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Tattoos, Uniforms Don’t Always Go Together, So MTFs Busy Removing Skin Art

by U.S. Medicine

October 4, 2011

WASHINGTON — Many young people of enlistment age have tattoos, and some percentage are required to remove body art that the military services deem inappropriate.

That sometimes can be a time-consuming, if not difficult, medical process.

Some tattoo inks are harder to remove than others, and it may be impossible to completely remove some body art.

“Yellows and greens are not as easy to remove as blues and blacks …The other thing to remember is that it may be impossible to completely remove all of the tattoo, and often times people are left with a shadowed or ghost-like image in the skin,” said Charles Greeson, MD, laser clinic director at Wilford Hall Ambulatory Surgical Center at Lackland Air Force Base, Texas.

While tattoo removal isn’t a priority for MTFs and patients have to pay out of pocket for the procedure, such knowledge may come in handy with the proliferation of servicemembers with skin ink. A Pew Research Center report released in 2010 found that nearly four-in-ten “Millennials,” those ages 18-29, have a tattoo. That report also stated that about half of those with tattoos in the U.S. have two to five tattoos and 18% have six or more.

Tattoos not uncommon

Each of the military services has guidelines on tattoos and, when the tattoos do not meet the guidelines, servicemembers may find themselves seeking tattoo removal. The Air Force’s dress code prohibits in or out of uniform “tattoos/brands/body markings anywhere on the body that are obscene, commonly associated with gangs, extremist and/or supremacist organizations, or that advocate sexual, racial, ethnic or religious discrimination.”

It also has a broader prohibition that is open to interpretation by commanding officers:  Tattoos/brands/body markings with unauthorized content that are prejudicial to good order and discipline or the content is of a nature that tends to bring discredit upon the Air Force are prohibited both in and out of uniform.”

Troops whose body art falls into those categories are required to initiate tattoo/brand/body marking removal/alteration. At the commander’s discretion, “members may be seen, on a space and resource available basis, in a Department of Defense medical treatment facility for voluntary tattoo/brand/body marking removal. When DoD resources are not available, members may have the tattoo/brand removed/altered at their own expense outside of DoD medical treatment facilities.”

“This is considered a cosmetic procedure according to AF regulations and is treated as such,” Col. Steven E. Ritter, MD, who is the Air Force Surgeon General Consultant for Dermatology, told U.S. Medicine a written statement. “Cosmetic procedures do not have priority over general dermatology conditions such as skin cancer, inflammatory skin conditions, infections, etc.”

In addition, anyone undergoing a cosmetic procedure, active duty, retiree or dependent, pays for the treatment at their own expense, according to prescribed billing guideline, he said. Even if a dependent or active-duty member is willing to pay for it, not all MTFs have the capability to remove tattoos.  “There are only a total of 16 MTFs (Stateside and Overseas) in the AFMS with dermatologists and few of these have the appropriate laser that can treat most common tattoos,” he said.

Tattoos, Uniforms Don’t Always Go Together, So MTFs Busy Removing Skin Art Cont.

Tattoo Removal

The dermatology residency training program at Wilford Hall Ambulatory Surgical Center has the capability and does about five tattoo treatments a week, Greeson said.

Removals range from cosmetic tattoos to skin damage or discoloration caused by injury or disease. Greeson said the patients who come in for cosmetic reasons may need the tattoo removed because it is inappropriate or it simply does not reflect who they are anymore.

“Maybe they got it at a younger age and they are trying to have a more professional image, or they are applying for a job and they don’t want that tattoo any longer. It could also be an old boyfriend or girlfriend’s name. I’ve seen that,” he said.

Removal is “straightforward,” Greeson explained, but it can take anywhere from three or four laser treatments to 15 or more treatments, depending on the quality of the tattoo, the ink type, density, depth and location on the body. The length of treatment sometimes comes as a surprise to patients.

“You have to set really good expectations with these patients as they come in, because they come in expecting the tattoo to be removed. A lot of what I hear when they come in is that they think it will be four to six treatments and the tattoo will be gone and that is what you often read in a lot of magazines and books. But honestly, it is rarely that quick,” said Greeson. “The prices add up pretty fast when you start paying per treatment.”

Residents Learn Removal

The dermatology residency program at Wilford Hall Ambulatory Surgical Center is a combined Air Force and Army program and is the largest in the military and one of the largest in the U.S., Greeson explained.

“We have a lot of laser platforms,” he said. “A lot of these things in the civilian world are used for cosmetic purposes, but we learn a lot from using these. We do treat cosmetic patients, although they are low priority, but we try to take a lot of those lessons learned from treating cosmetic patients and apply them to patients who have a medical indication.”

The program is trying different techniques for removal. One technique is to double treat in a single visit. A patient will have a treatment and then sit for 30 minutes before undergoing a second treatment.

“Before, you would do one treatment, and then the patient would come back in anywhere from three to six weeks for a second treatment,” he said. “Now, we will actually treat twice in one setting. We have found some improvement from that.”

Another technique they are trying is to add in a carbon dioxide laser, which targets water as opposed to pigment.

“It is somewhat helping with the removal,” he said. “It basically destroys tissue and punches little holes in the skin, and then it helps expel some of the tattoo ink content. …We are potentially going to do a little study to evaluate the effectiveness of that.”

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