Tattoo removal

One in 7 of the 21% of American adults who have a tattoo regret getting one. Before the development of lasers, common tattoo removal techniques included dermabrasion, TCA peel, excision (which is sometimes still used along with skin grafting). Tattoos consist of thousands of particles of a pigment suspended in the skin. While normal human growth and healing processes will remove small foreign particles from the skin, tattoo pigment particles are permanent because they are too big to be removed. Laser tattoo removal treatment causes tattoo pigment particles to heat up and fragment into smaller pieces. These smaller pieces are then removed by normal body processes. All tattoo pigments have specific light absorption spectra. Typically, black and other darker-colored inks can be removed completely. Certain tattoo pigments, such as yellows, greens and fluorescent inks are more challenging to treat. At each tattoo removal session, some but not all of the pigment particles are effectively fragmented, and the body removes the smallest fragments over the course of several weeks. The result is that the tattoo is lightened over time. Tattoo removal requires numerous treatment sessions, typically spaced at about 7-8 weeks apart. Treating more frequently increases the risk of adverse effects and does not necessarily increase the rate of ink absorption. The number of laser tattoo removal sessions, the energy level, and spacing between treatments depends on various parameters, including the area of the body treated and skin color. Tattoos located on the extremities, such as the ankle, generally take the longest. The amount of time required for the removal of a tattoo and the success of the removal varies with each individual. Factors influencing this include: skin type, location, color, amount of ink, scarring or tissue change, layering, and a patient’s own immune system.

Laser tattoo removal can be uncomfortable. To mitigate pain of tattoo removal local skin cooling and a topical anesthetic can be used. Immediately after laser tattoo removal treatment, a slightly elevated, white discoloration is often observed. Minimal edema and erythema of adjacent normal skin usually resolve within 24 hours. Subsequently, a crust appears over the entire tattoo, which sloughs off at approximately two weeks after a tattoo removal session. Fading of the tattoo will be noted over the next 7 to 8 weeks. Some patients treated with laser tattoo removal will show some transient changes in the normal skin pigmentation. These changes usually resolve in 6 to 12 months and rarely are permanent. If a patient is prone to pigmentary or textural changes(especially darker skin types), longer treatment intervals are recommended. Very rarely, burns may result in scarring but this usually only occurs when patients don’t care for the treated area properly. The newer lasers result in scarring only rarely. Lasers developed after 2006 provide multiple wavelengths and can successfully treat a much broader range of tattoo pigments than previous lasers.

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