Photo by Bon Duke / The Licensing Project

Erasing Tattoos Just Got Easier

While they once signaled rebellion and unconventionality, tattoos have become so commonplace that they might even be considered, depending on your perspective, conformist. As the number of people getting tattoos continues to rise, so does the number of people looking to get rid of them. “There’s the classic ‘Winona Forever’ situation, where a patient is no longer involved with the person whose name is tattooed onto their body,” says top New York (and goop favorite) dermatologist Dr. Robert Anolik, clinical assistant professor of dermatology at the NYU School of Medicine, who says he treats many such patients. “But there’s an equal number of people who come in with a tattoo they’re sick of, or they didn’t like how it turned out. I also get a significant number of parents bringing in teenagers who’ve gotten tattoos without telling them.”

Anolik’s update for all of them is decidedly more positive than it once was. “It’s a really interesting field that’s evolving tremendously—people have options now that they just didn’t used to,” he says of the advancement in tattoo removal. The challenge with tattoos, he explains, is there’s no standard pigment used in them, and no standard depths at which they’re applied. “It’s crazy,” he says. “You’re trying to get rid of an ink, and you don’t even know what it’s made of or how deep it is—it’s a fascinating challenge. Everyone heals differently, the depths that the needles go are all different. Amateur tattoos are generally the easiest, henna tattoos are designed to fade, but the permanent inks can be carbon-black ink, titaniums, cobalts, PPD [a known-to-be-toxic hair coloring ingredient], anything.”

The more pigment you have in your skin, the more challenging removing tattoos can become, Anolik says: “With darker skin, we need to go much more gently—if we’re too aggressive, we risk affecting the natural pigment of the skin.” Older tattoos are generally much easier to treat than fresh ones. Different colors require different treatments, too. For instance, Anolik says to be particularly cautious if the tattoo is pale beige or light brown. “Paradoxically, white ink can turn black when you try to vaporize it,” he says. “We see this especially with permanent makeup tattoos. If there’s any white or beige, the iron in those pigments can can turn black, so you can’t use a pigment-specific laser. Instead you’ve got to use ablative fractional lasers.”

For many years, the technology involved was similar to the way dermatologists targeted blood vessels and dark spots, using lasers to vaporize pigment particles in the skin. “It was sometimes amazing, sometimes not,” says Anolik. Pigment particles can be extraordinarily tiny granules, so the more rapidly the laser beam delivers energy, the better. “We used something called Q-switched lasers, which delivered beams of light by the nanosecond, for a number of years,” says Anolik. “But one of the major tech advances has been a laser sophisticated enough to deliver energy at a trillionth of a second—called a picosecond (I use one called the PicoSure laser).”

This rapid delivery of energy is especially helpful for resistant tattoo particles. “Blue and green and purple used to be the hardest—now they’re the easiest,” says Anolik. “I’m thrilled when I get a patient who’s tried to get rid of a big green stain, for instance, and is still stuck with 70 percent of it—I can really help someone like that.”

Everyone who walks into an office needs to know they’re in for multiple visits. “It’s usually monthly treatments, six to twelve times, and it might be twice that,” Anolik says. “There’s a possibility we hit a wall, but there’s also the possibility of a positive outcome, which I consider as clearing 90 percent or more of the tattoo.” Depending on the size and pigments used in the tattoo, removal can cost anywhere from $300 to $1,200 a session.

Anolik encourages every patient to have the area numbed with lidocaine so the treatment is painless. “They’re excruciating otherwise.” The actual zapping is fairly brief, Anolik says: “It takes a minute or two, you might feel tapping. You immediately see some whitening, which gives people a moment of false hope—the whitening is actually a gas—it’s the pigments vaporizing. The spot will eventually scab, then heal. It usually takes a week for the top half of the body to heal; below the knee, healing is always slower.”

Another big development: The concept of doing multiple laser passes in a single treatment. The challenge is that the tattoo ink, vaporized, is a gas, and the gas interferes with the laser getting through to the skin. You used to have to wait 20 minutes to do an additional pass, but now, a solution of an inert material called perflorodeclin (PFD) takes the gas away from the skin instantly, shortening the time patients have to spend in the office for each visit. “You can treat three times in row, to much more efficiently remove the tattoo,” says Anolik.

In addition to treating pale pigments, Anolik also uses fractional lasers to treat blistering. “Usually blisters from tattoo removal heal without scarring, but if a person has a tendency to blister, an ablative fractional laser disrupts the the blistering process—it’s not a wounding level of energy, and it can re-stimulate skin that has lost pigment.”

Anolik’s enthusiasm around the new developments is palpable. “We really can make a difference,” he says. So, what are some of the weirdest tattoo situations he’s seen? “I never judge,” he says. “Trends change: Men used to get lower back tattoos, believe it or not. They’ll come in to see us feeling incredibly embarrassed, and it’s great to be able to help them.”

The toughest case? The ones dragged in the morning after by their parents. “The most challenging is the teenager who gets a tattoo on a Saturday night out drinking. It’s done illegally, the parent finds it, and brings them in on Monday morning. Remember: A fresh tattoo is much harder to get rid of. If it’s over ten years old, the prognosis is much, much better.”