By Dr Neil Persadsingh,
Skin Specialist
Buy in haste, repent at your leisure. Or do some thing now and spend a life time regretting it, Or have a tattoo put on now and spend many years regretting that you did.
The custom of putting tattoos on our bodies is widespread in all cultures. In people whose ancestors came from Africa, the habit is particularly common. This is because the African adorned his body with tattoos to identify his tribe and the tattoo was used to show one's position in the tribe.
Today we have tattoo parlours springing up everywhere. There is no control over these parlours, and anyone can style themselves a tattoo artist.
When you get a tattoo, you run the risk of contracting hepatitis, a liver disease; syphilis; and even the HIV virus -- that's the virus that causes AIDS.
The tattoo artist should sterilise his needles properly, and he should use a sterile technique.
Most people who have tattoos put on do so when they are young, that is, in the teens or in their early 20s. As they get older and more mature, invariably they will want to take out the tattoo, and here is when the problems arise.
When we have a tattoo done, needles are used to deposit pigment deep in the skin -- below the epidermis (the toppermost layer of the skin). Cells called macrophages pick up the pigment and then migrate, carrying the pigment deep into the dermis -- the deeper layer of the skin. If the pigment remains in the superficial epidermis, we can remove the tattoos with chemical peels or by shaving them off. But invariably the pigment goes deeper and we will have to use other strategies to remove the tattoo.
Usually the patient will come demanding that the tattoo be cut out. Sometimes this is feasible, especially if the tattoo is small.
Sometimes we can cut out the tattoos in stages. Thus, a part is cut out today and this a stitched up and allowed to heal. A few weeks later another part is cut out and allowed to heal. We can sometimes achieve good results with this technique. The patient must be warned that sometimes a scar will remain and s/he should be prepared for this.
In some cases where a tattoo is large, we will ask the plastic surgeon to see the patient. The plastic surgeon may do an excision where he cuts out the tattoo, and he may do a skin graft to cover the defect left after he has done the excision. But this is relatively expensive.
The surgeon may use a tissue expander to give him the extra skin that he needs after he has removed the tattoo. The tissue expander is a small balloon which is placed under the skin next to the tattoo. The expander has a small tube which is available on the surface of the skin. The expander is injected with sterile water weekly and this will stretch the overlying skin. The new skin formed over the expander will then be used to cover the defect left when the surgeon removes the tattoo. This is very expensive.
Dermabrasion has also been used to treat the tattoo. In this process the skin is frozen with a spray of ethylchloride. We then take an injection syringe and wrap a piece of sterile sandpaper around it. This is then used to rub down the tattoo and to remove the tattoo. In every case in which I have seen this attempted, the results have been unsatisfactory.
There is a new machine, called an infrared coagulator, that is supposed to destroy the pigment in the tattoo by causing the pigment to evaporate. How this works out in practice remains to be seen.
Lasers have been touted as the answer to the removal of tattoos. The cases I have seen have all turned out bad, and I don't know if this is the answer.
Because of the tendency of our people to develop keloids, it is important that the patient understand that s/he may be removing the tattoo and trading it for a keloid. Many times after removal the scar may stretch and the patient is left with a wide ugly scar.
There have been many instances where the patients have become frustrated with the doctors and the surgeons, who they believe do not want to help them. It is important that the patient understand that some tattoos are difficult to remove. In some instances the surgeon may need time to assess the situation before he jumps in with the knife.
My colleague Dr Arscott reminds me of two plastic surgeons who were killed by a patient in England because the patient believed that he was getting the runaround and that the surgeons were not interested in helping him. This is indeed a tragic state of affairs. Tattoos are a problem which we can prevent.
Perhaps we can appeal to the tattoo artist to select the site with care and to do their work with the knowledge that most of the people who have a tattoo put on later will want to remove it.
However, if you are thinking about having a tattoo put on, please forget the thought, and if you already have a tattoo and you want it removed, visit your dermatologist who may be able to help you.