With the various problems that can arise in getting a tattoo, there are many who would like to get rid of their undesired body art. Some methods of removal are as archaic as they are barbaric, while others are clean and leave no mark on the person's body. To appreciate the newer methods of removal (with lasers), one must review the older methods that were (and in some cases, are still) available.

Dermabrasion is perhaps the lowest common denominator of all the methods of removal. This method is achieved by the sloughing of the top layers of skin until the middle layer, which contains the actual tattoo ink, is reached and taken off, removing the unwanted tattoo with it [figure 4.1].18 This can be achieved either through the use of such agents as caustic acids, sal abrasion (sanding with salt) [figure 4.2] , or using actual sandpaper. While only being somewhat effective (tattoo ink is usually too deep in the skin layers to be removed entirely with this method), this causes severe and often traumatic scarring that is usually less desirable or eye pleasing than the original tattoo ever was.19,20 However, since other methods such as laser removal were not available until recently and are mostly more expensive than the average person can afford (especially since tattoo removal is not covered in most health insurance programs) this still remains an option for self administered removal or as a "low-cost, low-tech alternative to the use of tattoo lasers."21

4.3 Staged Excision

Staged excision is a method that professionals use that involves cutting the tattooed portion of the flesh away, a small portion at a time [figure 4.3].22 As can be imagined, this method can cause severe scarring. Also, it may not be as effective on homemade tattoos (i.e. done with a "hand poke" method) because, while they typically do not have the same concentration of ink as professionally administered tattoos, these designs often go deeper into the skin. Surgery can be effective in restoring the skin to a more normal look, but plastic surgery can be expensive.23

4.4 Tissue Expansion

Another method which professionals use is tissue expansion.24 What this involves is placing a balloon under the patient's flesh. The balloon is then inflated, allowing the skin to stretch slowly. The tattoo is then cut out and the newly stretched skin is used to cover over this excised flesh. This method is more popular for smaller tattoos and leaves only a linear scar. However, in at least one case, this method used on a patient with a 2"x2" tattoo caused a big lump of extra skin to grow on her back, causing an almost "Quasimodo" type effect.25

4.5 Tannic Acid

A form of dermabrasion that has recently been investigated uses tannic acid. This method was discovered by Variot G. Nouveau in 1888. It involves the "mechanical destruction of the epidermis and the application of the necrotizing agents tannic acid and silver nitrate to the dermis."26 For mechanical destruction in this study, a tattoo machine was used. After the tannic acid was injected, the wound was taped with Leukoplast and removed 7 to 10 days later [figure 4.4]. Amateur tattoos (composed of ink particles up to 5 um in size) were more effectively removed than professional ones (composed of ink particles 50 um or more).27 Since tannic acid has had a history of causing liver necrosis in the treatment of burn victims inWorld War II and in two patients who received a diagnostic barium enema containing tannic acid,28 liver function tests were performed on patients after testing, with no adverse results. While this method does scar, no local anesthetics are required.