Why Are Tattoos So Hard To Remove? Episode 2

In this episode, we’ll talk about the mechanics of tattoos, and a surprising discovery made just in the last couple of years about WHY they are so hard to remove. You’ll also get to hear about the year I turned 18, which means …oh heck I’ll do the math for you! 45 in August of 2020.

Autobiology Bits with JLF, Episode 2

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Do you remember when the tattoo craze hit you and your friends?

Was it when you realized you were 18 and could actually get one without asking your parents? That’s when it hit my friends.

Just as graduation approached in my senior year of high school, the obsession with tattoos began. Not all my friends—but a lot of them. OK, nearly everyone. For some reason, I wasn’t into it and went the piercing route with a belly ring.

I was fascinated with tattoos though.

At the time, I was deciding between an art degree or a biology degree. (Shout out to Selby Doughty and Gene Wingert). Tattoos were a perfect mixture of my two interests. I couldn’t bring myself to do it personally, but I admired the artwork and beauty of what could be done to human skin.

Over the years, tattoos became even more popular with permanent make-up and then microblading eyebrows with semi-permanent tattoos. The once seedy “Tattoo Parlors” of our parent’s era transformed into trendy skin salons that could literally put any design, logo, quote, or portrait into permanent ink. Tattoo artists are truly talented people.

What also became popular were places that removed tattoos, and the stories went with them were not so pretty. Tattoos are hard to remove. But why?

It wasn’t until recently that I decided to figure out the mechanics of tattoos. Through my medical writing career, I understand a great deal about the skin, but I had never come across any scientific articles on them until last year. What I learned was pretty astonishing (to me, anyway).

Here it is: We, as humans—until 2018—didn’t know how tattoos stayed in our skin or why they were so hard to remove.

Hard to believe, right? You would think by 2018 we would have figured out something as simple as that. But we didn’t. In fact, what we thought we knew was wrong.

Here’s How it Works

First, tattoo ink is taken up in the dermal layer (the second layer) of our skin—which we knew.

If it was in the first layer, the epidermis, we wouldn’t be able to keep tattoos because they would disappear when we shed our outer layer of skin cells every month or so.

What we didn’t know: what was keeping the ink there? A study by Baranska et al. (2018) showed that it’s actually our the cells of our immune system!

Yep, those cells that are designed to keep you healthy by destroying bacteria, viruses, and other foreign objects that get into your skin—they are responsible for your keeping your tattoo there forever.

Theses particular cells are called macrophages. They look like a round cell that is covered in arm-like projections.

But what’s really amazing is what happens when the macrophages die. Another macrophage comes along and eats the dead macrophage cell with all the ink in it.

Think PacMan.

And then THAT macrophage stays there with the ink in it until it dies. And so on, and so on…each time one macrophage is eaten by another, a little ink may be lost or diluted, which is why over time tattoos get fuzzy.

When the dead macrophage releases its contents into the surrounding tissues, it so releases chemicals that signal for millions of new macrophages to come to the site. As a result, any available ink floating around is immediately eaten again. It’s nearly instantaneous.

The immune response is amazingly powerful and a nearly instantaneous event when the body senses injury. Every time the cells carrying the ink were destroyed, the cells would release the ink, only to be taken up by new cells. Your body can make an endless supply of macrophages if it needs to, so that’s just what it does.

Amazing, right?

You might be wondering why this was such as A-ha moment for scientists. One word: removal.

They could never figure out why tattoos are so hard to remove, but now they understood exactly why. It’s because of the immune cells.

This discovery is important not only to help develop quicker removal methods, but also because removal is a painful process.

How Tattoos are Removed

Tattoos are currently removed with a special type of laser called a Q-switched laser.

• The laser is quickly pulsed over the tattoo, delivering a precise amount of energy that is absorbed by the tattoo pigment.
• The energy is converted to heat, which breaks the chemical bonds inside the pigment; there is also mechanical destruction of the pigments from the pulse itself
• The resulting small pigment particles and other debris are then removed from the skin via blood vessels or the lymphatic system.

Whenever I learn something cool about the human body – I always ask myself: how can I use this information to be healthier?

The question is: can tattoos make your immune function worse… OR do tattoos help by activating the immune system in some way?

Both of these questions have been discussed at length. In fact, several years ago there was an anthropologist, Christopher Lynn, who was exploring these questions.

Lynn claimed that in healthy people, the more tattoos you get, the faster your body heals from them—it learns and gets used to the trauma of tattooing. In this instance, tattoos make the immune system more efficient.

While his theories were interesting, there are other researchers who felt there was not enough true science to make such claims. You can read the original study here, and the opposite opinion here. It’s always good to hear both sides—sometimes what we think we know is not the whole story, but merely a chapter in a much larger drama. Plus opposing ideas help us grow and learn…but I digress.

In people who are not so healthy or immune-compromised, the idea of a tattoo is worth a discussion with your physician first.

Infections are always a possibility, and if you are already having trouble with your health, it could be an added stress that your body can’t handle. There’s a great article here by verywellhealth.com (one of my favorite websites due to their extensive referencing) that talks about tattoos in patients with autoimmune disease. At the end of the article, there is a great list of skin conditions that have the potential to be exacerbated by tattoos.

So let’s recap – what have you learned?

1. Tattoos deposit ink in the dermis, the second layer of the skin.
2. The first layer of skin, the epidermis, renews itself roughly every 30 days.
3. A macrophage is an immune cell that eats up bacteria, viruses, and other foreign invaders in the body.
4. Macrophages eat tattoo ink and then stay in place for the rest of their lifetime; when they die they are replaced by another macrophage, and then another, and then another…
5. Tattoo removal by a laser requires several treatments and is a painful process
6. There are theories that a healthy person may experience a more efficient immune response with each new tattoo, but it is controversial
7. People who are immunocompromised should consult with a doctor before getting a tattoo

And that’s your bit of biology for today!