Tattoo Second Thoughts

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Tattoo Second Thoughts

What nurses should know about removal options

By Working Nurse
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Even if you have no tattoos yourself, at least some of your patients likely do — and some may now regret it. Luckily, tattoo removal has become increasingly sophisticated, making an unfortunate tattoo choice a little less permanent.

Tattoo Generation

According to a 2015 survey by The Harris Poll, about 29 percent of all American adults (and 47 percent of adults under 35) now have at least one tattoo. Some have also had second thoughts: Twenty-three percent of tattooed respondents said they regret one or more of their tattoos.  Completely erasing an unwanted tattoo remains difficult, but healthcare providers now have three well-tried, FDA-approved, outpatient tattoo-removal methods:

• Surgical excision: If the tattoo is small enough, a clinician can actually cut it out with a scalpel. This is the most invasive method, requiring stitches, but also the quickest and most precise.

• Dermabrasion: This technique, also called surgical skin planing, uses a sander to remove layers of tattooed skin. Multiple treatments are usually required.

• Laser surgery: The most popular method uses a laser to break up  ink-containing skin cells in a series of treatments (usually at least six,  sometimes up to 20) spaced six weeks apart. 


Although laser surgery is safe, Paula Pearlman, M.D., volunteer medical director for the tattoo removal clinic at Homeboy Industries (see the sidebar), warns, “It hurts. Bad.”

Cool air and numbing creams can help, but, Pearlman notes, “There are some body parts that are much more sensitive to pain.” Some tattoos are also harder to remove than others.

Amateur “stick-and-poke” tattoos and certain very dark or pastel colors are particularly tough.  “The removal process doesn’t always work,” Glosserman says. “Frequently, the original tattoo process can result in permanent, raised scarring on the skin. We can get rid of the ink, but the scar remains.”

Another common side effect, usually temporary, is skin discoloration. The website of the American Society for Dermatologic Surgery ( now offers a tool to help patients locate dermatologic surgeons skilled in tattoo removal.  Medical tattoo removal is costly and rarely covered by insurance, but patients should not be tempted by over-the-counter alternatives. “FDA has not reviewed them and is not aware of any clinical evidence that they work,” warns FDA dermatologist Markham Luke, M.D., Ph.D. 


Homeboy Industries -- RNs Invited to Volunteer

Originally founded as Dolores Mission’s “Jobs for a Future” program, L.A.-based Homeboy Industries is a nonprofit organization that helps men and women who were previously incarcerated or gang affiliated begin new lives. Among the many services Homeboy offers is a tattoo removal clinic, called “Ya Estuvo” (which in Spanish means, “It’s done”).

Each month, volunteer providers treat about 3,000 tattoos, many of them gang-related or in visible locations that hamper clients’ job searches. Paula Pearlman, M.D., volunteers three and half days a month at the clinic, whose providers include a mix of physicians, midlevels and RNs, all volunteers.

“RNs volunteer as assistants,” Pearlman explains. “We are working on credentialing RNs to do the actual removal, but there are issues that we still need to iron out.” Homeboy Industries is always looking for volunteers and would be excited to have more nurses willing to donate their time. In addition to tattoo removal, Homeboy offers mental health, substance abuse and domestic violence services, so expertise in those areas would be essentially useful to the organization.

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