So Long to Tattoos!

July 31, 2017

translated from La Opinión - July 17, 2017 

By: Jorge Luis Macías

Erika Mendiola receives treatment to have her tattoo removed by a nurse practitioner at the Sunrise Outreach Center of Los Angeles. (Jorge Luis Macias, Special Assignment for La Opinión)

"Ow, ow, ow!” Erika Mendiola cries in pain when the laser rays are applied to her right shoulder to remove the tattoo of a cross.

The laser has made contact with the ink and her skin boils. There is no splitting, cutting or scarring. But the pain is evident. The darker the ink, the more continuous the ray. And Laura groans in pain, even though the session with nurse Teresa Eligio lasted for less than five minutes.

For many people, the markings on their bodies have special meaning: the name of a loved one, membership in a group, etc. But occasionally, over time, what seemed like a good idea stops being one, and the pride turns into shame. Quite a few individuals opt to remove them.

Eligio, a nurse practitioner at the Sunrise Outreach Center of Los Angeles, does tattoo removals on 20 to 30 patients a day, each month.

That is the average number of patients who are seen by the Tattoo Removal Clinic at Providence Health Services, which has several hospitals in Burbank and the San Fernando Valley.

Every Saturday, the clinic located in North Hollywood fills up with people wanting to get their tattoos removed. Its popularity is due to the fact that it is free, in exchange for the person's doing community service. Many of the patients have had trouble with the law or have been involved in gangs.

“The idea is for them to leave the gangs, and to do so, they have to be busy, take that out of their mind, and so they have to get their tattoos removed,” explains Karina Cisneros, coordinator of the program, which has been around since 1982.

“A lot of our clients want to change, but it is hard for them to find work (sometimes because of their tattoos),” adds Cisneros.

The Demand for Tattoo Removal is Growing

According to a 2012 survey by Harris Interactive of New York, one in every eight U.S. adults with tattoos regrets having gotten them. Many now want to update, change or remove them.

In the meantime, the American Society for Dermatologic Surgery (ASDS) reported that in 2011 its physicians performed nearly 100,000 tattoo removal procedures, a jump from the 86,000 done in 2010. And from 2012 to 2013, the number of tattoo removals grew by 52 percent.

Unfortunately, getting rid of a tattoo is not as easy as just changing your mind.

Erika Mendiola got the tattoo of a cross on her shoulder because she liked it, now she is paying to have it removed. (Jorge Luis Macias, Special Assignment for La Opinión)

Laser, Dermabrasion and Other Methods

Tattoos are supposed to last forever. Artists create them by using an electric machine that bobs a needle up and down to inject ink into the skin, penetrating the epidermis, or outer layer, and depositing a drop of ink into the dermis, or second layer of the skin. Dermis cells are more stable than epidermis cells, so the ink would certainly remain there throughout someone's lifetime.

A safe and effective way of removing tattoos is by laser surgery performed by a dermatologist who specializes in tattoo removal, says Mehmet Kosoglu, PhD., who reviews applications seeking approval to market laser devices.

According to Dr. Markham Luke, a dermatologist with the FDA, the agency has approved several devices for use in tattoo removal. Approval means that the FDA has determined that the device is, to a large extent, equivalent to another device that is legally on the market.

Kosoglu explains that in removing the etchings with a laser, high-intensity laser energy pulses pass through the epidermis and are selectively absorbed by the tattoo pigment. The laser breaks down the pigment into smaller particles that can be metabolized or excreted by the body, or carried to and stored in lymph glands or other tissues.

The type of laser used to remove a tattoo depends on the pigment colors. Every color of ink absorbs light at different wavelengths; multi-colored tattoos may make it necessary to use different lasers. Lighter colors, such as green, red and yellow, are the hardest to erase, whereas blue and black are the easiest.

One laser treatment will not usually be enough. For Erika Mendiola, of Jalisco, Mexico, it would take approximately 10 laser sessions, a figure that coincides with the average estimated by the American Dermatology Academy. Each monthly treatment costs her $65 dollars.

Dr. Kosoglu points out that pulse lasers have been used to remove tattoos for over 20 years. Nonetheless, it can be a laborious process. “Complete removal, without scarring, is not possible sometimes,” says Kosoglu.

Other methods are dermabrasion —actually “sanding” the top layer of the skin— and excision, which involves cutting out the area covered by the tattoo and stitching the skin back together.

Pain and Side Effects

Does getting a tattoo removed hurt? It depends on each person's tolerance for pain. Or just ask Erika Mendiola.

“My skin gets a little swollen, but the pain goes away quickly,” she stated. “I would never get another tattoo. It's not worth it.”

Joaquin Flores is all too familiar with that pain. He has already had 16 laser sessions at the Providence Tattoo Removal Clinic. They are to take off two horns on his head and the writing that covers his entire neck –bad decisions, he says, from his youth. He wants to join the Army, but it does not allow these types of tattoos.

“When my son turned 5, I wanted to set a better example,” recounts the 32-year-old resident of Lancaster.

He says getting rid of these tattoos has turned his life around.

“More people talk to me now, all of those negative stereotypes are gone,” explains the security guard. "This (the program) is great. It has made a huge difference."

He’s asked if he would get tattoos again.

“I'd make better decisions. Probably not,” he says emphatically.

Dr. Leah Heap, who volunteers at the Providence Tattoo Removal Clinic, compares the pain of the laser procedure to being sprinkled with drops of hot oil or being snapped on the skin with a rubber band or elastic.

“Getting a tattoo removed is much more painful than getting one,” she offers.

A trained dermatologist or a registered nurse like Teresa Eligio can adapt the treatment to a level that is comfortable for the patient.

Some possible side effects are local bleeding, redness or slight pain, none of which should last for very long. Another possible side effect is scarring.

Lighter colors, such as green, red and yellow, are the hardest to erase, whereas blue and black are the easiest. (Jorge Luis Macias, Special Assignment for La Opinión)

Help for Los Angeles Inmates

In Los Angeles, the Sheriff's Department has introduced the Community Transition Unit and the Tattoo Clinic, which aim to prevent recidivism in inmates after they are released, and to increase their likelihood of finding employment, without tattoos.

The tattoo removal component began in February 2012 as an alliance between the LACSD Medical Services Office and the Inmate Services Office. Results are supervised by trained medical personnel, and although it started with just 25 incarcerated individuals, the program has grown and has now treated 276 men and 260 women.

“Visible tattoos, especially ones that are related to gangs or are profane, can negatively impact a prisoner's ability to find employment following their release,” said the Captain of the Medical Services Office, Kevin Kuykendall. “An ex-prisoner who can find work is better able to reintegrate into the community, and less likely to wind up in jail.”

With information from Francisco Castro.

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