Tattoo removal: It’s still imperfect

Carly Cardellino, an editor at Cosmopolitan, recently underwent picosecond laser treatments to remove a small tattoo on her foot. The new type of laser works in the same way as previous types, but better and faster.
Carly Cardellino, an editor at Cosmopolitan, recently underwent picosecond laser treatments to remove a small tattoo on her foot. The new type of laser works in the same way as previous types, but better and faster. New York Times

Years after Carly Cardellino quit her college sorority, she couldn’t leave behind one piece of it: a teal star and a red heart outlined in black, the group’s symbol, which she had spent $50 to have tattooed on her left foot during her sophomore year.

In 2009, after a laser treatment every four weeks for a year ($3,000), the tattoo “looked like a bruise – like someone stepped on my foot with a high heel,” said Cardellino, the senior beauty editor for “It looked worse than it did as a tattoo.”

Cardellino had resigned herself to covering the tattoo with a flesh-colored circular Band-Aid when, in December 2012, the Food and Drug Administration approved a new kind of laser that could remove, among other things, so-called recalcitrant tattoos. After seven treatments ($400 a session) in the office of Paul Friedman, a dermatologist in New York, the tattoo was gone.

“The skin is a little bit lighter,” said Cardellino, who attributes that in part to her obsessive use of sunscreen in the area. (Tattoos can’t be exposed to sun while they’re being treated.) “But if I showed you I had a tattoo there, you’d be like, ‘I don’t believe you.’ ”

The new laser, called a picosecond, because it fires pulses at a trillionth of a second, works the same way that the previous generation of lasers did, which is by breaking down the ink so that the body can absorb it.

But it has been widely hailed as the first major advancement in tattoo removal in 20 years. That’s because, compared to the old lasers, which worked merely in billionths of seconds, doctors say the picosecond both cuts treatment time in half and can remove colors of ink (reds, blues and greens) that previously barely budged. A small study published in the journal Dermatology showed that two-thirds of tattoos with blue and green pigments nearly disappeared after one or two treatments with a picosecond laser.

Supporters like to describe the difference in how finely the new lasers shatter ink as the difference between pebbles and sand. (Researchers are already at work on a femtosecond laser, which would pulse at a quadrillionth of a second, which in this analogy, presumably would pulverize the ink to silt.)

“It’s a really significant advance,” said Roy Geronemus, a dermatology professor at NYU Langone Medical Center, who has worked with lasers since 1983 and conducted some of the initial picosecond studies. (Geronemus is on the medical advisory board of the company that makes the laser.)

As with all cosmetic treatments, there is some element of marketing hype. Tattoo removal is a roughly $75 million-a-year business – mostly catering to young professionals who think tattoos are hindering their rise, mothers who decide the art no longer fits their image and tattoo enthusiasts who simply want to redecorate.

There is also a cross section of heartbreak and hopes dashed. Bruce Katz, a dermatologist in New York, has twice removed the same woman’s name from the same man’s buttocks. You connect the dots.

But the number of procedures performed in the United States has declined sharply in recent years, to 33,363 in 2014 from 58,429 in 2012, the most recent year for which the American Society for Aesthetic Plastic Surgery has figures.

Some doctors attribute the drop to the new laser’s ability to cut down treatments per patient (each treatment counts as a procedure, in the society’s accounting), but James Grotting, the society’s president, put a less-happy spin on it.

“The numbers are declining because tattoo-removal procedures haven’t given predictably good results,” Grotting wrote in an e-mail. He called tattoos “still an unsolved problem” because of the still-present possibility of scarring and the wide variation in how different colors and types of ink respond to lasers. Pink ink, for example, often contains iron oxide, which means it may turn black under a laser, a less-than-desirable outcome.

No one disputes that having a tattoo removed is much more expensive and time-consuming than having one put on in the first place, and the cost is seldom, if ever, covered by medical insurance. Only one woman interviewed reported a tattoo coming close to “clearing,” as it’s called, in a treatment or two, and hers was a tiny brown Zodiac sign on her right ring finger. (Cost and initial results vary widely by the size of the tattoo and its location – leg and feet tattoos are slower to disappear, likely because blood flow is less.)

Upon a touch of the laser, the skin crusts immediately. (If it doesn’t, “you know the ink isn’t absorbing the light,” Friedman said.) Exactly how painful is a process that, if it goes well, is supposed to lead to oozing blisters? Most doctors offer numbing cream and lidocaine shots, which means that by the time the laser hits (with an ominous-sounding snap), the worst part is over. Just ask Julian Schratter, an artist in Brooklyn.

Though Schratter happily spent five hours under the needle having a redwood tree tattooed from his right knee to his groin last year, he fears injections. “Ironic, I know,” he said. For his first appointment, his anxiety slowed the injection of the 10 lidocaine shots he needed during a 2-1/2-hour ordeal. Actual laser time: seven minutes.

Schratter, who has seven other tattoos and plans to replace the redwood with something else, was more relaxed for his second appointment, which took only about 45 minutes. Still, he joked, “deforesting is hard.”