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Walter Reed Lasers Blast Tattoos; Treat Other Conditions

By Rudi Williams
American Forces Press Service

WASHINGTON, Dec. 19, 2000 – Once upon a time, the only way to get rid of a tattoo was to "sand" it off or cut it out. Removing a small one was a painful, difficult job. Removing a large tattoo was long, painful, difficult one.

The Walter Reed Army Medical Center dermatology service here changed that for active duty members on July 28, 2000, by inaugurating its new laser center. Dermatologists use the lasers to treat many conditions, but their major missions have been to remove tattoos and to treat patients suffering from pseudofolliculitis barbae -- "razor bumps."

No one knows exactly when tattooing began, but blue tattoo marks have been found on Egyptian mummies dating back to 1300 B.C., said Army Dr. (Maj.) Kurt L. Maggio, director of the Cutaneous Laser Center at Walter Reed. He's treated more than 500 tattoo patients in his career -- about 125 of them since the center opened.

"Tattoo removal went nowhere for more than 1,400 years until the advent of laser in the '70s and '80s," he said. The oldest recorded method of removing tattoos, called salabrasion, was first used in 543 A.D. by a Greek physician, he noted. Salabrasion involves anesthetizing the skin around a tattoo and then using an abrading apparatus to rub or "sand" off the tattoo.

"It was either that or excising it -- literally cutting it out," Maggio said. Not surprisingly, the older methods of removing tattoos often left scars, as did the early lasers. The lasers of the 1990s, however, are so refined they don't leave scarring.

"People want tattoos removed for different reasons. For instance, if you're divorced, a tattoo could remind you of your ex-wife or ex-husband," said Maggio, who is also an assistant clinical professor at George Washington University Medical Center in Washington and the Uniformed Services University of the Health Sciences in Bethesda, Md.

He said people also have tattoos removed when their circumstances change. They outgrow their tattoos. Their marital status changes. Or their political or religious affiliations change.

"I'm having my tattoos removed so I'll look more professional," said Marine Cpl. Paul R. Chaney, a military policeman at Henderson Hall in Arlington, Va. "I'm trying to get into the administrative field, and having a tattoo on your hand doesn't look very professional." Chaney was 17 when a young woman used India ink and a needle to puncture a small, crudely designed cross between his thumb and index finger.

"I saw people getting tattoos before I was old enough to go into a tattoo parlor and thought it would be neat to have one," said the now 30-year-old Marine. "So I just had to have one."

"He has an amateur tattoo, which usually takes five to seven treatments. His is just India ink, which is usually easy to get rid of," Maggio said of Chaney's mark. Professional tattoos tend to be more complex and need seven to 15 treatments, he said.

Maggio said tattoo removals for active duty service members are free. That's a boon. Retirees and dependents have to pay about $200 for elective cosmetic treatments. The going rate on the street is about $2,000 to have a civilian doctor remove a tattoo like Chaney's -- $500 for the first visit and treatment and $200 each for six or seven more.

Before the laser center opened, Maggio said, Walter Reed rented a van from a laser rental company. "They'd park the van here and we'd treat patients in the mobile laser lounge," he said. "We used the same machine through a sharing arrangement with Malcolm Grow Air Force Medical Center at Andrews Air Force Base, Md. We treat a lot of folks who are in the Army, Air Force, Navy and Marine Corps. We try to treat them all equally."

Navy Petty Officer 3rd class Dana M. Allen, 23, walked into the treatment room. "She's a first-time patient, so we're going to try to figure out why she wants her tattoos removed," Maggio said. "She must understand that, although we can remove them nearly completely, there's frequently some indication that a tattoo was there. Sometimes a reverse image or a little bit of lightening. Sometimes the green colors won't come completely out. But in most cases, we can pretty much guarantee that there won't be any scarring."

Allen has large, professionally done, multicolored tattoos on both arms, back, stomach and ankles, and a tattooed wedding band on her finger.

"Removing all of these would be an enormous amount of work," Maggio said. "But she wants tattoos removed from her finger, stomach, ankles and back. The wedding band is what she wants removed most because it reminds her of her ex- husband."

Allen squirmed and squealed, "It hurts!" as Maggio blasted her finger with the laser.

"Tattoo removal does hurt," he emphasized. "Most people describe it as an annoying pinprick. More sensitive areas of the body, such as the ankle and fingers, hurt more than other parts. A lot of it depends on the patient's tolerance of pain."

"Don't believe that thing about women having a higher tolerance of pain than men," said Allen, a religious program specialist for the chief of Navy chaplains at the Navy annex in Arlington, Va.

"I'll put some numbing cream on her finger the next time she comes in," Maggio said.

Laser treatments take less than three minutes, after which Maggio covers the area with petroleum jelly and a bandage, and tells the patient to return in about six weeks.

The next patient was Navy Petty Officer 3rd class Jana E. Kopko, a light-brown-skinned Kiowa Indian. Maggio said different types of lasers are used depending on the color of the patient's skin.

"You have to be very careful when treating African Americans and other dark-skinned patients," the doctor noted. "We use an infrared YAG laser that penetrates deeper. It tends to leave the superficial skin color alone, so it's much safer for darker skin types.

"She's a challenging case," Maggio said. "She has a simple tattoo, but there is teaching value in her skin type, how it's going to heal and what laser to select.

Kopko said she had personal reasons for getting the tattoo on her neck six years ago. She now wants it gone because she's getting out of the Navy and plans to go to nursing school.

"I'd rather have that gentle bedside manner and a pleasing smile without a questionable tattoo on my neck to frighten the patients," said Kopko, a member of Construction Battalion Unit 403 at Naval Station Annapolis, Md.

When the Army announced its crackdown on tattoos, Sgt. 1st Class Carlos Cruz, a dark-skinned Hispanic, asked his supervisors if he could keep the small images on his hand and above his knee. The answer was no.

"They told me if I didn't have them removed, I could be brought up on charges," said Cruz, noncommissioned officer in charge of the operations division at the 311th Theater Signal Command at Fort Meade, Md.

Maggio said the Army's policy prohibits tattoos on the head, face, neck and hands. He noted that soldiers can't have anything on other parts of the body that's prejudicial to good conduct and discipline.

"For instance, nudity, messages of sedition, hate groups -- that kind of thing -- must be removed," he said.

"We have a few patients whose entire torso is a tattoo," the doctor said. "We try to talk most of those people out of removing them because it's such a complicated process and takes so many treatments. There's also a fair amount of pain is involved. We can do an entire back in about 20 minutes, but they need to come in about every six to eight weeks. It takes a lot of treatments."

Lasers enable doctors to treat many conditions they couldn't before, Maggio said. They're also used for scar removal, vascular tumors, blast injuries, treating blood vessel birthmarks on babies and children, and removing sun- damaged skin, such as wrinkles and freckles, he noted.

"I did a case a few days ago on a gentleman whose weapon misfired and blew up in his face," Maggio said. "There were carbon particles embedded in his skin on the entire left side of his face.

"We do a tremendous amount of facial veins -- people who have red noses and red cheeks from sun damage," he continued. ""We do a lot of leg veins and get wonderful results -- we're spearheading that. We also do a lot of cosmetic applications for folks who have had bad acne or chicken pox scarring. We resurface their face with the infrared laser."

Maggio said Walter Reed bought the state-of-the-art laser to help the clinic accomplish its mission of clinical, research and teaching excellence. About 15 resident doctors a year train with the laser.

"We get some benefit because we train five doctors each year from the Army and Navy," he said. "The Air Force has separate residency training programs for dermatologists."

He teaches the twice-yearly Walter Reed Laser Safety Course for about 50 Army, Navy and Air Force technicians, nurses and doctors. "They leave able to understand how to use a laser for various things," he said. "We're trying to integrate the use of lasers into our practice. Our laser usage is probably the highest in the hospital, probably the highest in DoD."

Maggio said he's enthusiastic about treating patients with lasers "because it's very safe as long as it's used correctly and people understand the reason for eye protection." He pointed out that everyone in the treatment room has to wear tinted goggles to protect their eyes from the laser.

He said everyone treated in the laser center comes distressed by something -- a tattoo, excess facial hair, an old scar.

"They're psychologically affected by it," Maggio said. "So, if we can improve their outlook and make a positive difference in their lives, I think we should. They appreciate the treatment they get here, and I hope that will also translate to improved retention.

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Click photo for screen-resolution imageArmy Dr. (Maj.) Kurt L. Maggio (right) uses a laser to remove an India ink tattoo from Navy Petty Officer 3rd class Jana E. Kopko's neck. Maggio is director of the Cutaneous Laser Center, which opened in July 2000 at Walter Reed Army Medical Center in Washington, D.C. All patients wear tinted goggles for eye safety. Photo by Rudi Williams.   
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Click photo for screen-resolution imageNavy Petty Officer 3rd class Dana M. Allen's large, professionally done multicolored tattoos may take a dozen or more laser treatments to remove. The advantage of lasers over previous removal methods is it leaves little or no scarring. Allen is a patient at the Cutaneous Laser Center, which opened in July 2000 at Walter Reed Army Medical Center in Washington, D.C. Photo by Rudi Williams.  
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Click photo for screen-resolution imageNavy Petty Officer 3rd class Jana E. Kopko faces five to seven laser treatments to remove the small tattoo on her neck. Photo by Rudi Williams.  
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Click photo for screen-resolution imageNavy Petty Officer 3rd Class Dana M. Allen squirmed and squealed, "It hurts," as Army Dr. (Maj.) Kurt L. Maggio blasted her finger with a laser to remove a tattooed wedding band. Maggio is director of the Cutaneous Laser Center, which opened in July 2000 at Walter Reed Army Medical Center in Washington, D.C. All patients wear tinted goggles for eye safety. Photo by Rudi Williams.  
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Click photo for screen-resolution imageNavy Petty Officer 3rd class Dana M. Allen shows the large tattoos on both of her arms. She also has large professionally done multicolored tattoos on her back, stomach, ankles and a tattooed wedding band. Photo by Rudi Williams.   
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Click photo for screen-resolution imageArmy Dr. (Maj.) Kurt L. Maggio uses a laser to remove a small India ink tattoo above the knee of Army Sgt. 1st Class Carlos Cruz. Maggio, director of the Cutaneous Laser Center, has treated some 500 patients since the center opened in July 2000 at Walter Reed Army Medical Center in Washington, D.C. Photo by Rudi Williams.  
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