Evolution of Tattoo Removal

Tattoos are not a modern invention—tattoos appear in art and on mummies dating back over 4000 years.  The regret that occasionally accompanies a tattoo likely isn’t new, either.  People choose to have tattoos removed for a variety of reasons, and historically, they have tried many techniques.

Physical Methods

Perhaps the first techniques attempted for tattoo removal were simple amateur techniques such as abrading the skin and attempting to physically rub off the tattoo.  In other cases, poultices may have been used as an attempt to draw the tattoo inks out of the skin.  In more recent times, physicians used metal or diamond grinding discs, wire brushes, sandpaper, or salt abrasion to grind away the tattoo.  These techniques were painful and met with limited success. They often resulted in scarring.

Chemical Methods

Salt was also used as a chemical method to fade or remove tattoos, sometimes being applied after a rough abrasion technique.  Currently, methods such as aggressive trichloroacetic acid (TCA) peels are marketed online as an option for tattoo removal.  However, this method often leads to chemical burns and scarring[i] and is strongly discouraged.   Less aggressive methods to lighten or remove tattoos historically included applying wine, citrus juices, sulfur, garlic, or even bird dung.  These methods are not likely to be harmful, but they are also not likely to be effective.

Heat and Cold (Photothermolysis and Cryosurgery)

Both extremes of temperature have been used as methods for tattoo removal.  Liquid nitrogen has been used to freeze off tattoos, but met with little success and a high risk of scarring.  Hot temperatures are more effective, and some of the first modern techniques in tattoo removal involved application of heat.  Electrocautery was one historically attempted technique for tattoo removal, in which an electrically-heated wire was inserted into the skin to destroy the tattoo pigments.  Although it is possible to effectively destroy the tattoo pigments with heat, the procedures are usually associated with significant pain and scarring.  The CO2 laser was one of the first lasers used in tattoo removal.  Although fairly successful, this laser generally ablated (removed) the upper layers of skin and caused significant heating (and destruction) of the tattoo pigments and surrounding skin.  However, this technique did not specifically target the tattoo pigments, and destroyed surrounding tissue as well as the tattoo.  Scarring was also fairly common with the CO2 laser when used for tattoo removal.

Selective Photothermolysis

The observation that lasers such as the CO2 laser could be used to remove tattoo pigments led to increased interest in being able to selectively target the tattoo pigments, destroying the ink particles while leaving the skin intact.  This led to the development of modern laser tattoo removal techniques, where the laser light is tuned specifically to match the pigment(s) in the tattoo.  These lasers, most of which are short pulsed (Q switched) and high peak energy have become the “gold standard” for most routine tattoo removals.  The laser energy breaks up the pigment particles into smaller pieces that get absorbed by the body and cleared out.  Today, many lasers can be successfully treated with laser tattoo removal, although some colors of ink remain challenging.  Because these lasers are designed to target the ink pigment particles, the risk of scarring is greatly reduced.  New advances in the field, including the PicoSure™ laser, show better removal of tattoo pigments with fewer treatments.  In particular, green and blue inks which have often been difficult to remove even with modern lasers may be successfully removed with the new PicoSure laser.

Surgical Removal

Surgical removal of tattoos is one of the oldest techniques, and continues to be used today, particularly for small tattoos, extremely difficult-to-remove tattoos, or if the person wishes for a faster removal of the tattoo.  In this case, the skin bearing the tattoo is cut off.  This technique may be acceptable for very small tattoos, but with very large tattoos, multiple surgeries may be needed to reduce scarring, and skin grafts may be necessary.

Revision Tattoos

Another option that has been used throughout history is re-working an existing tattoo to make it look like something else.  Although this does not remove the original tattoo, it can make it unrecognizable.  It is now possible in some cases to use lasers to remove or lighten part(s) of a tattoo in order to rework the design.  However, re-worked tattoos can be more difficult to remove in the future.

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