ISSUE 22 - LASER TATTOO REMOVAL

LASER TATTOO REMOVAL
By Brian Tucker


Johnny Depp sported a tattoo in the early 90’s that read ‘Winona Forever,’ referencing his engagement to actress Winona Ryder. When the relationship ended the tattoo was altered to read ‘Wino Forever,’ blocking out the ‘n’ and ‘a’ with black ink. Today, he could go the way of Danny Bonaduce, having it removed by laser.
Technology has come a long way it seems. Tattoo removal is as commonplace as hair removal or ridding noticeable spider veins. In an effort to clean up the image of marines, the Marine Corps began limiting tattoos last March, banning large tattoos below the elbow and the knee (the Army is not following the same pattern, allowing tattoos above the neckline). This led to many marines getting tattoos before the deadline. Still, what about removal?
In Wilmington tattoo removal is available at Atlantic Dermatology and now Lucky Seven Tattoo, the only tattoo shop in the area with a laser removal machine. Now, you can return to the tattoo parlor for removal or alterations if you’re in Johnny Depp’s predicament. It’s relatively painless and takes anywhere from four to ten treatments. But people enter into removal for a variety of reasons.
Laura, the nursing supervisor at Atlantic Dermatology said, “Usually we get people who get a tattoo on a weekend and realize they don’t like what they’ve done. People call and see what they can do to get rid of it.” She says that clients range in all ages, those who got them years ago and don’t want them anymore. But it may be work related as well. “Jobs require employees to not have them, they can’t cover them up.” Or it’s familial. “Spouses don’t like them for whatever reason and they feel like they have to get rid of them.”
But for those expecting removal to be done in a drive-thru fashion it’s not quicker than when the tattoo was originally inked. Removal of a tattoo is dependent upon several things, the colors used, the type of inks, which laser machine used for the removal and time. Most tattoos take between four to ten treatments. Between these treatments the skin has to heal and that period of time is different for the individual.
Atlantic Dermatology uses a machine that is in rotation between offices and they utilize different lasers for removal, depending on the tattoo. They have found that their Gentle Laze laser used for hyper pigmentation and laser hair removal treats them (tattoos) also. They allow up to three months between treatments but is dependent on the rate of healing.
“We evaluate everything at the consultation and if we feel they’re a good candidate - if they’ll get good results, if they’re tattoos are either, we call them jailhouse tattoos or if they’re professional tattoos. Because we don’t know the inks that were used,” Laura says. The homemade, or, jailhouse tattoos, might be harder to get rid of or easier to get rid of. The doctor or physician’s assistant don’t know what inks were used. These are the factors involved in evaluating and removing the tattoo and then there’s healing of the skin.
“It depends on how the tattoo is healing,” Laura says. “There may be blisters, almost like a burn. You put polysporin on it, covered till it heals. Sometimes we switch them over to a different laser to so they don’t have to wait that full three months. It may take six to ten treatments depending on the color. Dark colors work better. Oranges red and yellows and greens are harder. Dark blues, purples are easy. People don’t say it’s any worse than getting a tattoo.”
Atlantic Dermatology has been doing removal for nearly ten years and the number of clients is steadily growing, becoming a lucrative business. So it only makes sense that that tattoo parlors get involved in the business. Enter Wilmington’s Lucky Seven Tattoo.



I arrived at Lucky Seven Tattoo April 9th. While one staff member was preparing to ink a tattoo for a customer no one else was around. It was unusually quiet except for the faint, tiny sound of slaps coming from a small room near one of the inking areas.
I stood outside this particular room normally used for piercing, waiting to speak with shop owner Brian Price. In place of a door is a tan curtain and now closer I was better able to hear the tiny snapping sounds, like a whip cracked by a Smurf. The sounds were repetitive. They were the sounds of the laser being used to remove a tattoo. Price has been using the machine on himself to remove a tattoo in order to show customers in addition to correct part of another.
Piercer Mike Page and Price used the laser to remove tiny moles and page used it for some veins in his nose. “We’ve been practicing on ourselves,” Mike says, showing me the work underneath his shirt and left side of his nose. By doing so, they have experienced how much to use the laser for removal. Another staff member in training, Tracy, had peach fuzz on her lip removed in addition to two small moles that will require a few more treatments.




“I was thinking about tattoo removal for a few years because so many people come in for cover up’s,” Price says. “Just about everyone I know has something they want removed or covered up.”
Price also wants to work with the gang task service in Wilmington in regards to tattoo removal.
Paul Cenac, MD was in Wilmington from Atlanta that day to install a Q-Clear laser machine and train Lucky Seven staff members. The machine is the size of an old fashioned typewriter or cash register and resembles a prop from the Jetsons cartoon show.




I listen to Paul describe other uses for the machine, hair removal and spider veins.
“Seventy per cent women have spider veins,” he says. “Caused by weakening from estrogen”
Paul used the machine to remove hair on his left hand three years ago yet his right is still covered with black hair. He did so as a testament to his belief in the process and refers to the one hand with hair as ‘monkey knuckles,’ a walking billboard for hair removal. Removal is relatively painless and the process for hair removal works by the laser killing off blood supply to the hair. I asked them to use the laser on a sunspot/freckle on my right hand. It took longer to prep for the work than to actually do it. We put on protective glasses and Paul offered a cold compress to numb my skin. I declined.
Paul placed the laser ‘gun’ above my hand and using a red light as a guide, ‘fired’ a few times over the sun spot. It looks like this; pulses of light hit the ink, vein or sun spots to remove them. The gun looks like a laser pistol crossed with a Makita heat gun. It happens very quickly. The snapping sound happens and the light hitting my skin feels like a mosquito that’s landed and trying to dig in.
Photo-acoustic is the term for that snapping sound. Paul refers to it as a sonic boom at the cellular level.
“The sound of the pulse hitting the ink under the skin. That’s the sound of the pigment breaking up, when you hear the popping sound,” Paul explains.
I was left with what looked like faint spots of ash on my hand. It didn’t hurt and the area eventually scabbed over a little and fell away. Less than two weeks later the sunspot is completely gone. I have a spot of new skin that needs to catch up on its tan.
As further demonstration, Tracy sat down and used this process to have peach fuzz removed from her upper lip. Paul applied color to the area above her lip and began using the laser. It looked strange, tiny bursts of light above her lip, as though she were being subjected to something you’d see in a Terry Gilliam film. But she sat calmly until Paul was finished. The end result was that she now had a smooth and shiny upper lip, free from facial hair.
Brian’s arm is a little more complex. He has a detailed, all black Celtic tattoo that wound halfway around the upper portion of his arm, approximately three inches tall. He has been removing it over time to show customers. One half is disappearing, appearing as a murky light grey tattoo and the other half is still solid black.
After a first treatment there is scabbing and must heal before another treatment. It is no different than when you scratch your arm, scabbing over and eventually falling away leaving new, fresh skin. Here’s how the treatment process works;
The laser strikes the skin and ink underneath. It breaks it up the ink allowing the body to absorb the ink particles. At a microscopic level ink is like a basketball and the macrophage (cells that ingest a wide variety of particles in our body) is a tennis ball sitting next to the basketball. The macrophage can’t absorb the ink because it’s too big. The laser acts as a bullet hitting the basketball breaking it down so the macrophage can absorb the pigment. Then, the macrophage internalizes the pigment thus digesting it in the cell.





Different laser wavelengths are absorbed by different colors. Black and blues are absorbed by 1064 nanometer wavelength. Reds and purples are absorbed by 563 nanometers. Greens by 755. Those are three main wavelengths used for tattoo removal.
“It tickles at 532 wavelength nanometers and at 1064 feels like mosquito bite without the sting,” Paul says.
All tattoos are the full thickness of the skin, usually, and have to be removed in layers. Depending on the amount of ink initially injected, and depth, it will determine how many treatments necessary to remove all the layers. It takes usually 4-10 treatments. That may seem excessive but bear in mind that during the 80’s and 90’s a tattoo would be cut off leaving the shape of that tattoo.
“In twenty three years of laser advancement we’ve gotten to the point where the tattoo is removed from the skin,” Paul says. “We use the normal processes of the body to remove the ink.”



Paul Cenac has been involved with lasers since 1983 and the first lasers he worked with were for cancer surgery. Over the years he has worked with lasers that don’t damage tissue but work with living cells to accomplish desired results. They are thirty eight different medically effective lasers. There are three wavelengths used for tattoo removal, using two of those wavelengths at Lucky Seven Tattoo in a non-destructive manner.
The technology has only been available since 2004, what is called a quartz switched laser, so the on-off switch works at the speed of light through a quartz filter. This is recent in the history of lasers. Albert Einstein theorized lasers (light amplification by the stimulation emission of radiation) were possible in 1910 while working as a post office clerk. Writing his idea on the back of an envelope, it was nearly 35 years before mankind was able to recreate his theory and make the first laser in the 1940’s which was essential in the development of nuclear weapons that ended World War II.
That technology is the building block of nuclear power plants and medicine so laser technology and nuclear technology parallel one another. Advances in computers and solid state electronics and chips now allow users to have a laser the size of bread box that once was the size of ten by ten foot room and switch it on and off at the speed of light versus having to press a pedal manually.
Paul works with lasers in various clinics and Light Age Incorporated developed the Q-Clear laser machine. The owner of the Light Age Incorporated made Alexandrite-Laze in 1983, taking it commercial in 1986. It is the basis for all laser hair removal.
“We want them to use what we consider to be the safest lasers on the market. Even the safest laser on the market can be harmful if not used with proper training,” Paul says. “The company feels it’s really worthwhile to not only put a good instrument in the hand of the end user but to give them the training so they give the best results and in the safest manner.”
I ask Paul about spider veins, another application of the laser. He says that generally women have thinner skin and thinner vessels and capillary walls. Their capillary walls break easier resulting in more bruising since the walls are more fragile.
“With that thinness they dilate from pressure over time. As the vessels dilate and get bigger they become more visible through the skin. They occur frequently with more estrogen pulses women have, occurring more during pregnancy,” Paul explains.
The laser works on spider/varicose veins by coagulating the blood in the vein in which the body comes along and absorbs that coagulated vein, removing the unsightly appearance. In addition a person will have about 40 times more venus outflow from the skin. Removing those visible veins allows the skin to look clean and still be healthy.
But how is it that a tattoo parlor can use a machine one may only associate with a doctor? Technology has made it more accessible and treatable for one. Second, staff members at the tattoo shop are trained to use the machine and are overseen by a medical director.
Lucky Seven Tattoo has a local medical director, who’s about two blocks away, that oversees their. In North Carolina the rule is the medical director has to be within a half hour of the clinic.
“That person is the medical umbrella, the medical supervision of the process,” Paul explains. “Even if this machine was in his office it’s usually the tech’s who do the treatments so we train the tech’s how to use the equipment to do the procedures. This is like the tech’s are not in the office they’re here (Lucky Seven) but still under his supervision.”
This is similar to what Laura explained at Atlantic Dermatology where Dr. Stephen Crane does most of the treatments. “The physician’s assistants can do them,” she says. “There’s no scarring, some people, you can see a faint image. Some just have clear skin,” Laura says. What is left behind may resemble a light birth mark.
Costs of the procedure are varied and worth investigating. It may be more efficient to go to the tattoo parlor than a doctor’s office. That is dependent upon the person. It may be cheaper. A tattoo shop has more square footage than a typical doctor’s office. To some, it’s more comfortable and less clinical.



But tattoo removal is becoming much bigger. Dr. TATTOFF is a name that is getting around. During the mid-nineties James Morel and his brother published the magazine Pop Smear in New York City which resulted in a healthy, five year run. The magazine’s vibe was sex, drugs and rock and roll. Morel won’t disclose the tattoo, but he says one he had it didn’t exactly fit the magazine’s attitude.
“I had to have a tattoo removed,” he says, “a ridiculous tattoo.”
Morel went in search to have it removed. That experience eventually led to another business venture, one that is very successful in Beverly Hills, on the corner of Wilshire and La Cienega. As CEO of Dr. TATTOFF, he and his business partners own three stores in California under the name Dr. TATTOFF. In August they plan to open four Dr. TATTOFF stores a month and with backing from those with experience in chain stores, plan on building ninety across the United States.
It’s good business. Morel thinks so.
“Think of all the tattoos put on in nineties. That style is not particularly popular right now. Think of all the changes recently with technology. People’s personalities are changing so fast these days that what you thought was cool even two to three years ago you may not believe in. You know, maybe it’s time to have that removed. Get your Soul Asylum tattoo removed,” he says with a chuckle.
Dr. TATTOFF uses a Q-switch laser, he says is the best on the market. “The lasers they used before was a ruby laser. The problem with those lasers was they got the tattoo off but left scars. Before that were argon lasers but that was even worse.”
The lasers used now use wavelengths that are specifically targeted for certain ink colors that do minimal damage to the skin. “So basically you can have the color taken out and it doesn’t take your pigment out or damage the skin.”
Morel said that yellow ink is tougher to remove and that a nice black tattoo or dark color on light skin has a very high chance of being removed. Morel says it doesn’t depend on the person, that the general rule of thumb is a person wait 6-8 weeks between treatments and that you’re looking at six to eight treatments also. Dr. TATTOFF’s patient’s age range runs the gamut, people that are adults who as kids went to their friend’s garage when they were thirteen and got homemade tattoos.
“Generally 25 – 35 years old and the majority of them are women,” he says. “Homemade tattoos are easier. The professionals use so much ink and they do a good job with their coverage that it takes longer to break up the ink. Generally, those homemade tattoos they can’t get the ink in far enough.”
Even in Beverly Hills Morel says that less than ten per cent of patients are celebrities but does their fair share of work for them. “Just being in this town, my business partners are guys in the entertainment industry, who own clubs in town. The word gets around quickly, Grammy winners, Oscars winners. They (the movie industry) do a good job of covering up tattoos and putting them on in this town.”
One celebrity was Danny Bonaduce who got a black ring tattoo on his ring finger to demonstrate the strength of his newfound fidelity after sleeping with another woman. His wife disliked it because it reminded of him cheating every time she saw it. Enter Dr. TATTOFF.
Removing the ring was different not that it was close to the bone but because of the location on his body. Tattoos that are further away from your heart, more towards your extremities, your fingers or toes, take a little bit longer to remove because there’s not as much blood flowing through there and your system can’t work to get that ink out after it’s treated. It doesn’t go away as well as on an arm. It takes longer.
“Not a lot of people think about that,” Morel adds, that it’s harder for the body’s macrophages to work to remove the ink.


For more information check out
www.luckyseventattoo.net
www.atlanticdermatology.com
www.DrTATOFF.com
www.lightage.com