Tattoo regret: The dark side of removal
Tattooed Australians who regret their ink are being a put at risk of permanent skin damage because laser tattoo removalists aren’t required to have medical training.
Tattoo removal is a booming industry – there’s no shortage of potential customers.
Being able to undo what was once considered irreversible without extreme measures is good news. The tool of choice these days is a laser, which can and has caused burns and permanent scars on tattoo removal patients, according to reports.
Some removers use medical-sounding assurances such as “certified laser practitioner” or “accredited clinician”, which generally means they took a course offered by the laser maker, often a prerequisite for obtaining liability insurance. But that doesn’t mean they’re any good at removing tattoos.
In September last year, the then honorary secretary of the Australasian College of Dermatologists, Dr Cathy Reid, raised concerns about the use of lasers by people who lacked medical training and called for a national regulation regime. So far, that hasn’t happened.
Removal techniques have come a long way since the days of skin grafting, skin removal or the use of infra-red and other non-medical lasers. Best practice these days dictates that unwanted tattoos be gradually broken apart through the use of Q-switched lasers set to specific wavelengths depending on skin type and the colour and location of the tattoo.
The lasers are used in short bursts that break up the ink; the immune system then goes to work and gets rid of the dispersed particles over the course of many months and treatments (up to 15 treatments, six to eight weeks apart, for multicoloured tattoos).
Hilary Quinn, proprietor of Melbourne Tattoo Removal in the suburb of Caulfield, has been in the business for five years and says she’s seen more than a few burns and scars on patients who came to see her after suffering at the hands of an unskilled remover.
“I took a laser safety course, but that’s only about using lasers safely, not tattoo removal,” Ms Quinn said. “That’s a skill you acquire over time, and you need to approach it like an apprentice and build up your technique under the guidance of an experienced remover.
“The industry has really boomed, especially in the past six months or so, and unskilled practitioners far outweigh skilled ones. I know of many would-be tattoo removers who got a cheap laser machine, started off with little or no training, damaged a few people, and then got out of the business.”
Dr Philip Bekhor, director of the Laser Unit at Melbourne’s Royal Children’s Hospital, backs up Quinn’s assessment.
“In Victoria your local butcher could sideline in laser tattoo removal, and many removers scar up a lot of patients before they develop any real skill. In reality the process is extremely slow, not every colour responds well, and it can be painful. It’s an invasive procedure with the capacity for injury,” Dr Bekhor said.
Both Dr Bekhor and Ms Quinn say widespread use of cheaper knock-off versions of the Q-switched laser or, worse, the use of IPL lasers, are a principal cause of injury and unsuccessful tattoo removal. It’s no coincidence that proper Q-switched machines cost about $150,000, while IPL lasers go for between $10,000 and $15,000.
The lower costs of getting into the business in recent years, along with the longstanding lack of regulation in many jurisdictions, are key reasons for the big increase in the number of tattoo removers, both say.
The problem, Dr Bekhor argues, is that “IPL lasers function in milliseconds instead of nanoseconds, and the wavelength is too broad. They’re marketed as an all-purpose machine, including tattoo removal, but shouldn’t be used for that purpose. They often cause distorting of the tattoo and horrific burns and scars.”
Ms Quinn makes the same point. “Every second beautician seems to be offering tattoo removal with an IPL laser these days. It shouldn’t be used for that. It shoots a block of light of about two by six centimetres rather than the five to eight millimetre pinpricks of Q-switched lasers. It’s like trying to crack an egg with a machinegun