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 Ms. Cardellino, the senior beauty editor for “It looked worse than it did as a tattoo.”
Ms. 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 Dr. Paul Friedman, a dermatologist in Manhattan and Houston, the tattoo was gone.
“The skin is a little bit lighter,” said Ms. 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 (including reds, blues and greens) that previously barely budged. A 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 Dr. 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. (Dr. 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. Dr. Bruce Katz, a dermatologist in Manhattan, 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 Dr. 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,” Dr. Grotting wrote in an email. 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, particularly if one has, for example, tattooed pink lip liner.
Upon a touch of the laser, the skin crusts immediately. (If it doesn’t, “you know the ink isn’t absorbing the light,” Dr. 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 Greenpoint, Brooklyn.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.)
Though Mr. 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 two-and-a-half-hour ordeal. Actual laser time: seven minutes.
Mr. 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.”
Removing Ink: Do You Need a Doctor?
Many states don’t mandate that a doctor perform laser treatments. You may want one.
In essence, laser tattoo removal is touching a wand to a patch of skin. The procedure is regulated by states, many of which allow laser operators to work after as little as 16 hours of hands-on training.
Consider this, printed in boldface type, from the website of the laser company Astanza: “Entrepreneurs with no medical background in over 45 states operate highly profitable laser tattoo removal businesses on a day-to-day basis.”
The company goes on to point out that even if a doctor is required to serve as medical director, “this role generally requires only periodic check-ins.”
New York State requires that a doctor supervise laser treatments, but specifically adds that this “shall not be construed as necessarily requiring the physical presence of the supervising physician at the time and place where such services are performed.” New Jersey is stricter: doctors only.
Doctors generally charge at least twice as much as laser clinics, so why would you pay for an M.D.?
“You can teach a monkey to push a button,” said Dr. S. Tyler Hollmig, assistant professor of dermatologic surgery at Stanford University. “It’s judgment. That’s why you want a physician.”
Every doctor has a tale of a patient who comes in after a botched removal procedure. Treating a tattoo properly includes understanding the biology of the skin around it. There is no uniformity among tattoo ink.
And a patient may want someone who can analyze the color of the skin (darker skin is harder), the history of the tattoo (has it been treated before?) and its age (older tattoos are easier, since the body slowly gets rid of the ink, which may have faded anyway).
Tattoos need to be at least six months old to be removed, because the inflammatory response has to stop, or removal treatment may make it worse.
And it may be less painful to go to a doctor. Even if your state doesn’t consider operating a laser to be the practice of medicine, administering a shot of lidocaine usually is.
'I lost a job because of my tattoos'
- 22 September 2014
- Magazine
Readers have been getting in touch about their experiences of terminated job interviews, losing out on promised promotions and leaving jobs because of their tattoos.
It followed a Magazine article which asked whether discrimination against people with tattoos should be banned in the workplace.
Here are some of their stories.
'I was told I'm a bad example to children'
I'm 35 and quite heavily tattooed. I had a job as a mid-day assistant at a school. I was taken on having tattoos and facial piercings which during the winter months was fine as I was covered up, but when the summer arrived my arms were on show.
I was promptly issued with a "standards of dress" guide. It said that visible tattoos and facial piercings were not setting a good example and should be covered up. This was the first bit of communication I had received during my job.
I was good at my job and the children seemed to like talking about my tattoos. I did start a bit of a campaign but I didn't want to work in an environment that said because I have tattoos and a piercing I cannot do the job.
After a week or so I went to see the headmaster and resigned with immediate effect. He had called me in to have meetings with personnel over the issues I had raised, but I didn't feel I wanted to work in a place that discriminates against tattoos and piercings and I don't believe I should have to fight to justify that I'm a hard worker and a decent person.
I just feel it's sad that in 2014 we can be so discriminatory about people's choices, I feel sad that children grow up being taught these shallow-minded views. The best bit was that after a month or so of me leaving they had a school fete with a temporary tattoo stall for the children!
Karla Valentine, Suffolk, UK
'I had my working hours cut'
My old boss was against body modifications because of her religious beliefs. I was constantly harassed about my piercings and tattoos.
I had hours cut after getting my tattoos, even though they aren't visible. I have both feet done as well, but always wear socks and shoes. I work in childcare and was told that even out in public I had to keep appearances up, so to keep covered, because I might see the children I looked after outside hours.
In my uniform you can't see my tattoos. As I keep it professional but I've been told that I'm unapproachable and scary with tattoos and piercings and that could lose potential clients to the business.
Sam, Brisbane, Australia
'I was told to cover up'
I have both full sleeves and my previous employer stated you had to cover all tattoos when in work hours, which I found wrong because other members of staff were allowed to wear earrings which is another form of body modification. One rule for one et al.
I now work for a company that does not discriminate against tattoos. I am currently a contract manager for a hospital. In my previous job I was an operations manager where their policies stated that all tattoos had to be covered up at all times. This included any contractor working on site.
Jef, Teddington, UK
'My job interview was terminated'
I'm a heavily tattooed 20-year-old girl. I've had very mixed reactions to my art. I find that because I'm such a young girl and have as many as I do (I lost count at 50) that people either love them and find me brave or hate me and insult me by using my tattoos as ammunition.
I've even had an employer hang up the phone on me when they found out I had tattoos.
About a year and a half ago, in 2012, I applied for a job as a waitress. It was a half telephone interview, half seeing when you're free. It was going fine. The employer started talking about the uniform. When he said it was short-sleeved, as soon as I said I had my arms tattooed, he just hung up.
I was working as a shop assistant in a mobile phone shop when a customer started screaming in my face. They had some problems with their top-up I was trying to help them with but they had bought it from another shop and I couldn't give them a refund. They completely switched.
"You've only got this job because you've got tattoos," they shouted. They were saying I was disgusting and I'd let down the company. They just really kicked off - you know, when they do that look when they tut and they spit at the same time. And then walked out of the shop, so I went round the back and cried.
I have had awards for my customer service and in that shop my manager had sleeves, my other manager had a neck tattoo.
I'm not rude or horrible. I don't do drugs or anything. I work hard, pay bills, do charity work for animals and yet they call me disgusting names for no reasons. The art I have isn't even offensive. Just cause I'm heavily tattooed doesn't mean I'm nasty, scary or stupid.
Amii Parr, Reading, UK
'I missed out on a promotion'
I was promised a promotion when I turned 18. I was waiting on this promotion from a buser - a person who buses tables, washes dishes, serves food and stocks coolers - to a server at a bar and grill for five months.
On my 18th birthday I got a half-sleeve and my boss immediately denied me the promotion he promised me even though some of my co-workers had much more visible tattoos and piercings.
I quit a month later.
He didn't say directly that it was because of my tattoo, but the comments he made toward me made it clear he didn't like it. He asked me if I was crazy for getting it and why my parents would let me do this to myself.
He also said it's very dark (I don't really know if he meant dark as in black or dark as in creepy) and that I'm better for in the kitchen rather then being a waitress.
Emily, Wisconsin, USA
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