The Process of Tattoo Removal: A Memorable Lesson in Decision Making

Decisions come easy for some people and for others, even the smallest ones are a painful deliberation. I made the decision to get tattoos very quickly, but then later in life took quite a while to decide upon removal. Decision making is a process that like everything else, becomes smoother with life insights and a mindful process behind it.  

Both of my parents are artists and like most kids, I wanted to do what they did. Then like most young adults, I wanted to make sure that I did the absolute opposite. I donned a shirt and tie and joined conservative Corporate America. To keep my inner artist and punk rocker alive, I decided it would be cool to have some of my own art hidden under my nine-to-five uniform. 

Then the corporate-casual movement came out of nowhere. Casual Fridays were replaced with everyday golf shirts, in whatever horrendous color represented the company and embroidered with their logo. Every year it got more difficult to explain why I was wearing a long sleeved thermal under my golf shirt for a July conference in Scottsdale or Vegas. Somewhere between the explaining, hiding and profuse sweating, I decided to look into tattoo removal. 

Erno Tattoo, Haight Street, San Francisco

So here's what we're dealing with.

 

Say Hello to My Little Friend

Lasers were just coming onto the removal scene and shops were opening up in strip malls all over the place. It didn’t seem like it took much to get in the biz. Just purchase a big expensive laser, get an M.D. to put his name on the business (they don’t even need to ever be there) and then hire some estheticians to fire the gun. There wasn’t nearly as much info on the web back then as there is now, not to mention reviews. I read all I could get my hands on and went in for my evaluation. The good news was that my ink was all black - the easiest color to remove since the absorption spectra is best suited for the emission spectra of most lasers. The bad news was that I had a ton of dense, professionally applied, deep ink that would take many treatments to rid. 

My greatest concern was the outcome. At the time, all the before and after photos on the web were of the same three tattoos, each one about 5% of what I was attempting to remove. I wanted them to be gone, not to look like I had made a semi-successful attempt to do so. The owner of the clinic assured me that a clean palette was imminent and that they had successfully removed tattoos that big. My second concern was the cost. With the number of treatments I’d need, I was in for at least seven thousand dollars. I wasn’t really concerned about the pain. I have a very high pain tolerance and my research informed me that it felt like getting snapped with a rubber band. 

Time to Face the Music

I decided to commit and made my first appointment. My girlfriend at the time came with me for moral support. The nurse gave us our protective laser-proof eyewear and I settled into what looked like a dentist’s chair. She held the gun over my arm and began to pulse the laser. Within the first five seconds, I was afraid I might have made a terrible mistake. The pain was unbearable. I can only describe it as being stabbed by a tiny, red hot knife, hundreds of times per minute. It pretty much feels as one would expect getting burned by a giant laser would feel. 

There are a variety of lasers out there and I don’t think the technology has advanced much since my adventure a dozen years go. I was being tortured by a Q-Switched Ruby laser at 694 nanometers, the most effective for removing black ink. The Nd:YAG laser produces both green and red light, so that one is also well suited for removing the red, yellow and orange inks. Alexandrite lasers are most effective for getting out the stubborn green pigments and other bright colors. The way it works is that the laser blasts the ink particles with an incredible amount of energy for a few nanoseconds at a time. The surface temperature of the particle can rise to thousands of degrees before quickly collapsing into a shockwave into the surrounding tissue, causing the more brittle structures containing ink to fragment. After a while, the body’s immune system begins to whisk off the small fragments and the tattoo slowly fades. 

Is Something Burning? 

My girlfriend said that each time the 3mm beam spot of the laser struck the pigmented skin, that section would blossom like popped corn. She noted that the smell of burning flesh in the treatment room was vomit worthy. Somewhere around the 40 minute mark, I completely lost consciousness. I’m not sure if they noticed that I was totally checked out, but I have no memory of the end of the session nor leaving the clinic. I think my central nervous system simply said “enough is enough” and pulled the plug. Both arms were badly swollen under the layers of gauze and I went to bed as soon as I got home. I was scheduled to leave on a 6AM flight for an interview on the east coast and was now deeply regretting my ambitious scheduling. 

The Aftermath & Coping 

I woke up at one in the morning sweating uncontrollably with a high fever. I turned on the lights to discover I had bled through my bandages and shirt and onto the sheets. I still had a fever when I boarded the plane and fell asleep quickly. I awoke to the woman next to me letting me know that I had spilled something on the sleeve of my jacket. I glanced over to find that I had bled through my gauze bandages, ace bandages, dress shirt and finally onto my suit jacket. In spite of the stains and dementia, I nailed the interview and got the job. 

Two weeks later, I was back in the treatment chair but the practitioners had a new strategy: only do half my arms in one treatment. I started to get the feeling that they had never removed a tattoo this large and were winging it with the limits for pain tolerance and recovery. After my second treatment, I knew that I had to get something for the pain. Booze and aspirin were both out since they thin the blood which would botch my session. I tried the topical numbing gel lidocaine, but had an allergic reaction that made it hurt even more. I went in to my general care physician and asked for a Vicodin prescription. He actually laughed and told me that tattoo removal was relatively painless and that he couldn’t prescribe a narcotic for it. I removed my jacked to show him the blood-soaked bandages on both of my arms and left with a prescription and three refills. 

I then began cajoling different friends to schlep me from Santa Monica to the clinic in Orange County so that I could get loaded on Vicodin during the drive there. I’d feel invincible by the time I walked in the door, but as soon as that first laser pulse hit me, it was as if I had been popping sugar tablets. Wondering if the drugs did anything at all, I tried another session without only to discover that at the least, they were making me care a lot less about being torched. I got into the routine of my removal rituals. It started with finding a friend who hadn’t experienced the lingering smell of burned flesh in their car yet, then the timing of the painkillers to hit my system, readying my compression bandages, the shirt I would bleed on and finally fitting the bedsheets that were already ruined. 

The day after my second treatment after removing the compression bandages.

You can see how much lighter the elbow is just two sessions later.

The post-laser "sweating" that would take place for about a week after treatment.

All Things Come to an End

I ended up moving to San Jose for a couple of years and continued treatments in a laser clinic up there. This one was a legit medical center and things seemed to progress a bit faster. It didn’t bleed or scab so much with the lasers they were using, or maybe it was just the settings on the machine, the skill of the nurse technician or that I had less ink on my arms at that point. Sometimes a couple months would go by in between treatments, just because it took that long to psych myself up to get back in the chair. One of the crazy things about laser removal is that the results continue for weeks or months after a treatment. Once the pigment is obliterated into tiny fragments, it just continues to fade for quite some time. I lost track of how many sessions I went in for. I think it was around 15 to 20. 

In spite of all the excessive pain, blood and spending, it worked. If you look really closely at my arms, you can see areas of hypo-pigmentation, where the laser actually reduced my skin’s natural color, leaving it lighter than the surrounding area. In my current career, it doesn’t even matter that I have tattoos, but I like having the choice if they show or not. There are simply times that I don’t care to look like a Sons of Anarchy extra. If you’re interested in getting a tattoo removed, do your homework. Learn about the types of lasers the clinic uses and if those are best for the color of your tattoo. Find out where the nurse technicians were trained. Don’t let them be cagey about pricing. I found that some clinics with comparable equipment and technicians were over three times the cost of others - it pays to shop around. Be unwavering about your aftercare and recovery, making sure to use any ointments they suggest while keeping the treated skin out of the sun. Depending on the size and type of tattoo you have, it might just be a couple of a treatments and not the two year adventure I underwent. But yes, that tattoo can be totally gone. It just goes to show you that nothing is permanent. Not even tattoos. 

I miss your tattoos, Daddy.