FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

DAUGHTER SHOULD HAVE "WAITING PERIOD" BEFORE GETTING TATOO

Question: Tattoos seem to be more popular than ever. My daughter wants to get one, but I'm concerned that she may change her mind afterwards. Once you get a tattoo, can it be removed?

Answer: "Probably yes" is the safest way to answer this question. I'll explain the way tattoos are created, then I'll talk about removing them.

A tattoo is produced by forcing a small amount of pigment into the growing layer of the skin. This pigment is incorporated into the new skin cells making the color a permanent part of the skin. Tattoos can be done by amateurs or by professionals, and the process used to remove tattoos depends, in part, on whether it was professionally done. The professional usually deposits the pigments in the same level of the skin for each dot of the tattoo. In an amateur tattoo, on the other hand, pigments are usually deposited over a wider range of depths because the "tatoo artist" doesn't have the professional's specialized equipment.

There are as many reasons for wanting to remove tattoos as there are for getting them in the first place. All removal methods require the removal or destruction of the skin cells that now contain the tattoo pigments. The trick is to remove the tattoo without leaving a scar that is as conspicuous as the tattoo was.

Tattoos can be removed either by cutting out the entire area of the tattoo or by destroying the skin layer by layer down to the level containing the pigment granules.

If you want to restore a more nearly normal look to the tattooed area, complete surgical removal by a qualified plastic surgeon is the best and most expensive approach. This can be fairly simple when the tattoo is small and located in an area of the body where the skin is not under much tension. The surgeon carefully cuts out all the tattooed skin and closes the incision in a way the makes the scar as near to invisible as possible. This is a fairly simple and routinely successful when the tattoo is small. Larger tattoos are considerably more complicated, requiring multiple operations with skin grafting to cover the tattoo site. It is much harder to make the healed skin appear normal as if there was never a tattoo there.

The layer by layer removal of the skin can be accomplished in a number of ways: burning, freezing or scraping away the layers of skin are the common methods. There are several techniques for each of these methods. For example, the tattoo can be burned off with electro-cautery or by using a high-tech laser method. Freezing can be done with dry ice or with liquid nitrogen. Scraping can be done with a sharp blade or with a toothbrush and coarse salt. The skin destruction continues until all of the tattoo color is removed. New skin then grows in the area without the tattoo color. However, these methods usually leave some degree of "scar-like" appearance to the new skin.

Amateur tattoos cannot be effectively removed by the "layer by layer" method because each pigment granule is placed at a different depth. Often, some of the pigment is placed at the very deepest layer of skin. Because of this, the only effective way to rid yourself of an amateur tattoo is to have the entire thickness of skin in the tattooed area removed surgically. Because of this, I'd advise that if you or your daughter decide to get a tattoo, have it done by a professional.

Occasionally, a tattoo, whether done by a professional or an amateur, can be made less conspicuous by tattooing the same area again with a lighter color.

All tattoo removal involves considerable discomfort and expense. The services of a dermatologist or of a plastic surgeon are usually required to obtain satisfactory cosmetic results. The best way to avoid these problems is to be very sure that you want one in the first place. Think about it for quite a while. If it still seems like a good idea a month later, it probably will still be "OK" 10 years later.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.