NEW YORK (October 27, 1999) -- Once seen as an identity for bikers and street gangs, tattoos are now part of American mainstream culture. In fact, the number of tattoo studios has grown from 300 to over 4,000 nationally in the past 20 years. While some people keep their tattoos for life, many people regret their decision to decorate their body and eventually want them removed. Until the development of short pulsed lasers in the late 1980s, tattoo removal was painful and often resulted in scarring.
Speaking today at the American Academy of Dermatology's Derm Update '99, dermatologist Jeffrey S. Dover, MD, FRCPC, Associate Professor of Dermatology, Harvard Medical School, discussed the latest methods for tattoo removal. •Like all fads, tattoos may lose their appeal with people who have them in a matter of years," said Dr. Dover. "The problem is that unlike a hairstyle or a fashion trend, tattoos are much harder to reverse."
The practice of tattooing is mostly unregulated, despite a significant risk of blood-borne infectious diseases such as hepatitis. Even before their appeal fades, tattoos can pose problems that require medical treatment. Dermatologists often see recently tattooed patients with local allergic reactions that can last for years.
The Food and Drug Administration (FDA) currently lists tattoo pigments as "color additives" intended only for application to the skin surface. Amateur tattoos usually consist of a single pigment color. Professional tattoos are more elaborate designs using multiple pigment colors.
Several types of lasers can effectively remove tattoos with a very low risk of scarring. The type of laser used to remove the tattoo depends upon the pigment colors. The three lasers most commonly used in tattoo removal are the Q-switched Ruby, the Q-switched Alexandrite and the Q-switched Nd: YAG. Black and blue tattoos are the easiest to remove; green and yellow are the hardest.
Lasers remove tattoos by vaporizing the pigment colors with a high-intensity light beam. Black tattoo pigment absorbs all laser wavelengths, making it the easiest to treat. Other colors, such as green, selectively absorb laser light. These colors can only be treated by selected lasers based upon the pigment color.
"Anyone considering a tattoo should keep in mind that removing it is painful, takes multiple procedures, requires topical or local anesthesia and is expensive," cautioned Dr. Dover. "Laser removal is a big advance in the procedure, but it is not perfect."
Side effects of lasers are generally minimal, but may include hypopigmentation, where the treated skin lacks the normal skin color; hyperpigmentation, which is an abundance of color in the skin at the treatment site; infection of the tattoo site; or lack of complete pigment removal. There is also a 5 percent chance that the laser treatment will result in a permanent scar.
Prior to the use of lasers as a method of tattoo removal, the procedure involved the use of one or more destructive surgeries. Dermabrasion, when the skin is "sanded" to remove the surface and middle layers; cryosurgery, which freezes the area prior to its removal; and surgical excision, where the dermatologic surgeon removes the tattoos with a scalpel and closes the wound with stitches, were the most common forms of tattoo removal.
Lasers have become the standard treatment for tattoo removal because they offer a "bloodless," low risk, highly effective alternative with minimal side effects. Each procedure is done on an outpatient basis during a single or series of visits.
The American Academy of Dermatology, founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership over 12,000 dermatologists worldwide, the Academy is committed to: advancing the science and art of medicine and surgery related to the skin; advocating high standards in clinical practice, education, and research in dermatology; supporting and enhancing patient care; and promoting a lifetime of healthier skin, hair, and nails. For more information, contact the AAD at 1-888-462-DERM (3376) or www.aad.org.
The American Society for Dermatologic Surgery (ASDS) was founded in 1970 to promote excellence in the field of dermatologic surgery and to foster the highest standards of patient care. For more information on cosmetic surgery and referrals to doctors in specific geographic areas, please contact the ASDS Consumer Hotline, 1-800-441-ASDS (2737), during weekday business hours or visit our Web site at http://www.asds-net.org.
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