Tattoos provide a means of adolescent self-identification, with long-term consequences for future employment opportunities, domestic relationship stability and spiritual lives. Although tattoos pose potential challenges for many Americans, they are particularly problematic for former prisoners and gang members. Tattoos that may have helped signify individual and group identity in their earlier lives become burdens that hold them in subcultures that foster recidivism. These tattoos are often aesthetically unacceptable for polite society (including a variety of workplaces), and may convey suggestions of racism, sexism, or hostility that are repellant in the larger culture.

Traditional tattoo removal procedures such as laser therapy are too expensive for most youths who are at risk. A laser procedure may cost $10,000 or more, and is typically not covered by insurance or Medicaid. But there is one medical procedure that offers promise for inexpensive, safe, and effective tattoo removal. The medical technology is whole light therapy, developed in Germany and recognized by medical authorities in the United States. Whole light tattoo removal has also been used in clinics in Texas and throughout the United States, often serving indigent patients on a pro bono basis.  This technology has also been used to remove tattoos from hundreds of young people in Central America, under the medical supervision of clinics sponsored by the Maryknoll Brothers (Roman Catholic) and the Mennonite Central Committee (Protestant). But no systematic, scientifically sound evaluation process has been implemented to establish the risks of this procedure, or the likelihood of aesthetically satisfactory results, or the ultimate consequences for life-course trajectories of the patients.

Our project is intended to lay the groundwork for research to evaluate the costs, and the medical and social outcomes, of whole-light therapy for tattoo removal delivered to youths at risk.  Given promising findings in this regard, the ultimate goal is to make tattoo removal widely available to youths whose tattoos are an impediment to transitioning to a “straight” life.  The project embodies the C-StARR goal of developing interventions that reflect multi-level causal processes.  Three of these levels are particularly relevant: institutional (especially the labor market), interpersonal (household and peer group), and individual (self-identity).

1. There have been a number of meetings among investigators, including interested persons at RTI and the University of Chicago, to discuss study design and methodology. We also sought to determine the state of the science and use of this technology for tattoo removal.  Additionally we discussed next steps and future funding opportunities to conduct an efficacy and cost-benefit study after this study’s completion.
2. Dr. Tamera Coyne-Beasley trained in the use of whole-light therapy for tattoo removal by the developer, Dr. Tolbert S. Wilkinson.  Dr. Coyne-Beasley traveled to San Antonio for a brief training session in Dr. Wilkinson’s clinic.  She was required to purchase the equipment as part of the training program.  She participated in formal instruction and presentation on: (1) the importance of tattoo removal, (2) how tattoos can serve as obstacles to an individuals’ progress, (3) importance of type of tattoo, tattoo ink and location of tattoo, (4) tattoo removal process with whole light therapy, and (5) skin maintenance protocols and follow-up necessary to achieve good results.  She participated in tattoo removal of 15 patients using the purchased equipment.
3. Dr. Coyne-Beasley began laying the groundwork for a safety and efficacy study in the San Antonio clinic.  She reviewed charts for the few patients that had them (most of his cases in the public clinic have little documentation), and spoke at length with several of Dr. Wilkinson’s clients about their experience.
4. The research team designed a prospective study to be conducted in Dr. Wilkinson’s public clinic.  While he was closely consulted at every step, and initially appeared to be enthusiastic about hosting this study, in the end he appeared to lose interest in the scientific portion of this effort.   The research team decided that it was not productive to continue attempting to work with him.
5. Through a mutual contact, Philip Cook recently made contact with Dr. Dana Sprute, MD, who has had a public tattoo-removal clinic in Austin for many years that utilizes the whole-light therapy.  Dr. Sprute is with theSeton Health Care Network, the largest health care network in Austin.  She is interested in conducting a study of medical, social, and employment outcomes for youthful patients, and has volunteered her clinic to host the study.

Our effort to initiate a prospective study in Dr. Wilkinson’s clinic ultimately failed.  However, Dr. Coyne-Beasley learned a good deal about his procedure, and what might be required in order to encourage broader adoption.  While scores of medical providers have been trained in the method, and thousands of patients have been treated in the United States and Latin America, there are no systematic studies in the literature that document outcomes or cost.  Further, it would be useful to create a standardized written protocol in English, which does not now exist.

Remarkably, clinics delivering whole light therapy are often held in church basements or other informal settings, with medical providers volunteering their time.  But a complete treatment is not simple or quick.  On average 3-5 treatments are required to remove a tattoo (depending on type of ink and location), spanning 12-20 weeks. The post procedure management of the tattoo site requires daily pressure dressings and occasional antibiotic ointment.  If mismanaged there is a risk of infection. And the treatment leaves a scar that may be an unsatisfactory outcome to the patient.

We believe that the low cost of the whole-light procedure warrants further effort to determine its safety and efficacy.   Furthermore, we remain interested in conducting a study of tattoo removal (by any medically acceptable means) as a rehabilitation measure for youths at risk.