Although tattoos have been around for centuries, removing them has been problematic. Today’s lasers can remove the pigment under the skin, but the practice is time-consuming painful, potentially dangerous – and unregulated in Switzerland.
Sunlight streams through the windows onto yellow walls, a blue pine floor and artistically rolled green and maroon towels. A Buddha sits on a low shelf. Leonardo Da Vinci’s Vitruvian Man hangs on the wall. They watch over the guests who return at regular intervals to the tattoo removal practice in the Zurich suburb of Dietlikon.
A blonde woman in a black leather jacket is reading a fashion magazine at a table in the lobby. She has come for a consultation, in the hope that the practice’s novel QX MAX four-wave laser will be able to remove the red and purple tattoo she has had on her calf for the past 12 years, since the age of 18.
According to Patrick Aeberli, who handles the treatment side of the two-man Tattooentfernungspraxis, the company carried out more than 1,000 sessions in 2012, its first year of operation. In 2013 the number of visits to the studio has «increased phenomenally», to as many as 350 per month. Already, the company is expanding, with a third person scheduled to join the team in January 2014.
On its website, the company claims to be the market leader in tattoo removal not only in Switzerland but in much of Europe. The laser it leases is one of the only models capable of breaking down tattoos in all colours, and is valued at upwards of CHF150,000 ($165,000). Dietlikon is reportedly the only place in Switzerland that this state-of-the-art laser is being used for the removal of tattoos.
Informing the patient
Seated in a leather chair across the desk from Aeberli, the blonde client explains that she wants to be able to wear skirts in her job in the human resources department of a major international company (see info box for a recruiter’s perspective).
Already, two tattoo removal clinics in Germany have failed to remove the pigment in her calf, and white elements of her tattoo have turned grey from the treatment.
Aeberli inspects the tattoo from across the desk. His laser can’t do anything for the grey patches, but they’ll eventually regenerate on their own, he says. Meanwhile, the red, purple and black should be no problem.
«When did you want to get started?» he asks.
The new client’s consultation has taken place at record speed. Unlike medical research studies in Switzerland, which require both written and oral explanations of potential risks and side effects of a treatment, as well as the signing of a form, informed consent is not required for the removal of tattoos here.
But «correct, truthful and comprehensive» education of patients is «of great importance» according to a research paper published this year in Der Hautarzt, an international professional journal for dermatologists.
Paying for past sins
The woman is anxious to get started. The chair reclines, and she lies on her stomach next to a small white machine, her calf exposed. Aeberli puts on black gloves, disinfects the tattoo, and picks up the laser. As he begins tracing over the tattoo, the laser crackles and pops. The woman tenses, her free leg pulsing up and down. It hurts more than getting a tattoo, she says. She buries her head in her arms.
How long it takes to remove a tattoo depends on many different factors, including the tattoo’s size, age, type of ink, colours and whether the tattoo was applied by an amateur or a professional. Removal of an average tattoo may require 12 visits or more, with six to eight weeks between treatments to allow the skin to regenerate.
Among the potential risks of tattoo removal are burning, scarring and lack of recognition of early-stage skin cancer due to the removal of a potentially cancerous mole. In addition, very little is known about the effects of pigments and dyes on the human body, the Federal Office of Public Health told swissinfo.ch.
Lack of regulation
Although the public health office publishes requirements for dyes used in tattoo ink and for sterilisation of instruments used for tattooing, the cosmetic use of lasers for tattoo removal by non-medical professionals is not regulated at all. In fact, a laser that is marketed for non-medical use does not need to meet the guidelines for medical use – even if it is essentially the same laser.
«At the moment it’s possible to buy a small, low-performance laser over the Internet,» says Aeberli. «And everyone from beauty salons to tattoo studios has bought one of these devices.»
Swissmedic is the organisation responsible in Switzerland for ensuring that authorised therapeutic products are of high quality, effective and safe. It told swissinfo.ch that both the beauty and tattoo removal markets have been booming for a couple of years, but these markets are not covered by the Federal Act on Medicinal Products and Medical Devices.
Regulation is on the way. The public health office is working on a draft bill to cover non-ionising radiation and the cosmetic use of lasers, and expects to present its recommendations to the cabinet in 2014, a spokesperson told swissinfo.ch.
In the meantime, there are some recommendations on the health office’s website. In particular customers are «strongly advised to undergo treatment only if it is offered by medical personnel or a trained professional with a federal diploma under the supervision of a physician».
Insufficient knowledge
Aeberli learned how to operate a laser at the privately-run Swiss Laser Academy, where he received certificates for proficiency in the use of lasers for cosmetic and medical purposes and in dermatological treatment with energetic light sources.
The authors of the research paper in Der Hautarzt – who are affiliated with German university clinics – are sceptical about non-medical qualifications. «Equally questionable are the frequently offered workshops for companies, which give the student the impression that he has sufficient experience in laser therapy after a weekend course,» they write. «Usually the participants receive an impressive certificate that is designed to give patients a certain amount of confidence.»
Aeberli agrees that «a certain level of education should be required» for tattoo removal. He also believes that only medical lasers should be used, «where you’re sure of their quality, and sure that the wavelengths are exact». Changes are needed, he believes. But «what is too much control? What is too little? It’s hard to say where the limit should be.»