tattoo ink is what is in the ink besides the carrier solution and the dyes. If a tattoo shop doesn’t adhere to safety precautions, a range of infections (especially hepatitis) might be contained in tattoo ink if the tattoo artists dips the needle in an infected person, back in the ink container, then into a new client’s skin. A variety of safety regulations are established by the state and local authorities that work to prevent this cross-infection.

Some chemical reactions exist between skin and tattoo ink. You can look at the Material Safety Data Sheet for the pigment or carrier to see what some of the interactions might be. Allergic reactions, scarring, phototoxic reactions (i.e. reactions from sunlight and other light) are possible.

Plastic-based pigments can be intensely colored and very difficult to remove. Some inks glow-in-the-dark in response to black (ultraviolet) light, some of these are safe, but some are radioactive or toxic. The lack of regulations on tattoo ink make out-of-the-ordinary inks potentially risky; most standard tattoos will cause no visible reaction with the skin, with red ink the most common.

Carrier keep pigment evenly distributed in a fluid matrix, inhibits the growth of pathogens, prevents clumping of pigment, and aids in the application to the skin.

Safest and Most Common Ingredients:

Ethyl alcohol (ethanol)

Purified water

Witch hazel

Listerine

Proplyene glycol

Glycerin

Scary stuff can be used, too

Denatured alcohol (toxic, can burn skin)

Other alcohols (methanol)

Antifreeze

Formaldehdye (very toxic)

Black Ink is made of Iron Oxide (Fe3 O4) or (Fe O), Carbon, Logwood

Natural black pigment is made from magnetite crystals, powdered jet, bone black, and amorphous carbon from combustion (soot). Black pigment is commonly made into India ink.

Logwood is a hardwood extract from Haematoxylon campechisnum, found in Central America and the West Indies

Red Ink is Cinnabar (HgS) or mercury sulfide, Cadmium Red (CdSe), Iron Oxide (Fe2O3), Napthol-AS pigment, Iron oxide is also known as common rust. Cinnabar and cadmium pigments are highly toxic. Napthol reds are synthesized from Naptha. Red ink carries risks of allergic or other reactions.

Blue Ink: Cobaltic aluminate (azure blue)

Green Ink: Chrome oxide (Casalis green), Hydrated chromium sesquioxide, Malachite green, Lead chromate, Ferro-ferric cyanide, Curcumin green, Copper salts with yellow coal tar dyes

Yellow Ink: Cadmium sulfide (cadmium yellow), Ochre

Violet Ink: Manganese violet

White Ink: Titanium dioxide, Zinc oxide

Flesh Colored Ink: Iron Oxides

Tattoos are applied by injecting ink into a person’s skin. An electrically-powered tattoo gun punctures the skin between 50 and 3,000 times per minute and reaches a depth of up to several millimeters.

In tattoos, the ink particles (commonly 2-400nm with 40nm average) are embedded in a protein envelope. A prominent network of connective tissue surrounds each of the fibroblasts containing ink particles, effectively entrapping & immobilizing any cell. The lifespan of these fibroblasts is unknown and may persist for the life of the individual.

The tattooing process causes damage to the epidermis, epidermal-dermal junction, and the papillary layer (topmost layer) of the dermis.

The layers are homogenized (mush-like) right after the tattooing process.

One of the first responses of the body to tattooing is to stop the bleeding caused by broken capillaries that are leaking to the surface of the skin. The body’s autoimmune response will include swelling as cells such as neutrophils respond to the injury.

Neutrophils are phagocytic cells that clean up the area by swallowing the ink and flushing it through the lymphatic system.

The ink itself is initially dispersed as fine granules in the upper dermis, but gathers into more concentrated areas at 7-13 days.

Tissue reforms around the tattoo pigment in the form of a re-vitalized epidermis, a strengthened epidermal-dermal junction, and ink is trapped in dermal fibroblasts

Fibroblasts are cells that are important in healing wounds and are the most common connective tissue in animals.

After a month the epidermal-dermal junction is in the process of reforming and cells that a trapping the ink are taking their positions in this region. Some ink is being eliminated through the epidermis.

The epi-dermal junction will be completely reformed within two to three months with the tattoo ink present in dermal fibroblasts surrounded by connective tissue that holds the ink in place.

Swelling, Redness, Tenderness: common for 24 hours to a week

Scabbing: somewhat common when skin punctured and bleeding results from tattooing

Possible infection (Hep-C, HIV, staph, etc.): rare, but possible when tattoo parlors do not follow safety protocols

Scarring/Raised Skin: common with unskilled tattoo artists, occurs when tattoo is applied too deeply and roughly

Allergic Reaction, esp. with red ink

Ink particles are moved into the deeper dermis over time due to the actions of mobile phagocytic cells (think immune cells) causing the ink to look bluish, faded, and blurry.

Examination of 40+ year old tattoos shows that the ink is in the deep dermis and also found in local lymph nodes.

With the presence of larger than normal amounts of migrating phagocytic cells, the chances of ink movement increases, thus accelerating the fading of the tattoo.

Some colors disappear completely with time: White, yellow, red, and flesh tones

During sun exposure many Langerhans cells undergo apoptosis (a type of cell death where cells break apart into many small fragments).

Other Langerhans cells migrate into the dermis and minor inflammatory reactions occur.

The inflammatory reaction is not restricted to the epidermis, but also involves the dermis. Such a reaction causes the recruitment of more phagocytic immune cells to the area.

Overview: Laser tattoo removal is the preferred method of removing an unwanted tattoo. Over the past 30 years, technology and providers have developed to a point where the procedure is highly effective with minimal side effects and within the budget of most patients. This presentation is intended to provide a comprehensive explanation of laser tattoo removal for an audience of potential patients and the health professionals and advisers who assist them in making decisions regarding their tattoos.

Organization of Information: This presentation will be divided into four parts, with one section that presents a scientific perspective on tattoos, one that discusses laser physics and tattoo removal, one that reviews the medical components of laser tattoo removal, and finally what we provide as advice to laser tattoo removal patients.

This information is intended to neither encourage nor discourage anyone from getting a tattoo or having a tattoo removed. Instead, it is a review and discussion of the best available information that is relevant to potential patients, their health care providers, and the public in general.