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by Rick Barker, with permission

With the resurgence of the tattoo these past two decades there has naturally been a growing interest in having tattoos faded or removed. Of an estimated 48 million Americans with tattoos today, roughly 17 percent are said to want them removed, according to a Harris Interactive poll.
The reasons behind removing tattoos are varied, but often times have to do with the tattoo’s location. If it’s visible, it can be a distraction to people we work with and possibly hold us back from getting promotions. The art itself may no longer reflect who we are. Gang- or hate-related tattoos can be life threatening, not to mention a hindrance to a good career. And a former lover or spouse’s name may not be popular with a new lover or spouse. Many of us simply want to fade a tattoo prior to getting a cover up.
Whatever our reasons, we have a variety of options to consider today, none of which are perfect or pain free

Laser Tattoo Removal
Almost everywhere we look today, we are told laser tattoo removal is the way to go. True enough, but a problem for most of us is the price. Laser tattoo removal is not covered by most health insurance plans, costs upwards of $400 per treatment, and removal usually requires eight to 10 treatments. If you are one of the lucky few who can afford laser, there are still a few things you need to know.
Different lasers are needed to remove different colors in a given tattoo. The laser that works great on black ink can’t make a dent in red or yellow ink. Depending on the colors of your tattoo, your laser surgeon will need at least three different types of lasers. Ask your doctor if he or she has all of the lasers needed to remove your particular tattoo.
Many doctors advertising laser tattoo removal let a nurse or laser technician perform the actual procedure. It is possible—albeit not common—to find doctors that specialize in laser tattoo removal and do the work themselves. Avoid, however, the doctors who only have one laser to work with and don’t actually do the procedure themselves. Even expensive scars can be unsightly.

Cost: $$$$$
Pain: Severe without anesthesia
Effectiveness: 95 percent

Dermabrasion involves sanding the top layers of skin with an abrasive tool, while excision involves surgically removing—cutting out—the tattoo from the body. These are two of the least desirable ways to remove a tattoo because of the possibility of extreme scarring; nonetheless, excision may still have a place in tattoo removal today. Consider that few tattoos are ever 100 percent removed. In most cases there is some residual ink left where the artist went in a little too deep. Excision may be an excellent way to remove even the small lines or dots that may remain after your primary tattoo-removal effort. Most cosmetic surgeons are skilled enough to remove the remaining ink and close the incision with little to no visible scaring. Like laser removal, this won’t be cheap, but it may be worthwhile.

Cost: $$$$
Pain: Minimal with local anesthesia
Effectiveness: 95 percent

Variot Tattoo Removal
Variot tattoo removal has been around for more than a century and uses a tattoo machine and an acid to remove tattoos. In 1888, French physician Variot G. Nouveau tattooed a solution of tannic acid, glycerin, and distilled water into the skin of a patient over a tattoo. The result was a thick scab. When the scab healed and parted from the skin, it took a lot of the tattoo with it. There was scaring and certainly room for improvement, but Dr. Nouveau proved that over-tattooing with an acid to remove a tattoo does work.
Dr. Nouveau’s technique was later improved upon and introduced to America in 1928 in an article called “A Study of Tattooing and Methods of Removal,” by M.D. Shie, in the Journal: American Medical Association. Variot was then considered the best way to remove tattoos. Decades later, tannic acid was found to be a carcinogen, and lasers appeared on the scene shortly thereafter. Variot tattoo removal was all but forgotten by the medical community.
In 2004, after a long hiatus, Variot was reintroduced by W. Cheng in the British Journal of Dermatology as a Chemical Extraction Technique. In that research, a San Francisco doctor reported only a 6 percent chance of scarring while removing body tattoos, and a 2 percent chance of scarring while removing permanent makeup tattoos. Instead of using the original tannic acid solution, the doctor created his own solution and used a state-of-the-art medical grade tattoo machine.
Today many tattoo artists have heard stories about or experimented with tattooing saline or hydrogen peroxide into the skin, or simply dry-tattooing the skin (derma-pricking) in efforts to fade or remove a tattoo. Several companies sell their own preparations to be tattooed into the skin in efforts to fade or remove a tattoo.
Your best hope today of finding someone who offers some variation of Variot tattoo removal might be within the permanent makeup artist community, but a few traditional tattoo artists do offer the service. It’s usually cheaper than laser and can be more gentle to the skin when done properly.
Cost: $$$
Pain: Mild with topical numbing creams
Effectiveness: 90 percent

Trichloroacetic Acid (TCA)
The thought of applying an acid to our skin to remove anything seems extreme or even insane to most of us. However, that is exactly what thousands of men and women do every day in order to remove fine lines, wrinkles, and acne scars from their faces. This is commonly referred to as a facial peel, and it can be done on the body as well. In that regard, acids have been used to remove fine stretch marks, brown spots, warts, and calluses on the hands or feet. Acids have many more uses and are sometimes referred to as the poor man’s laser.
TCA is a popular nonprescription acid commonly used by doctors, health spas, and private individuals to treat the skin conditions mentioned above. It usually comes as a clear, water-like liquid and is applied to the skin with a cotton swab. TCA has been twice medically tested and proven to fade and/or remove tattoos. Results were initially published in the British Journal of Plastic Surgery in 1988 and the South African Medical Journal in 1990. In both studies, TCA was found to be a simple and effective tattoo removal agent with an 85 percent success rate.
The process behind TCA tattoo removal is actually very simple. A mild or controlled burn is generated on the surface of the skin, much the same as we do with a laser. This burn triggers our body to repair the damaged skin by growing new skin. In the process of doing this, the ink breaks apart naturally and migrates to the surface with the new skin growth. Your body actually does most of the work. The acid or the laser is simply the trigger mechanism.

Cost: $
Pain: Mild for most, moderate for some
Effectiveness: 85 percent

Tattoo Removal Creams
Many tattoo removal creams contain hydroquinone, which is usually the active ingredient in skin bleaching creams. Over the counter sales of skin bleaching creams containing hydroquinone are banned in the UK, France, Australia, Japan, and several other countries because it is known to cause cancer and a debilitating skin disease called exogenous ochronosis.
In August 2006, the FDA proposed a similar ban on over-the-counter sales of hydroquinone in U.S. markets. If or when the FDA’s proposed ban is made law, tattoo removal creams containing hydroquinone will be taken off the market.
While the idea of a smooth, pain-free cream removing a tattoo may be appealing, there is no published medical evidence that it can do so. Barring new evidence, consumers should use caution if considering one of these creams, particularly when hydroquinone is involved.

Cost: $$$
Pain: Excluding Cancer and Ochronosis, none.
Effectiveness: No published studies to support claims available.

Tattoo Removal Reality Check
There is no such thing as perfect pain-free tattoo removal. Most tattoos are never 100 percent removed and there is usually some skin discoloration. If you try to take out every last bit of a tattoo, there will likely be scarring.
Trying to remove a tattoo too quickly will also lead to scarring. Patience and persistence are usually the most important ingredients in any tattoo removal strategy. The latter said, it is possible to get most of the tattoo out so that it is no longer recognizable as a tattoo and may be easily covered with a little foundation or a new tattoo.

The information provided above is to be used as general information only and is not intended to replace medical advice, to be interpreted or used as a medical treatment program, or to be used to diagnose or cure any disease or medical condition.


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