Possible To Use Skin Grafting for Half Sleeve Tattoo?

Question

I've got a large colorful tattoo(half sleeve)...when laser therapy fails,could it be possible to get the tattoo surgically removed.Can a tattoo this size be removed or surgeons could refuse me due to the large size involved.I know a large skin graft is needed and a big scar will remain after surgery but I don't care. Is it usual to remove tattoos like mine this way or definitely is something that the majority of surgeons won't accept?

Robert M. Lowen, MD · Answer

Removal is possible and routine in my practice, but you have to be patient, and it is expensive.

	Three issues to be addressed:    Size, Color, and Pain

	Since the Q-switched ruby laser was introduced in the 90's, I have used it to remove multicolor tattoos including greens.  The Medlite Q-switched YAG allows the removal of black and red and is the laser of choice for large tattoos that do not have green, blue or purple.  If those colors are also there, I use the ruby as well.  For straightforward half sleeves that are black or red, the Medlite YAG is fast and cost effective.

	The original Spectrum ruby laser is not made any more. It is rare to find a practice that has one, but it is the most powerful tattoo laser, and is effective on green, blue and purple. However, it is slow, one pulse per second, so for a large tattoo it takes a longer time than a YAG laser, and will cost more.

	The Medlite YAG has some attachments to try to cover green and blue, but they are underpowered and very slow with small spot sizes.  There are some Alexandrite lasers that may be effective on blues or purples.

	Pain is an issue for multicolor tattoos, more so than black tattoos, because you really need good anesthesia to use the ruby laser.  Both lasers hurt, more than getting the tattoo, and I have never tried to remove any but the smallest tattoos without topical or local anesthetic.  The usual practice is to infiltrate dilute local anesthetic under the skin.  Some patients will get by with a topical anesthetic cream applied an hour in advance, but that would only work for a tattoo that was being treated only by the YAG laser.

	Since the advent of Q-switched lasers, skin grafting, dermabrasion, and tattoo excision don't make sense because they leave a scar that is permanent and unnecessary.  The shoulder is a very scar-prone area so the borders of a skin graft might heal with hypertrophic scars.

	If you can find a practice with a Medlite 6, I would give it a try, even with colors other than black or red.  It might take a while but you would probably get rid of most of a multicolored tattoo.  Careful administration of local anesthetic, meaning not using too much xylocaine in relation to body weight, would take care of the pain.

Sanusi Umar, MD · Answer

Removing a tattoo through surgery will leave a scar. A laser procedure would probably be the best option even with the size and multiple colors involved in your tattoo.

	Also, research laser tattoo removal practitioners who have extensive skills and experience.

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