Inked and Regretful: Removing Tattoos

That tattoo on your arm of a former flame—the one that seemed like a
great idea years ago—is kind of embarrassing today. And your spouse is
not too crazy about it either.

You may not know that FDA considers the inks used in tattoos to be
cosmetics, and the agency takes action to protect consumers when
safety issues arise related to the inks.

At the other end of the tattoo process, FDA also regulates laser
devices used to remove tattoos.

FDA has cleared for marketing several types of lasers as light-based,
prescription devices for tattoo lightening or removal. A Massachusetts
company recently received FDA clearance to market its laser
workstation for the removal of tattoos and benign skin lesions.

According to a poll conducted in January 2012 by pollster Harris
Interactive, 1 in 8 (14%) of the 21% of American adults who have
tattoos regret getting one. And the American Society for Dermatologic
Surgery (ASDS) reports that in 2011, its doctors performed nearly
100,000 tattoo removal procedures, up from the 86,000 performed in
2010.

Unfortunately, removing a tattoo is not as simple as changing your mind.

Artists create tattoos by using an electrically powered machine that
moves a needle up and down to inject ink into the skin, penetrating
the epidermis, or outer layer, and depositing a drop of ink into the
dermis, the second layer. The cells of the dermis are more stable
compared with those of the epidermis, so the ink will mostly stay in
place for a person's lifetime. Tattoos are meant to be permanent.

An effective and safe way to remove tattoos is through laser surgery,
performed by a dermatologist who specializes in tattoo removal, says
FDA's Mehmet Kosoglu, Ph.D., who reviews applications for marketing
clearances of laser-devices.



Lasers Used for Decades
"Laser" stands for Light Amplification by Stimulated Emission of
Radiation. Kosoglu says that pulsed lasers, which emit concentrated
light energy in short bursts, or pulses, have been used to remove
tattoos for more than 20 years.

However, it can be a painstaking process. "Complete removal, with no
scarring, is sometimes not possible," Kosoglu notes.

FDA clearance means this method for removing tattoos complies with
agency requirements for safety and effectiveness, according to FDA
dermatologist Markham Luke, M.D. Other methods include
dermabrasion—actually "sanding" away the top layer of skin—and
excision—cutting away the area of the tattoo and then sewing the skin
back together.

There are also do-it-yourself tattoo removal ointments and creams that
you can buy online. "FDA has not approved them, and is not aware of
any clinical evidence that they work," says Luke. In addition, Luke
says that tattoo removal ointments and creams may cause unexpected
reactions, such as rashes, burning, scarring, or changes in skin
pigmentation in the process.



How Does It Work?
With laser removal, pulses of high-intensity laser energy pass through
the epidermis and are selectively absorbed by the tattoo pigment. The
laser breaks the pigment into smaller particles, which may be
metabolized or excreted by the body, or transported to and stored in
lymph nodes or other tissues, Kosoglu explains.

The type of laser used to remove a tattoo depends on the tattoo's
pigment colors, he adds. Because every color of ink absorbs different
wavelengths of light, multi-colored tattoos may require the use of
multiple lasers. Lighter colors such as green, red, and yellow are the
hardest colors to remove, while blue and black are the easiest.



Does It Hurt?
"That depends on a person's pain threshold," Kosoglu says. Some people
compare the sensation of laser removal to being spattered with drops
of hot bacon grease or snapping a thin rubber band against the skin. A
trained dermatologist will be able to adjust the treatment to the
patient's comfort level.

Generally speaking, just one laser treatment won't do the trick.
According to the American Academy of Dermatology, the procedure
requires multiple treatments (typically six to 10) depending on a
tattoo's size and colors, and requires a few weeks of healing time
between procedures. Some side effects may include pinpoint bleeding,
redness, or soreness, none of which should last for long.

Luke says that these laser devices are cleared for use by, or under
the supervision of, a health care professional. The removal procedure
requires using the correct type of laser, understanding the reaction
of tissue to laser, and knowing how to treat the area after the
procedure.

"If you have any concerns about having a tattoo removed, it's a good
idea to consult your dermatologist, who is knowledgeable about laser
treatments," Luke concludes.

The ASDS has a list of dermatological surgeons who specialize in tattoo removal.

Consumers are asked to report adverse (negative) reactions from
tattoos, as well as problems with tattoo removal, to FDA's MedWatch.
This article appears on FDA's Consumer Updates page, which features
the latest on all FDA-regulated products.

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