This week, a film crew from TV Tokyo in Japan interviewed and filmed Dr. Kaplan for a segment on laser tattoo removal in Los Angeles.  This is part of a larger program they are doing about tattoos.  We will post the clip of the interview once it is available.  (You can watch Dr. Kaplan speaking a little Japanese!)

Sunrise Outreach Center is a laser tattoo removal center near downtown LA that helps ex-gang members remove their tattoos. They had had their laser stolen after a break-in earlier this year. The laser was not found but they were able to secure a grant in order to purchase another one. The center’s directors, Rosemarie Ashamalla and Dr. Luis Moreno, turned to Dr. Kaplan to train the staff on the use of the new laser. Dr. Kaplan was happy to help this past Saturday, 7/10/2010, and the training was a success. Sunrise Outreach services a great need in their community, so it was a shame when their laser was stolen. It was quite fortunate that donors assisted them in obtaining another laser so that they can continue the work that had started!

According to a recent article on NBC Los Angeles, the California legislature is considering a bill to regulate and license tattoo parlors.  Currently, there are no state regulations for tattoo and body piercing parlors, even though there are licensing requirements for manicurists and hair salons.  This is despite the fact that it is possible to spread hepatitis and other blood-borne disease via tattooing and tattoos are permanent, unlike manicures and hair cuts.

The bill has cleared a senate committee and is likely to pass through the legislature.  The Governor vetoed a similar measure last year, however.  The bill is supported by the Alliance of Professional Tattooists and Association of Professional Piercers.

The unique character of lasers used for tattoo removal is that they are “Q-switched.”  The Q-switching means that a super-fast shutter opens during the laser pulse, allowing only nanoseconds of light to be let through.  Traditional lasers use slower shutters that allow much longer pulse duration, typically in the millisecond range.  Q-switched lasers remove tattoo ink and pigment through a photo-acoustic effect.  This occurs via a very high-intensity energy that causes the pigment particles to shatter without imparting too much heat that could burn the surrounding tissue.  The pigment particles shatter because of their inability to expand fast enough as the q-switched pulse of energy hits them.  With traditional lasers, targets are not shattered but rather burned away.  That system works great for laser resurfacing or laser hair removal but if it were used on tattoos, it could cause a deep burn.

One alternative that we are currently investigating is the possibility of using fractional laser, i.e. Fraxel, to burn away tattoo pigment without causing scarring.  This is not available for treatment yet, but could possibly be in the future if results are positive.

There is a plethora of creams available online that claim to remove tattoos.  A couple have strong web presence and popularity.  Tattoo removal creams can be divided into two major categories: caustic and non-caustic.  The caustic category contains creams and solutions that are acids and function like heavy-duty chemical peels.   They work by burning the skin down to the level of the tattoo ink.  This can definitely work, but carries significant side-effects of scarring.

The non-caustic category of tattoo removal creams is purported to work by unverified mechanisms.  So-called “fading ingredients” are said to somehow specifically fade the tattoo ink yet leave the rest of the skin unaffected.  From a mechanistic standpoint, it’s not clear or conceivable how such a chemical would work.  Tattoo inks are composed from a wide variety of chemicals  within each individual ink brand and there are multiple brands to choose from for each color.  There cannot be one chemical that could react with all these different tattoo inks.  Furthermore, there are no published scientific studies in the medical literature to support such claims.

To date, the only FDA-approved treatment for tattoo removal is laser.  Other methods, such as glycolic acid or salabrasion may work, but the scarring they cause can far outweigh the original disadvantages of the tattoo.  Less aggressive tattoo fading creams have yet to show clinical effectiveness in peer-reviewed scientific journals.  A search of the Pubmed database for “tattoo removal cream” yields nothing related to what is advertised on the internet.  So until new research shows otherwise, only laser tattoo removal can reliably remove tattoos with minimal scarring.

One of our philosophies at Tattoo MD has been that there is no single laser that is best to removal all tattoos.  Although Q-switched YAG (such as the Medlite C6) is great for black and red tattoos, it really is not as good for blues and greens.  The 1064 nm wavelength is well-absorbed by black inks and the 532 by brown and red.  The 694 nm wavelength of the Q-switched ruby laser is better absorbed by green and blue inks.  For that reason, Tattoo MD has gone with a combination of two lasers to best target the broadest range of tattoo colors possible.

Recently, new Q-switched lasers are coming to market that contain both a YAG and a ruby module within them.  The Tattoostar FX by Asclepion from Germany is one of these.  It still needs FDA approval, but will offer an exciting new option for providers of laser tattoo removal.  Other laser manufacturers seem to be bringing out similar products.  Since Tattoo MD already has 2 lasers that do this, we have no need to change systems, but we do feel confirmed and vindicated by these developments.

The theft of the $50,000 laser last month from Sunrise Community Outreach in downtown Los Angeles is a real shame.  This program provided a way for gang members to erase tattoos from their past and start a better life.  A thief smashed the windows and wheeled out the laser down the street.  These lasers all have serial numbers and are very limited in number, so it’s unclear what could be financially accomplished by doing this.  Unfortunately, the center did not have burglar alarms nor business insurance against equipment loss.  If anyone has further information that could help in the case, please contact them at www.sunriseoutreach.org/

There are many things to consider before getting a tattoo.  Of course there’s the technique and reputation of the artist.  Then there’s your individual tattoo design and location on the body.  You should also consider what kind of ink you are going to get.  A good artist should know what ingredients are present in the ink, if there are metallic compounds or anything that can lead to toxic metabolites.

These days, there are also options for inks that naturally fade or are easily removed by laser, such as Freedom-2.  Not every tattoo artist believes in them or knows about them and they tend to be more expensive.   However, you should realize that one day you may feel differently about your tattoo than you do at the beginning.  Also, there’s a chance that it won’t come out the way you expect and you’ll have instant regret.  At the very least, you should avoid ink that contains metallic compounds, as that will make the tattoo very difficult for laser tattoo removal.

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When you have a tattoo that you want to get rid of, you may want to get treatments as close together as possible.  It is possible to speed up how quickly a tattoo is removed by doing treatments more frequently than the recommended 4-6 weeks.  However, doing that would cause you to need additional treatments and increase the total cost of your tattoo removal.  The greatest amount of fading does occur in the first several weeks after your laser tattoo removal.  Additional fading continues to occur after that but decreases with time.  So you could even wait longer than 6 weeks between treatments, but it may save you only a little in cost, at the expense of stretching out your treatments.  In our experience at Tattoo MD, 5-6 weeks is the optimal time interval that takes into account cost-effectiveness and time.

One alternative technique attempted for tattoo removal is to re-tattoo over a previously tattooed area with saline or a skin-colored pigment.  The idea is to try to push the ink in the upper layers of skin deeper and hopefully out of visibility.  If ink is then placed over this, it is used more or less as a skin-tone cover-up tattoo.  A similar technique claims to employ chemicals that “bind” the pre-existing tattoo pigments and somehow take them away.

Unfortunately, there are serious theoretical and practical problems with all these methods.   In the saline method, the main way that it works is by creating a wound over the previous tattoo. By repetitively re-tattooing the area with a pigment-less needle, a broad wound is formed.  The resulting scar tissue contains ink mixed with it, but more importantly, causes a textural and color change of that skin permanently.  Removing a tattoo is quite easy by comparison to removing that kind of scar.  If the re-tattooing places flesh-toned ink over a darker tattoo, it will only work if a severe wound is created.  As you may guess, you can’t tattoo over a darker tattoo with a lighter pigment.  You’ll still have a dark tattoo mixed with a lighter one.  The older dark ink has to be pushed into the skin.  So again, there is scarring, covered by flesh-toned ink, which looks nothing like normal skin.

Finally, there is the binding-agent re-tattooing technique.  Although it sounds promising, at Tattoo MD, we are seeing some patients that have had this done for a few treatments.  It also tends to result in scarring and unsatisfactory tattoo removal.

Re-tattooing techniques of tattoo removal are not published in any peer-reviewed medical journals and have not been subjected to the rigorous testing required of FDA-approved devices, such as q-switched lasers.  At this time, we are not offering these alternative techniques due to the incomplete tattoo removal results, along with the disadvantage of severe scarring.