Tattoo Removal Using Surgical Techniques: Experience With 350 Cases

Introduction: There has been an exponential increase in the number of young adults seeking tattoo removal in recentyears. The main reason is a prohibition of any form of tattoo in recruitment of army, paramilitary force, police, and otherjobs. Most studies done on tattoo removal are either on laser removal or have established results of only one particularsurgical method of tattoo removal. However, almost all known surgical methods of tattoo removal have been performed inthe present study.Aims and Objectives: The aim is to study the clinical outcome of various surgical methods of tattoo removal to search for anideal one.Materials and Methods: A study was conducted in 350 patients. Tattoo removal was done with surgical methods. The varioussurgical techniques used were excision and primary closure, serial excision, tangential split thickness excision, tangentialexcision with dermal over grafting, and excision with grafting. The factors which determined the choice of procedure weresize, site, shape, depth of tattoo, skin laxity, and presence of complication of tattooing or previously attempted tattoo removal.Patients were followed for 3 months.Results: Excision and primary closure were done in 26 tattoos. Serial excision in 9, split thickness tangential excision in 2,tangential excision with dermal over grafting in 179, and excision with grafting in 134 tattoos were done. Scar stretching, minimalcolor changes, and hypertrophy were seen after tattoo removal. Post-operative marginal hypertrophy was seen lesser in tangentialexcision with dermal over grafting (60%) than in excision with grafting (75%) though it could be managed conservatively. Patientsatisfaction levels were well achieved.Conclusion: All procedures resulted in complete tattoo removal, and each had its own application and limitations. It was difficultto label one procedure superior to the other.

Scar-Saving Flap during Serial Excision by Borrowing from the Opposite Side

BACKGROUND: Congenital melanocytic nevi may have various shapes according to the anatomic location. Therefore, it is desirable to apply proper surgical designs to the diverse forms considering the characteristics of the sites as well as the shape and size. OBJECTIVE: The purpose of this article is to introduce a new scar-saving flap design for semicircular defects after removing congenital melanocytic nevi without excising additional normal skin. METHODS: In most cases to excise semicircular nevi, normal skin should be excised to prevent dog ear, resulting in the long length of the scar. So we use a new scar-saving flap design by borrowing a partial length from the opposite side. RESULTS: We used this new technique for 4 cases of large semicircular skin defects. In all cases, this method had some advantages from this perspective: (1) it does not require excision of normal adjacent skin to convert a semicircular defect into a crescent shape or to remove dog-ears (2) the final suture line is not much longer than the diameter of the original defect and (3) it makes the removal of a much larger volume possible in one procedure rather than using the classic serial excision technique, which consists of a central elliptical excision within the confines of the nevus. In this way the frequency of procedures and discomfort to the patient can be reduced. CONCLUSION: We think that a scar-saving flap design by borrowing a partial length from the opposite side can be a good strategy for a semicircular skin defect.

Scar Revision of Wide Facial Scar by Serial Excision Using the Sure-Closure(R)

Conventional methods of scar revision of wide facial scar are skin graft, local flap coverage, local flap using the tissue expander, and free flap method, but these methods have disadvantages such as color dismatching, deformity of facial structure, inevitable additional scar, great expense, and waste of time. From April 1996 to April 2001, we performed the scar revision of wide facial scar by serial excision using the Sure- Closure(R) in 8 patients. Of these, 4 had scars on the cheeks, 2 on the preauricle, and the remaining 2 on the mentum and temporal area. The mean follow-up period was 18 months, ranging from 6 to 24 months. By pinching the skin on the scar site, we got a rough idea as to whether the available skin on either side of excision margin was sufficient for closure. The tension on the skin margin was 3.0 kilograms and the device was employed over a duration of 50 minutes. A skin stretching device is designed to exploit the viscoelastic properties, that is mechanical creep and stress relaxation. In this study, we use the serial excision with the Sure- Closure(R), because excessive scar excision could result in the deformity of facial structure and wound dehiscence, hypertrophic scar, and skin necrosis. The skin stretching device is easy to use and achieves good aesthetic results in the scar revision of wide facial scar.