Tattoo Removal Takes Tiny Steps Forward


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Carly Cardellino wanted to make the tattoo she got on her foot in college go away. She did.

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Jennifer S. Altman for The New York Times

Years after Carly Cardellino quit her college sorority, she couldn’t leave behind one piece of it: a teal star and a red heart outlined in black, the group’s symbol, which she had spent $50 to have tattooed on her left foot during her sophomore year.

In 2009, after a laser treatment every four weeks for a year ($3,000), the tattoo “looked like a bruise — like someone stepped on my foot with a high heel,” said Ms. Cardellino, the senior beauty editor for Cosmopolitan.com. “It looked worse than it did as a tattoo.”

Ms. Cardellino had resigned herself to covering the tattoo with a flesh-colored circular Band-Aid when, in December 2012, the Food and Drug Administration approved a new kind of laser that could remove, among other things, so-called recalcitrant tattoos. After seven treatments ($400 a session) in the office of Dr. Paul Friedman, a dermatologist in Manhattan and Houston, the tattoo was gone.

“The skin is a little bit lighter,” said Ms. Cardellino, who attributes that in part to her obsessive use of sunscreen in the area. (Tattoos can’t be exposed to sun while they’re being treated.) “But if I showed you I had a tattoo there, you’d be like, ‘I don’t believe you.’”

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An image of Ms. Cardellino’s tattoo after her first series of unsuccessful laser treatments.

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via Carly Cardellino

The new laser, called a picosecond, because it fires pulses at a trillionth of a second, works the same way that the previous generation of lasers did, which is by breaking down the ink so that the body can absorb it.

But it has been widely hailed as the first major advancement in tattoo removal in 20 years. That’s because, compared to the old lasers, which worked merely in billionths of seconds, doctors say the picosecond both cuts treatment time in half and can remove colors of ink (including reds, blues and greens) that previously barely budged. A small study published in the journal Dermatology showed that two-thirds of tattoos with blue and green pigments nearly disappeared after one or two treatments with a picosecond laser.

Supporters like to describe the difference in how finely the new lasers shatter ink as the difference between pebbles and sand. (Researchers are already at work on a femtosecond laser, which would pulse at a quadrillionth of a second, which in this analogy, presumably would pulverize the ink to silt.)

“It’s a really significant advance,” said Dr. Roy Geronemus, a dermatology professor at NYU Langone Medical Center, who has worked with lasers since 1983 and conducted some of the initial picosecond studies. (Dr. Geronemus is on the medical advisory board of the company that makes the laser.)

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Ms. Cardellino, senior beauty editor at Cosmopolitan.com, in her Manhattan office.

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Jennifer S. Altman for The New York Times

As with all cosmetic treatments, there is some element of marketing hype. Tattoo removal is a roughly $75-million-a-year business — mostly catering to young professionals who think tattoos are hindering their rise, mothers who decide the art no longer fits their image and tattoo enthusiasts who simply want to redecorate.

There is also a cross section of heartbreak and hopes dashed. Dr. Bruce Katz, a dermatologist in Manhattan, has twice removed the same woman’s name from the same man’s buttocks. You connect the dots.

But the number of procedures performed in the United States has declined sharply in recent years, to 33,363 in 2014 from 58,429 in 2012, the most recent year for which the American Society for Aesthetic Plastic Surgery has figures.

Some doctors attribute the drop to the new laser’s ability to cut down treatments per patient (each treatment counts as a procedure, in the society’s accounting), but Dr. James Grotting, the society’s president, put a less happy spin on it.

“The numbers are declining because tattoo-removal procedures haven’t given predictably good results,” Dr. Grotting wrote in an email. He called tattoos “still an unsolved problem” because of the still-present possibility of scarring and the wide variation in how different colors and types of ink respond to lasers. Pink ink, for example, often contains iron oxide, which means it may turn black under a laser, a less-than-desirable outcome, particularly if one has, for example, tattooed pink lip liner.

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No one disputes that having a tattoo removed is much more expensive and time-consuming than having one put on in the first place, and the cost is seldom, if ever, covered by medical insurance. Only one woman interviewed reported a tattoo coming close to “clearing,” as it’s called, in a treatment or two, and hers was a tiny brown Zodiac sign on her right ring finger. (Cost and initial results vary widely by the size of the tattoo and its location — leg and feet tattoos are slower to disappear, likely because blood flow is less.)

Upon a touch of the laser, the skin crusts immediately. (If it doesn’t, “you know the ink isn’t absorbing the light,” Dr. Friedman said.) Exactly how painful is a process that, if it goes well, is supposed to lead to oozing blisters? Most doctors offer numbing cream and lidocaine shots, which means that by the time the laser hits (with an ominous-sounding snap), the worst part is over. Just ask Julian Schratter, an artist in Greenpoint, Brooklyn.

Though Mr. Schratter happily spent five hours under the needle having a redwood tree tattooed from his right knee to his groin last year, he fears injections. “Ironic, I know,” he said. For his first appointment, his anxiety slowed the injection of the 10 lidocaine shots he needed during a two-and-a-half-hour ordeal. Actual laser time: seven minutes.

Mr. Schratter, who has seven other tattoos and plans to replace the redwood with something else, was more relaxed for his second appointment, which took only about 45 minutes. Still, he joked, “deforesting is hard.”

Removing Ink: Do You Need a Doctor?

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Credit
Dola Sun

Many states don’t mandate that a doctor perform laser treatments. You may want one.

In essence, laser tattoo removal is touching a wand to a patch of skin. The procedure is regulated by states, many of which allow laser operators to work after as little as 16 hours of hands-on training.

Consider this, printed in boldface type, from the website of the laser company Astanza: “Entrepreneurs with no medical background in over 45 states operate highly profitable laser tattoo removal businesses on a day-to-day basis.”

The company goes on to point out that even if a doctor is required to serve as medical director, “this role generally requires only periodic check-ins.”

New York State requires that a doctor supervise laser treatments, but specifically adds that this “shall not be construed as necessarily requiring the physical presence of the supervising physician at the time and place where such services are performed.” New Jersey is stricter: doctors only.

Doctors generally charge at least twice as much as laser clinics, so why would you pay for an M.D.?

“You can teach a monkey to push a button,” said Dr. S. Tyler Hollmig, assistant professor of dermatologic surgery at Stanford University. “It’s judgment. That’s why you want a physician.”

Every doctor has a tale of a patient who comes in after a botched removal procedure. Treating a tattoo properly includes understanding the biology of the skin around it. There is no uniformity among tattoo ink.

And a patient may want someone who can analyze the color of the skin (darker skin is harder), the history of the tattoo (has it been treated before?) and its age (older tattoos are easier, since the body slowly gets rid of the ink, which may have faded anyway).

Tattoos need to be at least six months old to be removed, because the inflammatory response has to stop, or removal treatment may make it worse.

And it may be less painful to go to a doctor. Even if your state doesn’t consider operating a laser to be the practice of medicine, administering a shot of lidocaine usually is.



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