Erasing the Past
The tattoo trend has yet to fade fully, but for many the exhibition is over.Body art is being put into permanent storage.Human canvases are being whitewashed.The thrill is gone, and for many, so is the tattoo, aided by revolutionary new laser techniques.Increasingly, former devotees of personal penmanship find themselves uncomfortable in their own skin.Like the middle-aged woman who found that through the years, with cellulite and stretching, that cute kitty on her thigh turned into a horrifying jungle beast.And the newly ordained priest with the Viking on his forearm.And the newlywed whose husband just isn't turned on by a fire-breathing dragon on a woman's back.And the young executive who figures it just isn't country-club chic to have an arrow pointing to his abdomen complete with instructions of where to go from there.There are people who haven't been to the beach in years, people who yearn to erase the evidence -- if not the memory -- of their past wayward ways.Attribute it to the demographic, the times, the new science, but people are taking a new look at tattoos -- which in recent years have found acceptance, honor, even enshrinement.The last decade has seen the rise of scholarly conferences on the subject, art exhibitions featuring the work, even a tattoo museum in Amsterdam. But recently counter-trendies have found their desires dovetailing nicely with technology.A new generation of lasers has brought a new opportunity to remove tattoos without the horrors of in-office scraping and chemical peels, or nightmarish home remedies ranging from bleach injections to searing flesh against hot exhaust pipes.At the forefront is a new breed of doctor specializing in laser tattoo-removal -- masters of light who see it all even as they remove it all -- or nearly all, since even this generation of lasers isn't foolproof.Or entirely painless. (Especially when it comes to paying.)But today, when it comes to unwanted body art, a clean slate can be just a shot of light away.First used for surgery by neurologists to gynecologists, lasers have been used cosmetically for only about 10 years -- and for tattoos, only about five years.Today's laser beam is quite a versatile little fellow.It can clear up your warts, your scars, your brown spots and your stretch marks. Your spider veins.Your port-wine stain birthmarks.Even your strawberry hemangiomas. (You don't want to know.)While wrinkle removal remains the most widely used laser procedure, tattoo removal is second and climbing fast.Medical Alliance, Inc. -- the nation's largest leaser of lasers -- has tripled its business in the past two years. Locally, it now reports approximately 100 procedures monthly, up from 30 monthly three years ago. And there's a month-long waiting list for its tattoo-removal lasers.The laser treatment bombards the tattoo with a light frequency that is selectively absorbed by certain inks. The laser fractures the pigment into small particles, eventually to be absorbed by the body and carried away.Following a tattoo-removal procedure, the area usually turns white and swells slightly for about 20 minutes. For the next several days, a blister or scab may form, which often bears the color of the tattoo pigment being removed. The skin usually returns to normal within seven to 10 days. Six to eight weeks are commonly allowed between treatments.Although bruising is common, infection is rare if the affected area is treated with an antibiotic cream and kept out of sunlight. Scarring is also rare, although the laser process can leave a change in skin texture, a lingering coarseness that will never let the patient fully forget an old friend now rendered invisible to the general public.Two or three treatments are typically necessary to remove amateur tattoos that are usually one dark color and close to the skin. But today's sophisticated professional tattoo-jobs can take six to 10 visits to remove fully.At an average of $250 per visit, paying the price for a misbegotten night on the town can turn out to rival a luxury cruise. Even then, with more than 100 tattoo inks in use -- none of them approved by the FDA -- success is not a sure thing. But as times change and impulse remains, many think it is worth it to see the light.To Eric Bernstein's patients, an old tattoo is at best an embarrassing nuisance or, worse, a barrier to career advancement, social status, even marriage -- a scarlet letter fashioned at needle point.But to Bernstein, one person's rash decision becomes a gift to science, an ideal laboratory to study the effects of the most recent laser technology in a field that seems to evolve exponentially.Bernstein, an associate professor of dermatology and cutaneous biology at Thomas Jefferson University, has offices at Jefferson Hospital as well as in Marlton, New Jersey. He works fast and frequently -- more than ever now that demand for his services has tripled in the past two years. With a workload of more than 20 tattoo removals a week -- about 20 percent of his cosmetic laser business -- using a technology so advanced other doctors travel from around the country to watch, you could call him Dr. Zap -- man of a thousand points of light.Bernstein, 38, has been involved with lasers his entire career, starting as a researcher at the National Institute for Health in 1987. He first studied lasers as a method -- when combined with certain dyes -- of carrying away cancer cells.His work with laser tattoo removal began at Jefferson in 1993, when the field was as new as a freshly inked body. He since has become one of the leading voices in the field, with companies often loaning him lasers in the developmental stage just to get his suggestions.It doesn't get any zippier than Dr. Zap. He works fast. In and out, over and done. Not that he lacks bedside manner. The look in his eyes say, "Yes, Madame, how unfortunate about your Harley Davidson endorsement." Personally, he is pink and pure as a toddler fresh from the warm bath. Not so much as a birthmark. He will heal you, preserve you, brighten the God-given canvas.Patients range from underage teens with tattoos barely dry from the night before, brought in by angry parents, to World War II vets looking to spend $500 to remove a $5 anchor or naked lady.Most commonly, it's as simple as the name of a former object of affection, a solitary act of heated passion that has long since cooled.Other times, a person has been so devoted to self-inking through the years that Dr. Zap removes one tattoo only to find another older, more primitive, long-forgotten tattoo underneath.Either way, Dr. Zap's research benefits from a lesson that others learn the hard way.Some have had it harder than others.To a 12-year-old boy, there is something irresistibly compelling about Donald Duck smoking a cigar. For Jeff Martin, it was a good enough idea to have imprinted between his shoulder blades, for all eternity.It would be just like the one on his older sister's boyfriend. Cool. For all time.The boyfriend agreed to do the work free. It was sort of in the family, he said.All he needed was a sewing needle, thread and a bottle of India ink.It hurt. He knew it would. Pain was part of the experience. In fact, the more it hurt, the more it seemed like a manly rite.But young Jeff felt more pain than he had bargained for when the older boy proudly announced he had finished the artwork. He eagerly looked into the mirror and found "FUCK YOU" imprinted on his back. Uncool. For all time.Jeff Martin successfully hid the badge of dishonor for about six months before his mother saw him playing a pickup basketball game. He was skins.Horrified, Martin's mother investigated the possibility of having the tattoo removed.At the time, the options were limited.He didn't want the scarring that came with scraping it off.They considered a skin graft, but the expense and complexity of the procedure were a little too much.There wasn't much else that they knew of.So "FUCK YOU" haunted Jeff Martin through playground basketball games, tryouts for the swim team and days at the beach when older boys threatened to do more than kick sand in his face."Hey pissant! You talking to me?"So it went, for 21 years, until last year he heard about the laser process being performed at the University of Pennsylvania Medical Center's department of dermatology.Martin isn't 12 anymore and his life includes show-business aspirations. He figures removing the 21-year-old epithet could have career implications, possibly helping him with a video his band is planning, and with a part-time modeling career.But first he must retrace and erase.Martin has begun the process, making three visits to the clinic, with several more to follow on designated "tattoo days" -- when the unhappily tagged line up and wait to have "pieces" removed from their body.It could be anything -- a Jewish patient needing the procedure to be buried in a consecrated cemetery to a simple botch job by a "skin scratcher," as unqualified tattoo artists are known in the trade.People who have concealed a bad bit of ink for years are a closeted bunch -- but here and there will compare notes, vent steam.Not Martin.His complaint is something beyond the expected, even here. This may be a laser clinic, but it's still polite company.When Rich Zych removed his shirt on his first office visit, Bernstein knew he had something special. A real specimen.The college student was covered in creatures and colors so tightly woven they seemed clustered in mute conversation, or frozen in battle.The illustrated man was just what the doctor ordered. He had his work cut out for him -- and he loved it.Zych's body work can be traced back to an automobile accident six years earlier that left him near death, in a coma for 16 days.His injuries included a fractured skull, bruised brain, punctured lung and broken hips, ribs and arm.But in a moment that he knows only by its retelling, his mother noticed something else during an early bedside vigil that she found fundamentally alarming even under those gruesome circumstances. "My God," she said to her husband, looking at the small, yellow sun that Zych had applied to his shoulder only weeks before, designed to impress the girls as he entered his freshman year of college. "Our son has a tattoo."But that would be only the beginning.As Zych slowly recovered through two years, he did it one tattoo at a time.First the doctors thought he would die. Then they thought he'd be paralyzed. Then, mentally dependent on his parents.But step by step as he progressed, they changed their prognosis. Eventually, they began referring to him as the "wonder boy."Along the way a friend got him reading about Native American tribal customs -- including the tradition of applying permanent images to the skin to signify accomplishment.Soon, with each breakthrough in his rehabilitation, Zych began the habit of getting a new tattoo, a trophy of sort for his unlikely recovery.Before long his right arm was covered with a sleeve of Indian tribal pieces -- each with their own meaning. A thunderbird, a tortoise, another sun.An eye on his chest indicated watchfulness and was soon joined by a shaman's eye on his back to indicate wisdom.On and on, secretly."You already have enough scars on your body," his mother would say when the subject of the first, small sun would come up.But the way Zych saw it, the more tattoos he had, the less they'd look at the scars.And, he sometimes boasted just half in jest, he now had the world's most identifiable body.But, as almost anyone who comes to Dr. Zap will say, it's funny the way things change.Zych graduated in May. He found himself on the job market. The scars began to fade. The future became more important than the past.After three metal plates, 19 screws and dozens of tattoos, he figured it was time for his rehabilitation to take another step. He was all for having some tattoos removed, clear out some space on the old epidermis. The questions were: Where, how and how much?He found that while a tattoo artist might be able to cover up a jailhouse-style piece of work, add color to pep up something faded and gray, they weren't equipped to do the work he was after. Then he started hearing the horror stories of archaic processes and their pain and disfigurement.He figured he had enough scars for one body.Finally, it was his uncle -- whose business includes repair of medical lasers -- who told him about the new uses of the equipment.He recommended Eric Bernstein -- very fast but very careful. Dr. Zap was about to inherit enough work for an entire laboratory.Almost everyone in Vicky Panaseviz's family has a tattoo. Her grandfather started the trend while he was in the Army, getting tagged with an old-fashioned, midnight-blue eagle on his arm, although time has so disfigured it, there's no telling what it is. Somehow she doesn't figure him as a candidate for tattoo removal.Not her father, either, who continued the family tradition with wings from the Army and an eagle featuring her brother's nickname, "Poncho."Then came Poncho, a mechanic who chose a skull with crossed wrenches. That's not coming off, either.Even her sister-in-law boasts an ankle shamrock with the names of Vicky's nieces and nephews -- who themselves may one day get tattoos.Vicky was 15 when she decided to get hers.After all, her friends at Hallahan had them. You could say it was a tattooing kind of school -- tiny ones, mainly, on the girls' ankles or shoulders. Little flowers, things like that.But you could say Vicky got a little carried away.Since she didn't meet the 18-year age requirement to have it done professionally, she picked up ink and needle at the mall and convinced her best friend's boyfriend to do it by hand.At first she just wanted her initial on her shoulder. Then she wanted a flower going through it. Then a star at the top. It was red, green, yellow and black and it had everything.Vicky's mother -- one of the few people in the Panaseviz family without a tattoo -- saw the one on her back, wasn't too happy but there wasn't anything she could do about it."It's your money," she grumbled.But she didn't stop there. On she went, this time with a professional, getting an angel on her shoulder, babies on her stomach.By the fourth one, Vicky's mother was really mad. "Vic, you're gonna regret it." And she was right.She started to hate them, beginning with the first.She liked the "V" when it was puffy and still bleeding. But once the swelling went down, well, it looked like a "V" but it also looked like crap. It was uneven and amateurish and made her look rough.She tried to have her tattoo-artist clean it up but it didn't work. She decided to live with it.Then things changed big time when Vicky turned 17 and got a job selling beauty products.She loved the glamour of the job and the money wasn't bad. She needed that. The one rub was, with her tattoos, she couldn't wear tank tops or bare midriffs. Bummer.She checked around, consulting with several dermatologists who "just didn't do much of that kind of thing" before she was referred to Sherman Leis, a Bala Cynwyd plastic surgeon.Leis had seen the future coming several years back and became one of the first plastic surgeons to get into tattoo removal and one of the only to own his own equipment.He knew all about it.Leis explained to Vicky that since primitive man first put stone to skin, humankind has been looking for a way to get images onto bodies -- and a way to get them off.He also explained that, until recently, things were pretty much back in the Stone Age when it came to tattoo removal.One option was dermabrasion, which used a coarse brush or burr to remove all of the epidermis and some of the dermis, where the pigment settles. The problem arose if too much dermis was removed, leaving an especially ugly scar.Another technique was skin shaving, using a hand-held machine that gave the appearance of barbers clippers. Originally used for skin grafts in burn cases, skin shaving was about as pleasant to undergo as it sounds.Then there was chemical peeling -- where phenolic acid was applied to the surface of the tattoo. But the physician never had complete control over the depth of the peel and the result was sometimes very unfortunate.All of that, he explained, has been solved with lasers. It's a new day, a bright day for the tattoo-impaired. But there's one remaining problem."I don't mean to be a snob," he said. "But modern laser tattoo-removal is usually too expensive for the average sort of person who has tattoos. I see a lot of people who just don't come back. They decide to live with it."At his going rate of $500 to $800 per session, Leis explained, a person would have to be very successful in business to afford such a procedure.Was she successful in business?Vicky explained the beauty-product job."If I worked in the salon part I could have tattoos," she said. "They're more artistic types. But I have to be like a business lady."Ultimately, Vicky took the plunge and spent much of her savings to have the offending "V" removed. Now she's rebuilding her finances with the job.She plans to keep the others until she can afford to have them removed, which will not be anytime soon. As her mother told her, "It's your money, Vic."And even though her boyfriend hates the babies on her stomach, he's all for the angel on the shoulder. Besides, she figures, the babies don't stand out so much -- not with the navel piercing.Rich Zych sits in Dr. Zap's procedure room this day, shirtless, full of hope and color.He has already spent much of a year here, having a bear claw and arrowhead blasted from his torso.Today is his fourth of five sessions to remove a feather tattoo that Zych is especially unhappy with from his arm."Bad workmanship," Zych grumbles. "I got it on the Boardwalk in Atlantic City. It was cheap. You should never get a tattoo just because it's cheap."Typically, a doctor needs different lasers for different colors of a tattoo.The dark blue and black of traditional tattoos are the easiest to remove, readily absorbing any laser light.Certain colors are far more difficult. Yellow and green are especially tenacious.And for those who are light-skinned any tattoo remotely flesh-colored can turn black when the laser hits it.But Eric Bernstein's equipment -- the most advanced available -- comes closest to avoiding these problems.Dr. Zap's baby is a $199,000 YAG laser -- the latest in the family of new pulsing lasers -- the breakthrough that allowed doctors to target the affected area without letting the energy spread to and burn the surrounding skin. it was also the breakthrough that allowed lasers to be applied to tattoo removal on a widespread basis.In a field now developing at a pace similar to computer technology, few doctors are interested in a massive outlay for what could soon be last month's model. As a result, the laser field has taken off.But Dr. Zap, with the resources of Jefferson behind him, finds himself operating with a technology so advanced that other doctors regularly fly in just to watch and learn.And, as he sits here today, on display for two other doctors, Rich Zych is the advanced course.Tattoos are kind of like the bar business in the opinion of Kevin Konieczny -- owner of Bridge's Cafe and one pain-in-the-ass piece of body art."The two best days in a bar owners life -- the day he gets it and the day he gets rid of it. Same with tattoos."He's still waiting to get rid of both -- for a buyer for his bar at Bridge and Torresdale, and for a waiting line at Temple University's clinic to remove the tattoo -- a 3 x 3 unicorn on his calf that he once believed would speak for him through the ages.With the boom in tattoo removal, there are waiting lines for rented equipment all over. The way things are going, you might think tattoos were going out of style, even if everybody he knows here in Kensington say they want to get another.Not Kevin.It was 10 years ago -- Kevin was 17 and went into the tattoo parlor with two buddies just to look. One dare led to another. Then the other guys got theirs first and there was no way Kevin could sissy out.His buddy got a unicorn -- with his wife's name underneath.The other guy got a unicorn, too, but didn't know where to stop. As the years went by he got flames, a castle and some smaller stuff here and there. And his girlfriend's name.When it got to be Kevin's turn the choice was obvious. He and his friends were unicorn men. Not having a wife or girlfriend, it was undedicated.He wanted black and blue, but the tattoo artist did it in a red and yellow reminiscent of Ronald McDonald.But if the "artist" was dumb, he was big and dumb.Kevin didn't argue.As he walked down Kensington Avenue, Kevin felt proud of his little buddy, no matter what the color, and brought the news home. His mother didn't believe it. "You didn't get a tattoo," she said, thinking the whole thing was some sort of adolescent humor grownups didn't get. Then she saw it. "You didn't get a tattoo!" she shrieked. Then the crying started. Kevin thought the tattoo was cooler than ever.But as time went on he changed his mind.Somehow, as he got older, the unicorn no longer said, "Kevin."Now he's self-conscious about wearing shorts to family affairs.He recently went on cruise and shared a hot tub with these fancy Europeans. He doesn't think they were laughing at him, but with the language barrier, who could tell?He felt dirty anyway.What a mistake. That thing was a lot easier to get than it will be to remove.And as it turns out, the Ronald McDonald colors don't just look like hell, they're hell to remove. Although Temple hasn't given Kevin his first appointment yet, they foresee a long series of them.He often complains about this in his bar. The problem is, Kevin's bar is a tattoo kind of place.It goes right down to the help -- the waitress with the cross on her back and the peace sign on the inside of her lip. She's in favor of keeping the unicorn and wearing shorts more often to show it off.Another girl sports an arrangement of poinsettias just above her butt. She's lobbying for Kevin to cover the unicorn with something larger, "trendier," she says.Then there's the customer who has "nobody's fool" tattooed on his neck. Every time he gets wasted he gets another tattoo. He's in favor of Kevin getting a series of new ones, maybe with a common theme."It's embarrassing, you know? I mean a fuckin' unicorn on your leg. This thing makes me feel like a punk.""I've got a wife," he protests. "A seven-year-old daughter."But even here, support is scarce for removing the tattoo.Since he left it blank 10 years ago, what about her? If he really loved her wouldn't he tattoo her name on his leg?But he's made his decision.He'll wait his turn in line. With that kind of line, he must be onto something. What do these people know about trendy anyway?He's starting to think that when it comes to this skin business, time is on his side.Everyone puts on safety goggles and Rich Zych feels a twinge of anxiety. Just because he has felt pain beyond belief doesn't mean that Zych can't feel a little nervous. Dr. Zap approaches the waist-high machine, picking up a wand similar to a dentist's drill, preparing for the central act of his booming practice."You'll feel it like the other times," he informs.Most patients apply a numbing cream to the tattoo before the procedure, but Zych doesn't want to wait. Besides, between the hospital needles and the tattoos, he's accustomed to a little bit of the devil.Carefully, efficiently, Dr. Zap traces the red outline of the feather with a pulsing light. The bead of light dances in place, giving Zych a sensation similar to a snapping rubber band, reminding him of the feeling of originally getting the tattoo.At $250 to $500 per treatment, the pain could be much more than a rubber band. Insurance companies refuse to cover tattoo removal, adopting a "you play, you pay" philosophy.But Zych lucked out. Seeing such a vivid example and willing subject, Dr. Zap agreed to work on Zych's gallery of body art free of charge if the illustrated man would, on occasion, serve as an illustrative subject when he showcases his state-of-the-art laser."It's really hot," Dr. Zap will tell anyone who asks, sounding like a teenager talking about a new sports car. Staying on the cutting edge of the technology and the trend keeps Dr. Zap moving as quickly as the procedure will allow.They come in. He looks at them. Sometimes he marvels. Some are truly beautiful. Fantastic colors. Works of art. But zapped nonetheless. Dr. Zap's light show continues.Yes, Dr. Zap is a brain. But now he works as a carpenter, taking a workmen's pleasure in the simple process. He bombards the feather tattoo in minute bursts. Out, out damn spot. Though infrequent, there have been times when even Dr. Zap with his 21st-century technology has failed and has seen a patient give up after 10 times or so.But these occasions are rare.Today is not one of them.Dr. Zap takes 10 minutes to treat two inches of tattoo. It leaves a burning sensation that will remain for several hours and the tattoo could continue to fade for as long as three or four months. Zych will need to wait at least six weeks before his next treatment.Zych ponders today's small success for a moment. The patience he learned through his painstaking physical rehabilitation comes in handy when he thinks ahead to the clearing canvas of his body.He'll be back for more. Much more.As for Bernstein, he's off to the next patient.At the speed of light.