Until recently, little research has been done on tattoo removal performed on people of color. A sad fact, considering that the majority of people with tattoos leaving gangs and many leaving prison represent Hispanic ethnic groups and blacks.
Dr. Jo Marie Reilly, a professor of family medicine at the University of Southern California’s Keck School of Medicine, and her team of medical school student researchers conducted two studies to better understand and serve this population.
Her interest in the subject evolved from her work at USC, as well as 18 years as a volunteer at Homeboy Industries’ tattoo removal clinic.
“At USC a huge part of my job is to try to train the next generation of medical students who will go into primary care in vulnerable communities. I teach them clinical skills, how to work in the communities and how to do research on the work they do in these communities,” she says.
For the past 10 years, she has also had some of her medical students and residents volunteer at Homeboy.
The first study, A Descriptive Analysis of the Epidemiology and Motivations for Laser Tattoo Removal in an Underserved Population, was published in the Journal of Community Health in September 2021. It analyzed a representative sample of 862 patients who received tattoo removal procedures between January 2016 and December 2018 at Homeboy Industries’ Ya’Stuvo Tattoo Removal program. A team of 30 volunteer medical professionals provides more than 4,000 free tattoo removal treatments each month as part of this program.
Defining tattoo removal patients and their motives
The study’s goal was to understand who the patients are and their motives for getting and removing their tattoos. It also evaluated the challenges that people who were formerly incarcerated or gang-related face in getting their tattoos removed and the importance of access to tattoo removal for this population.
What the study found demographically was that:
- 80% of the clients identified as Latino, Chicano or Hispanic.
- 56% were male.
- the average age at first visit was 30.
The most common reasons for receiving tattoos were:
- gang affiliation (46%).
- current or ex-relationship (28%).
The most common reasons for tattoo removal were to:
- improve employment opportunities (66%).
- change their life (46%).
- look better for their family (43%).
- avoid negative attention (37%).
The study’s stated purpose: To deliver patient centered and culturally sensitive care, it is imperative to understand the motivations behind acquiring and removing tattoos.
Surprising research study findings
In spite of the fact that Reilly had been volunteering at Homeboy for nearly two decades, several things in the study surprised her.
“We didn’t realize the geography and how far people travel to get their tattoos removed. They came from northern California and other states. The age of most of the people getting it done was a little older than we thought. We thought that the people would be in the 18- to 25-year-old group. But we were having people in their 30s and even into their 40s saying that ‘This life isn’t for me, and I have to make some changes,’” she says. “Also, the fact that there were just as many women as men. Some of the women were jailed and some were trafficked.”
Complications and best practices research
Reilly was also the lead researcher on a second paper, Tattoo Removal in People of Color Who Were Formerly Incarcerated or Were Gang Members: Complications and Best Practices, that was published in November.
The study analyzed the data of dark-skinned patients who had been incarcerated or gang-involved and were getting their tattoos taken off. It found that:
- 74% had five treated tattoos or fewer.
- 63% of the tattoos were each treated from three to 10 times.
- Most common tattoo removals took place on the upper extremities (47%), face (12%), back (11%) and neck (10%).
- Of the 2,118 tattoos in the sample, only 163 were expected to be completed.
Tattoo status can predict who will finish the process
Those with complications – including keloids, scarring and hypo- and hyper-pigmentation – were far less likely to complete the tattoo removal process. The study found that 14.4% of those who didn’t experience complications completed the treatment, while only 7.3% of those who experienced complications completed theirs.
Tattoos put on by amateur tattoo artists caused fewer complications than those done by professionals, with 4.3% experiencing complications from amateur applications, vs. 9.4% from tattoos done by professionals.
Color can add to complications
Tattoos done in blue or black ink produce fewer complications – 4.9% – than those done with colors like green, yellow or red – 10.8%.
Although there are a range of complications that result from tattoo removal performed on people of color, one stands out above all of the others.
“In this population, the biggest thing was completion rates,” says Reilly. “Our completion rates weren’t nearly as high as we hoped they would be. Many people aren’t benefiting as much as they can because they don’t stick around. It could take more than a year, and that can discourage people. We have to set expectations from the get go.”
The researchers also learned about how tattoos are performed in jail settings and how that makes a difference in the types of scarring people might get. If there is scarring, the patient needs to be informed that it can’t be removed.
The researchers discovered that some in this population lack patience. “Some people tried to get the tattoos off themselves. They’ve used cigarettes to burn themselves, used over-the-counter tattoo removal chemicals that allow them to do self-treatment. And they tried Amazon tattoo removal machines. As a result, they were scarred even more and caused a lot of trauma on their skin before they come to us,” she said.
“It made us understand that this population really needs tattoo removal. They’re so desperate that they try to do it themselves. They come to us with trauma that we can’t fix. We need to provide more services and make people aware of the services.”
Among best practices in regards to tattoo removal for people of color, the report recommends that tattoo removal clinicians:
- Provide pretreatment counseling so the patient fully understands the process.
- Receive additional training to become aware of the risks unique to tattoo removal in this population.
- Create a positive experience so patients will be willing to come back for further treatments.
- Develop cultural competence skills and receive training in trauma-informed care.
Editor’s note: With two papers already completed, Reilly and her team are busy working on a third, which is expected to be released in the summer. The third study focuses on the outcome of tattoo removal. Although there are many anecdotal stories out there, as far as we know, no one has done a scientific study on the subject. Currently the team is busy interviewing patients to figure out how their situation has changed. Are they getting jobs? Are they getting better jobs? How has their self-confidence and self-esteem changed? How has the relationship with their families changed? Stay tuned. We’ll let you know when the current study is published.
