Definition: Decorative tattoos result from the placement of colored pigments in the skin, just under the surface. Traumatic tattoos result from injury or accident-related deposition of dark fragments or pigment under the surface of the skin. Therapeutic tattoos are those used for various medical purposes, but otherwise are similar to decorative tattoos.

Removal: Options for removal of tattoos include: surgical excision in a single or staged fashion; with or without skin grafting; the use of various acid preparations and bleaching agents; destruction by electrosurgical methods, destruction by cryosurgical methods; tattooing over the colored pigments with flesh-colored tattoo pigments; dermabrasion; combinations of the above; and various laser treatments. The current state of the art of tattoo removal is based on recent developments in laser technology. The Q-switched laser systems represent the latest technologic advances that are specifically designed for elimination of tattoos. These lasers work by producing a short pulse of intense light that passes harmlessly through the outer or top layers of skin to be selectively absorbed by the tattoo pigment. This laser energy causes the tattoo pigment to fragment into smaller particles that are subsequently removed by the body's immune system. Because darker colored tattoos may have larger deposits of tattoo ink or pigment, several treatments may be required to achieve maximal fading of your tattoo. Studies have shown that professional tattoos require, on average, six to eight treatments, whereas amateur tattoos require fewer, averaging four to six treatment sessions to achieve a satisfactory fading.

Description of treatment session: Each treatment session can be broken down into three phases: the pretreatment preparation, the treatment, and the posttreatment healing phase. The pretreatment preparation phase includes careful monitoring of medications consumed. Aspirin and nonsteroidal anti-inflammatory agents such as ibuprofen (Motrin, Advil), can produce pronounced bruising after treatment and should therefore be avoided. During this period, Tylenol is recommended for minor aches and pains. During the treatment sessions, some patients experience a minor amount of discomfort. It is hard to predict the patients in whom this will happen, but many patients benefit from pretreatment application of EMLA cream. This is a prescription item that is applied under the occlusive dressing two hours prior to the laser treatment session. It is wiped off just prior to the actual laser surgery. Detailed instructions will be distributed to you if you choose to use this anesthetic cream preparation. Some patients prefer that local anesthesia be injected into the tattoo site prior to laser therapy. During laser treatment, your eyes will be covered with protective eyewear. The actual laser treatment takes a very small percentage of the total clinic visit. Following the treatment session, a dressing will be placed on the treatment site. You will then be given detailed instructions for care of the treatment site; they will be described and given to you in written form by the nursing staff. Furthermore, a follow-up appointment will be scheduled prior to your discharge from the clinic.

In the postoperative phase, your treatment site may develop a crust and/or a scab that should be handled gently so as to minimize potential for alterations in the texture of the skin. This open sore will heal over the course of the ensuing one to three weeks. After it has healed, it will gradually and continually fade. Subsequent treatment sessions should be scheduled four to six weeks apart.