MOST people are proud with their tattoos. However, some are not satisfied and want them altered or changed. Tattoos can be altered or masked temporarily with special make-up or can be changed permanently with re-tattooing the old design by injecting new pigments.
Lighter pigments are used for dark tattoos while darker pigments are used to cover a fading unsightly tattoo. About 17 percent of people with tattoos express regrets of having been tattooed and want them removed.
There are several domestic, social and personal reasons for removing tattoo:
1. The subject has lost interest or is beginning to dislike the tattoo.
2. Not satisfied or getting bored with the design of the tattoo.
3. Tattoo is not helping promote body image; instead it has contributed to sense of embarrassment.
4. Removal of tattoo may help improve and enhance self-esteem.
5. Fading image or poor quality of tattoo
6. Rehabilitation of a gang member requires removal of tattoo.
7. Tattoo is an obstacle to employment. Some jobs require that an applicant with tattoo need not apply.
8. Subject is uncomfortable with the tattoo (allergy to the ink pigment).
9. Antisocial messages or obscene subject of tattoo.
10. Painful reminder of a failed relationship with the subject of the tattoo.
Removal of a tattoo is considered an expensive procedure and there is no technique presently available that can satisfactorily remove tattoo completely without residual scarring, keloid formation and pigmentary changes. Patients should expect these realities before undergoing any of the following procedures:
1. Cauterization: Experts do not recommend cauterization in removing unwanted tattoos because of the scarification it may produce. However, amateurs advise the use of heat such as the burning cigarette or the very hot iron applied on the tattoo. A third degree skin burn is expected and an unsightly scar is common.
2. Acids such as nitric acid or tannic acid have been used to remove tattoos. The effect is the same as cauterization with skin burns and eventual scarification.
3. Salabraisions: Or the use of salt to remove the tattoo. It consist first of applying and rubbing irritating substance such as red pepper on the tattoo for several days followed with the application and rubbing of salt over the tattoo. This procedure may be repeated several times. Again, the result is the unacceptable scarification.
4. Dermabraision: Under local anesthesia, the outer portion of the skin is abraded mechanically either the use of sterile sandpaper or an electrically powered high-speed mechanical rotator at 33,000 revolutions per minute. The abraded skin is allowed to regenerate with the expected severe scarring.
5. Cryosurgery: The use of liquid oxygen, freon, carbon dioxide or liquid nitrogen to produce necrosis of the skin with sloughing off of the pigments. Again scarring is expected.
6. Surgery: Difficulties in surgical removal of tattoos depend primarily on size. Smaller tattoos may not be difficult to excise. Large tattoos may need the expertise of the plastic surgeon and the patience of the patient. Surgical treatment of large tattoos requires several stages of operation to complete and most will need skin grafting.
7. Lasers: The latest method of removing tattoo is the use of laser. Earlier, lasers such as the carbon dioxide or argon were not very encouraging. The result of the treatment was associated with some degree of scarring and hypopigmentation of the skin area.
Lately, the Q-switched lasers are being used with some success. There are several types: the ruby laser removes the green pigments: aluminum garnet laser removes the red pigments; alexandrite laser removes the blue-black pigments. Removing unwanted tattoos may require several treatments and each treatment will require local anaesthesia.
Reminders about tattooing and body art:
1. Tattoo is a permanent form of body art, very difficult to remove and very expensive. Try to experiment with the temporary or fake tattoos first before deciding to experience the permanence and the consequences of true tattoos.
2. Of the temporary or fake tattoos, do not use "black henna" as a darkening agent to avoid sensitization and future severe allergic reactions.
3. The common complications of tattooing and other forms of body art are bleeding and infections. Avoid drinking alcohol or taking analgesics before the procedure. Analgesics such as aspirin may cause prolong bleeding and may become a problem.
4. Individuals with medical problems such as diabetes or any bleeding tendencies should avoid any form of body art.
5. To prevent infections the artist should wash hands and wear gloves. Instruments used should be sterile or disposable. Use the one-time disposable ink cartridge then discard. The work area should be clean. Avoid doing the procedure in toilets, marketplaces, malls or friends' houses.
6. To prevent keloid formation one should avoid any form of body art (tattooing, body piercing, etc.) on children with positive history of keloids (keloid formers), those with positive family history of keloid formation and in children over 11 years of age.
7. Avoid the amateur way of tattooing or body piercing such as the do-it-yourself or a friend doing it for you. High incidence of infections and other complications are reported with amateurs doing the body art.
8. If signs of infections are present such as redness, swelling and tenderness over the skin site, report to the proper authorities (parents and health care providers) for proper management.
* References: Body Art: Anne Laumann, Fitzpatrick's Textbook of Dermatology 7th ed. 2008; Decorating the "Human Canvass." Martel S., Anderson, J. Contemporary Pediatrics. August 2002. (PVI)
