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Rethinking Your Ink? What To Know About Tattoo Removal

Nina Hawkinson, a 40-year-old lawyer in California, is in the process of saying goodbye to a lower back tattoo she got more than two decades ago. Initially, she was very happy with her tat. But, over time, connotations surrounding “tramp stamps” and strong disapproval from her parents prompted Hawkinson to rethink her ink. After waffling for a while, she decided to get it removed in honor of her dad’s 70th birthday. 

More tattoos are peeking out of waistbands and shirt collars than ever before; today, nearly 30 percent of Americans have tattoos, a nine percent increase since 2012. But while body ink has increased in popularity, so have procedures to get rid of it. The global tattoo-removal market is projected to reach $4.8 billion by 2023, per a recent Associated Press article.

Why is tattoo removal trending? For one thing, advancements in laser technology have made the process faster and less painful than it used to be. Also, some tattoo removal firms say the pandemic has driven more removals because people have spent so much time staring at themselves on screen. I.e., it’s part of the same “Zoom Boom” getting credit for upticks in other cosmetic procedures, such as nose jobs and adult braces.

If you’re considering removal, here’s what you need to know about getting un-inked.

Do I need to see a doctor for tattoo removal?

Tattoos need to be removed properly, or safety concerns arise. Experts recommend seeking out only licensed medical professionals. A  board-certified dermatologist or tattoo removal specialist is your best bet, says Dr. Jeffrey Orringer, professor and division chief of the department of dermatology at the University of Michigan.

What’s the safest way to get ink removed?

Laser therapy (also called “laser rejuvenation” and “laser surgery”) is currently the safest, most effective way to get a tattoo removed. This is true for body art tattoos as well as cosmetic tattoos, such as permanent eyeliner or eyebrow tattoos. 

Before laser therapy became the holy grail of tattoo removal procedures, dermatologists used other methods to un-ink patients. While these methods still exist, many are trickier to execute and are more likely to leave scars. These methods include surgical excision, where your derm carves the tattoo out of your skin, chemical peels, which lightens tattoos until they’re completely faded, and dermabrasion, a surgical procedure in which a doctor uses a medical grinding tool to shave off the ink. 

Whatever you do, don’t try anything at home. The American Academy of Dermatology strongly warns against DIY removal, which can cause bad scars and infections. Two similar, popular DIY methods are home-made dermabrasion, which mimics the surgical procedure by rubbing down a tattoo with sandpaper, or salabrasian, where you rub off a tattoo with table salt. (Ouch.) 

How exactly does laser therapy work?

To understand laser removal, you really have to understand what it means to get tatted: An ink-filled needle passes through the skin’s outer layer (the epidermis) and deposits ink into the skin’s middle layer (the dermis). What we see as a gorgeous flower or dragon tattoo on a person’s skin is, in reality, thousands of microscopically small balls of ink, Orringer says.      

Laser therapy directly penetrates that skin with its light waves and targets these small fragments of ink. This causes the ink particles heat up and explode into small fragments. White blood cells chew up these particles, a process Orringer compares to Pac-Man munching on dots. Then, the lymphatic system flushes out the ink, now waste, through sweat, urine and fecal matter.

Lasers come in different wavelengths to remove different colors of ink. Q-switched lasers are considered the standard in tattoo removal. They come in dual wavelengths, which means they can target multiple colors at once. Newer methods, like picosecond lasers, have risen in popularity because they are quicker and more efficient at targeting tattoo pigment, so they can lessen the amount of sessions you might have to go through. The catch is they’re more expensive. 

What should you expect from the removal process?

When you decide to un-ink, you’re in it for the long haul. Tattoo removal usually takes a year or more. When you find a specialist you like, they will review your medical history, take a look at your ink and come up with a treatment plan and timeline. 

Before your first removal session, they will perform a laser patch test to make sure you don’t experience any adverse allergic reactions. Patients usually require multiple sessions, six to eight weeks apart, but the precise number varies. “It’s not one and done,” says Dr. Bobby Buka, dermatologist, author and co-founder of The Dermatology Specialists in New York City. 

Are certain tattoos more difficult to remove than others?

Yes! As a rule of thumb, it’s easiest to remove older, black tattoos, because some of the ink has already faded, while it’s harder to get colored tattoos removed. Location also makes a difference. The farther a tattoo is from the heart, the harder it is to remove, explains Orringer. There are more veins near your heart than in other areas of your body, which means the pigment gets flushed out faster. Hand and foot tattoos are some of  most difficult to remove because of lower blood flow. 

How much does getting un-inked actually hurt?

Many dermatologists say getting a tattoo removed is about as painful as getting inked in the first place. But pain ratings vary by patient. For Hawkinson, removal has been “excruciating.” Regardless of your threshold for pain, you’ll likely receive a topical anesthetic cream, or a local anesthetic injection, before going under the laser to help numb the area and mitigate pain. 

But stop and think before popping your go-to painkiller before your treatment. Aspirin and non-steroidal anti-inflammatory drugs (i.e., Advil) can cause post-treatment bruising, so the American Society for Dermatologic Surgery cautions against taking them. 

Does insurance cover removal?

It depends. This is often considered a cosmetic procedure, so it typically isn’t covered. A tattoo that cost “five hundred bucks to put on could cost five thousand to come off,” says Buka. Factors that can affect cost include the tattoo’s age and color, whether it was done professionally and its location on the body. Check with your insurance provider for more details. 

What side effects and longterm risks should you be prepared for?

Common side effects include scabbing, blistering, redness and swelling. Think of it like a bad sunburn. Hawkinson says the biggest side effect has been intense itching, which she combats with a combination of Aquaphor and prescription hydrocortisone.

Rarer longtime risks include scarring, discoloration and infection. Laser removal can char the top layer of your skin, which makes it somewhat more vulnerable to infection. Make sure to spend time on aftercare to lessen your chances of infection. Keep the conversation with your derm going, and ask them about potential risks. They are your most important resource through the process.

Luckily, there is one thing you don’t need to discuss with them, if you feel shy about it, which is why you’re getting a tattoo removed. That’s your business, and people de-ink for all sorts of reasons. The number one type of tattoo Dr. Buka’s asked to remove? “Other people’s names,” he says. “Buy them something nice instead.”

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