Tattoos

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 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.

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.

Infection. 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.

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.

Ways of removing tattoos
In some areas of the UK, you cannot have your tattoos removed under the National Health Service. In a few parts of the UK, the National Health Service 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 and, 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 need 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.

Excision involves cutting out the area of skin that bears the tattoo, and is a good way to deal with a small 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.

Useful contacts
Lasercare are a chain of clinics providing laser treatments in the UK. They are private, but some are based in National Health Service hospitals. Their website has information about tattoo removal. Tel: 01423 563827.
www.lasercare-clinics.co.uk