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.