13 VITAL QUESTIONS TO ASK WHEN YOU SHOP FOR LASER TATTOO REMOVAL

You're interested in removing a tattoo. You've heard lasers are best (it's true!). Maybe you've heard about different lasers. You've heard it hurts. You've never done any of this before. Help!

I've prepared this little SHOPPING LIST for anyone looking for local laser tattoo removal. These are the questions you want to ask, the questions you NEED to ask.

You might not find anyone who scores perfectly on all 13 of them, but at least you know what you're getting yourself into if forced to compromise.

Here goes...

1. How long has the business been removing tattoos?
A business' long track record means you can trust them to be around for the 1-2 years you might be going there, and it's even better if you're prepaying for treatments. It's a tough industry, and it's common for laser tattoo joints to go out of business, due to high overhead costs.

2. How long has any given practitioner been removing tattoos?
A business' knowledge is only as good as the knowledge of their technician(s). Think of it this way, if their only practitioner has 2 months of experience, then so does the business. "Institutional experience" is not helpful, because bricks and mortar don't know how to remove tattoos. The goal is to find the person with the most experience.

3. What does the practitioner do besides laser tattoo removal?
Dermatology offices may boast physicians and other medical professionals, but they're spending most of their time doing the vast specialty of dermatology and maybe not lasering so many tattoos. This is a good thing, because they're detecting cancers and saving lives. Still, you might want to move on if tattoo removal is something merely occasional for them. The dream scenario is someone who lasers tattoos all day, every day.

4. What are the practitioner's medical credentials?
Many states allow non-medical people to handle lasers and remove tattoos, but that doesn't make it a good idea. Find someone with as much medical education as possible (measured in years, not hours), and be prepared to pay the difference. Funny thing is that there isn't always a difference, and the professional can cost the same or even less than the person with the weekend course certificate and laser bought off eBay.

5. Does the practitioner carry malpractice insurance?
Anyone going near your skin with a laser must have special liability insurance. It's a cruel irony that the ones who really need insurance usually don't have it. Your licensed medical professional will be insured against unforeseen problems that may never arise, thanks to their skills and education. Regular business insurance doesn't cut it, although it's helpful if you slip on their wet floor and hurt yourself. Don't feel shy about asking for proof of insurance.

6. Do they take pain control very seriously and offer numbing?
This one is easy. If they say they don't numb, move on. If they say it's supposed to hurt, move on. If they say numbing "doesn't work," move on. They're jerks, when you consider that anesthetics have been cheap and available since the early 1940s.

7. What kind of laser technology do they have?
I consider this to be less important than all of the above questions. Finding a best practitioner means you'll find someone you can trust to employ effective technology. Sure, picosecond lasers are newer and better than older nanosecond (Nd YAG, Q-Switched, etc.) lasers, but never let it be the dealbreaker. I'd much rather see a physician with an old nanosecond laser than a non-medical person flinging a picosecond beam around, without insurance.

8. Will they be there if you have problems? Will they even be there the next day?
Some outfits operate out of vans. The mobile idea may seem great for them, but imagine getting a medical procedure somewhere that's going to be a patch of empty parking lot by nightfall.

9. What can and can't they promise?
Be wary of anyone who promises a tattoo will be gone in X treatments, or that any tattoo or color will respond perfectly. There are physical limitations at play that no one is immune to, no matter what laser they're using or how much experience they have. Do they suddenly get noncommittal when you try to pin them down? Good! THEY'RE the ones to trust. There are no promises with laser tattoo removal. Beware of promisers.

10. Do they manage their own medical complications?
Say you have bad, deep blistering, maybe a non-healing burn, or perhaps an infection (these are possible issues with older, nanosecond lasers and their inadequately-trained handlers). You call, asking for help. A medical professional will see you without hesitation and treat the complication appropriately. Anyone else will probably shrug and suggest the ER, and that's a good thing, because you don't want them suddenly playing doctor when a problem arises.

11. Can you get a live person on the phone easily?
If you can, that's someone who cares about clients and respects their time.

12. Do they have Before & After pictures?
Yes? Good, now ignore them. Good practitioners with good equipment make tattoos go away, end of story. Before & After photos are cherry picked, anyway. Everyone does it. I promise you there won't be photos of the stubborn ones. Before & After photos are kind of like a ripped, muscular guy telling you that one gym works better than another.

13. Are they respectful?
You don't need anyone making you feel bad about your choices. If you get a judgmental vibe, take it seriously and consider moving along. Saying goodbye to an unwanted tattoo should be a positive thing.

I hope you find this list informative, and I wish you the very best of luck in researching this very important decision!

Richard Rosol, MD
Owner, TattooMedics Laser Tattoo Removal
Providence, Rhode Island

DOES LASER TATTOO REMOVAL HURT?

It's the first question to cross people's lips: Does laser tattoo removal hurt?

The short answer is that IT SHOULDN'T. Safe and effective anesthetics have been in wide use since the early 1940s, so there's no excuse for not using them, right?

Maybe you've seen the videos on the Internet of people writhing and screaming as their friends--and even the technician!--tell them to suck it up. Let's face it, pain isn't cute, no matter how much you try to dress it up in a video. We're not talking about getting-a-tattoo pain, either. This pain is on a whole new level.

So why doesn't everybody numb up for laser tattoo removal?

Let's back up a little.

Laser tattoo removal works by shattering trapped ink crystals in the skin's live layer--the dermis--without breaking skin. With the latest picosecond lasers, such as our PicoSure, that explosion is extremely effective, reducing the ink to very fine particles so that the body's immune system can safely remove them. This shattering happens in a veritable "forest" of pain nerves. This would be extremely painful were it not for effective numbing.

The best numbing medicines are available only by prescription, which is probably the main reason non-physicians attempting laser tattoo removal commonly don't provide them. To be truly effective, topical anesthetics must be used properly. Improper application is a common error made by well-meaning practitioners, contributing to the myth that numbing doesn't help.

Also, there is a myth on the street that treatments are less effective with anesthetics. It sounds like something our mother would say ("It has to hurt to work!"), but it's simply not true. In reality, treatments are more effective with numbing, because the pain can be so severe that people will cancel their future appointments over anticipated pain, and tattoos don't get removed that way.

The overwhelming majority of our patients enjoy their treatments and look forward to the next. That's the way to do laser tattoo removal humanely, putting the patient first.

Laser tattoo removal SHOULD NOT HURT. Don't let it. And don't let anyone talk you into it.

Richard Rosol, MD
Owner, TattooMedics

10 UNEXPECTED TATTOO TRAPS you need to know before you get your next one.

If you're planning the latest and greatest tattoo, it wouldn't hurt to hear a little wisdom first from the experts in tattoo mistakes: the folks who remove unwanted ones all day.

I'm a rare thing, an MD who specializes in laser tattoo removal. Besides being up on all the anatomy, physiology, physics, and chemistry, I've acquired another, altogether different skill, and that's the psychology of tattoos. That is, the emotions involved in getting them, removing them, loving them, and hating them.

So here's a rundown of the 10 most common reasons people remove certain tattoos, and tips on avoiding a mess.

"...even the best planned tattoos fall victim."

1
IT'S TOO. Too big, too small, too dark or thick. Never, unfortunately, too light or thin.

Prevention: Careful planning will help you steer clear of this one, of course, but even the best planned tattoos fall victim. Discuss your design carefully with an experienced artist, and fearlessly examine your expectations. If you're good at Photoshop, use it! Slap that puppy directly onto your body part, and see how it looks. If it's TOO, fiddle with it until it's right.

NOTE: You have to live with a tattoo for a few weeks or months before deciding whether it's really too TOO.

2
AN ARTISTIC MISS. Sometimes a tattoo can be great in every respect, but an artistic error throws it off. One client hated a portrait tattoo because the face was aimed outward, and not toward the midline. True, all rules are made to be broken, but this one just looked wrong. Also, arrows in bendy places... SMH "Straight as an arrow" is the expression, right? Artistic successes include people or animals over body parts that move, giving them added life.

Prevention: Think carefully about your artistic intent, and be sure your artist shares it. A good tattoo artist is just that: a good artist.

"[Narrow] the explaining down to people who see you with your clothes off..."

3
PRIVATE THINGS IN PUBLIC PLACES. If you want to memorialize something painful on your skin where other people can see it, expect endless questions about it--even from total strangers. For some people this gets very old, very fast. It can even prolong or worsen their grief. Same goes for anything of special meaning to you. You'd be amazed how quickly it gets un-special in a grocery checkout.

Prevention: Private things in private places. This narrows the explaining down to people who see you with your clothes off, and that's probably okay.

"No."

4
TECHNICAL FAIL, known medically as a Crappy Tattoo. Stick and poke. "Free" tattoo. Alcohol-related. I could go on and on.

Prevention: No.

5
MORE FUN TO PLAN THAN TO HAVE. Are you the type of person who loves the weeks leading up to a holiday or wedding, only to feel let down on the Big Day itself? It happens with tattoos, and the scary thing is that it happens to the most fastidious planners. Symptoms include acting excited about a new tattoo, but feeling, deep down... meh. People experiencing this pitfall usually head straight into planning the next one, to feel the fun again, and the cycle continues.

NOTE: We call this Christmas Day Syndrome, and it doesn't necessarily result in bad tattoos, as long as the tattoos that result aren't bad tattoos.

Prevention: Know yourself.

"Great sex should make happiness, not tattoos."

6
EX'S NAME(S). This one will never go away. We even have a special discount for it, because we feel sorry.

Prevention: Every partner is a potential ex, but this isn't a romance column. Wait, we will add that great sex should make happiness, not tattoos.

7
IT WAS PEER PRESSURE. It happens to the best of us. If you bought an expensive car or boat or whatever, chances are you were following someone else's example. It's not easy being with a bunch of friends in a party mood and the only one who refuses to get the souvenir tattoo everyone else is getting. Except you. Party pooper. The kicker is that you probably don't get to pick the tattoo.

Prevention: Tell them needles make you throw up to the point of dehydration, then offer to be the photographer/videographer of the event. Their sneers will turn to cheers.

"If a tattoo idea is popular, slow down. Think."

8
CHANGING TASTES AND FASHIONS. How to address this one briefly? We remove a lot of tribal tattoos. I mean a lot. What is in will eventually go out. That's the nature of community tastes, fads, and fashions.

Prevention: If a tattoo idea is popular, slow down. Think. If it still seems like a good idea, keep it too light or thin (See 1, above). For more advice on removability, see our blog entry on the subject here.

9
IT'S FUNNY! For 5 minutes.

Prevention: Learn a few really great jokes and tell them with, y'know, your voice.

"Never pass up a life lesson or a chance to laugh."

10
NOT A TATTOO PERSON, I GUESS. Sometimes when folks get their first tattoo, especially at a later age, they learn that it just doesn't fit them. We can help them erase it and have a good laugh about it.

Prevention: Advice instead: Don't ever pass up a life lesson or a chance to laugh.

Are You in The Gap?

We call it "The Gap" for short, "The Expectation/Results Gap" for long. It's that often-uncomfortable place between what you wanted and what you got.

What does The Gap have to do with tattooing and, by extension, laser tattoo removal?

Whenever we plan an action and carry it out, our satisfaction with the result has everything to do with how we were expecting to benefit from the action. For example, did you think the new car would be a date magnet before you bought it, as the advertising led you to believe? Did your social calendar burst at the seams after you took it off the lot? Or did that cake you spent hours baking look like the picture in the cookbook? If not, you found yourself caught in The Gap.

So often tattoo dissatisfaction (we don't like the word "regret") happens in The Gap. There are lots of reasons a new tattoo might fail to measure up to expectations.

• The tattoo concept was not fully communicated to the artist, or the artist did not fully understand the artistic intent.
• The tattoo was beyond the artist's technical ability.
• The customer had not fully developed or realized the concept.
• A less-than-ideal body site was chosen for an otherwise excellent piece.
• The finished tattoo seems more "noticeable" (too large, colorful, dark, etc.) than imagined.
• The subject matter of the tattoo hasn't aged as well as expected, as with "trend" tattoos.
• The customer was expecting more admiration of the tattoo from friends and family.
• The tattoo was a lot more fun to plan than to have.

...To name only a few.

Understanding your own psychology and personal experiences with The Gap can be very helpful when considering new tattoos and preventing calamity. Clearly many of the problems in the list above could be prevented by a good tattoo artist (not just a tattooer, but an actual artist) with experience and a willingness to collaborate. "Do your homework!" is a piece of time-honored advice that should never be underestimated. Apart from the artist, knowing yourself is the best way to negotiate The Gap.

Do you have a tattoo in The Gap? Do you know how it got there? Knowing the answer to that question is the single best way to acquire future tattoos with lasting relevance.

And TattooMedics can help you out of the one you're in.

Richard Rosol, MD

Front View: Our Receptionist Liz on the Versatility of Laser Tattoo Removal.

Tattoos are pieces of art we often use to portray significant times, people, or things in our lives. Some tattoos are done purely for art's sake and broadcast our tastes and aesthetics.  But what we perceive as significant or beautiful can change, the same way other likes or dislikes shift with no apparent notice. Not a fan of the text under your portrait tattoo? Wish you could just erase those blue flowers that are clashing with the rest of your tattoos? Are your Roman numerals just plain wrong?

Things don't always go as planned, but don't worry! There's more to laser tattoo removal than just erasing tattoos! We quite commonly edit errors, misspellings, or anything unwanted. So you can keep what you love and remove what you don't. Laser tattoo removal also gives much more artistic freedom to cover-ups. They don't have to be bigger, darker, or limited to certain characteristics anymore.

As a tattoo collector, I see myself as a constant work in progress. As I grow and change, it's okay for my appearance and body artwork to change as well. Tattoo removal is not “anti-tattoo,” but the eraser to your ever changing self. No wonder it's gaining popularity among collectors!

Ask the Doctor: Why should a physician remove my tattoo?

Laser tattoo removal (LTR) has seen enormous growth since the early 1990s.  It's no wonder, since the tattoo industry has been riding a high wave just ahead of the lasers.  Seeing great opportunity in erasing unwanted tattoos, people from all backgrounds--and some with no relevant background at all--have been purchasing Class IV medical lasers and aiming them at tattoos their owners are sometimes desperate to remove.

These days laser tattoo removal is being done mostly by Certified Laser Technicians operating as estheticians, RNs, Nurse Practitioners, and others having no college degrees or advanced training before obtaining their certification.  They can be found in spas, salons, dermatology/plastic surgery practices, esthetic laser centers, stand-alone laser tattoo removal establishments, and tattoo shops.  They can be extremely experienced and competent, especially if they work in a setting that performs only laser tattoo removal, without a long menu of other services.

But experience is only part of the equation.  LTR, done conscientiously, calls upon knowledge of physics, anatomy, physiology, and psychology.  The physics alone can be quite dizzying, but an in-depth knowledge of the physics is essential to understanding any laser's strengths and limitations.  One must also understand the physiologic responses to the kinds of energy to which the tissues are being subjected.  This knowledge not only guides the choice of safe, effective energy, but it also informs patient qualification, personalized aftercare plans--and pain control, a crucial aspect of LTR all too often ignored.

Many states have been slow to regulate LTR and other uses of medical-grade lasers.  Rhode Island and Massachusetts allow persons with no medical background or licensure to perform laser procedures as long as there is a medical director.  The responsibilities of the medical director, however, are poorly delineated.  For example, there is no requirement that he/she be on-site, nor is any supervision required.  Patient cases and charts need not be physician-reviewed.  Indeed, there is no expected standard of medical record-keeping.  Laser technicians are not mandated to carry professional liability insurance, nor are medical directors required to add LTR activities to their malpractice insurance policies.

In addition, there is little to no oversight to ensure that lasers and other devices are being used in the manner for which they were FDA approved.  This point is very important to consumers, since any use outside of a device's FDA approval is tantamount to experimentation, and a patient's skin should not be the target of anyone's experiment, except in a proper research study under full disclosure.

When a licensed medical professional performs your procedure, you benefit from many years of hard-fought, rigorous study.  Prescribing power means better pain control, and therefore greatly improved satisfaction.  Extensive study of biostatistics confers a respect for sound, evidence-based practice.   With a State Licensing Board to answer to, higher quality is maintained through accountability.  Looking beyond that, a physician is ethically bound to take your well-being seriously.

A physician who will perform your procedure personally, while rare outside of the Providence area, is worth the search and will not necessarily cost more than a technician.  It's very important to shop thoroughly and ask the tough questions.

I believe that when a medical-grade laser is being used, a medical procedure is being performed.  Whether State and local regulators agree does not affect the importance of your skin and the knowledgable care it deserves.


Richard Rosol, MD, owns and operates TattooMedics Laser Tattoo Removal, in Providence, Rhode Island.

Ask the Doctor: Can I remove a tattoo and still have fun in the summer sun?

Summer is a time of long, sunny days and carefree displays of skin.  For tattoo collectors, it's prime time for showing off new acquisitions and letting it all hang out.

But summer can be stressful for owners of tattoos that are outdated, embarrassing, lacking in personal relevance, or just plain badly done.

A question we hear frequently is, "When should I start treatments to have a tattoo gone by summer?"  Sometimes people just want to know if it's practical to remove a tattoo when the sun and beach are calling, given healing times and required care of the treatment site.

Any time of year can be the right time to receive laser tattoo removal treatments, with a little forethought.  At TattooMedics, we help our patients plan their treatments around weddings, vacations and other important dates.

Special care must be taken to protect the treatment area from sun exposure.  Depending on the phase of healing, the tattoo can be covered with zinc oxide (for complete UV blockade) or conventional sunscreens with an SPF of 30 or higher.  It's true that a freshly-treated tattoo cannot be kept wet for the first few days after treatment (ruling out swimming, hot tubbing, etc.), but that doesn't cramp most people's style with a little advanced planning.  Unlike getting a new tattoo, the risk of infection is extremely low with laser tattoo removal, since the dermal barrier remains intact.

It can take up to a year to remove some tattoos.  So if you're feeling the pain of hiding an unwanted tattoo this summer, now is the time to act to get it out of your life for Summer 2017!