The American Society for Laser Medicine and Surgery (ASLMS) has expanded their New Beginnings tattoo removal program to offer free branding tattoo removal for survivors of sex trafficking.
Partnering with the National Trafficking Sheltered Alliance, whose 100+ agencies serve survivors of human trafficking and sexual exploitation nation-wide, the program addresses the great need in safely removing the tattoos that signify their dehumanization. The NTSA is a network of service providers that provides referrals to survivors and an accreditation program that allows third-party vetting of service programs to ensure their quality and commitment to care.
The New Beginnings Program
The service, offered by volunteering board-certified ASLMS physicians nationwide, began as a way for cancer patients to remove their radiation tattoo marks. Radiation marks are small tattoos used to line up radiation therapy, usually shaped like pinpricks.
For cancer survivors, these tattoos are often an unwanted reminder of a painful period of their lives. Tattoo removal could potentially signify a new chapter in their lives and help them move forward.
In April of 2022, the expansion of the program to include survivors of human trafficking was announced, offering the same new beginning to thousands of survivors across the country. Over the past year, the program has blossomed to over 80 participating ASLMS physicians.
What Is a Branding Tattoo?
Human trafficking, or the trade of human beings for the purpose of forced labor, commercial sexual exploitation, or sexual slavery, is the fastest-growing criminal market. 2021 estimates put the number of people in modern day slavery at over 50 million.
“These tattoos are a dehumanizing practice signifying these victims are the traffickers’ property and they are for sale,” explains ASLMS president Paul M. Friedman, MD. “They can often be a constant reminder of the trauma a survivor has endured and therefore act as a barrier in the healing process. This makes the removal of the brand a profound step in allowing survivors to lower barriers to fully, physically, emotionally, and psychologically exit them from their trafficking situation, reclaim agency over their bodies, and start a path to a new restorative life.”
More Than Just Tattoo Removal
When the ASLMS announced the expansion of the New Beginnings program, it was alongside a study demonstrating that survivors found tattoo removal to be a key part of their overall healing process. This study found that the 3,200 survivors surveyed rated the impact of removing branding tattoos a 9.2 on a scale of 1-10 (ten being the most impactful).
New York dermatologist Doris Day, MD is a participating physician in New Beginnings and member of the ASLMS who offers this service. In her experience, survivors approach their tattoos and removal in a multitude of ways.
“For some people, they’re badges of honor and good reminders, so not everybody wants them removed,” Dr. Day says. “And some people are interesting because they want some removed, but not all. It’s not as if they want everything gone because they are trying to erase the past. Some are more visible than others, so they don’t want other people to judge them or have to explain it to other people.”
When someone does want all signs of these tattoos removed, it can mean leaving behind a constant, painful reminder. “For some it’s a part of their past that they just don’t need daily reminders of. They’ll never forget it, right?” Dr. Day says. “It’s a part of their history and their past. But they don’t need that daily reminder.”
Montclair, NJ dermatologist Jeanine Downie, MD notes this program does more than just remove tattoos. “For the indignity of human trafficking, these generous procedures done by physicians can bring some sense of dignity back into these embattled women’s lives,” Dr. Downie says.
A branding tattoo with the initial “R” on this patient’s left ring finger, indicating possession.
Before and after five treatments with 1064 nm picosecond laser and perfluorodecalin patch.
Photographs courtesy of Paul M. Friedman, MD
How Laser Tattoo Removal Works
These days, the process of removing a tattoo is simple. “The process of tattoo removal in 2023 is quick, easy and relatively painless for most people,” Dr. Downie explains. “The doctor covers your eyes with laser goggles, focuses the laser light on the tattoo, and hits a foot pedal or a handheld trigger to target the color in the pigment of the tattoo.”
The light and heat from the laser are absorbed by the ink particles that make up the tattoo. Once the laser breaks them down into smaller particles, the body’s immune system can remove them. This can take anywhere from four to ten sessions, depending on the age, size, and color of the tattoo.
“Yellow, red and green are notoriously the most difficult ink colors to remove,” Dr. Downie notes. This is because the different colors of ink absorb light differently. Since black absorbs all wavelengths of color, it’s actually the easiest color to eliminate. On the other hand, white and light color tattoos reflect light and make it harder to fully remove.
What Might Complicate Laser Tattoo Removal?
Alongside the variation in color, Smithtown, NY dermatologist Marina Peredo, MD notes that the method of tattooing can also change the way it is removed.
“If a tattoo is professionally administered, all of the ink is at the same level in the skin,” Dr. Peredo explains. “But when it is hand-done or done by an amateur, the pigment is at different layers in the skin, which is harder for the laser to remove.”
Notably, laser treatment may have some consequences for patients with darker skin.
“Skin of color patients or any individual with pigmented skin unfortunately may find some of their own physiological melanin being removed by the tattoo laser,” Dr. Downie explains. “This is a phenomenon known as “shadowing,” where the tattoo laser removes not only the ink from the tattoo but some of the natural skin color and leaves a shadow behind.”
One of the best ways to reduce the potential side-effects of laser tattoo removal is for the treatment to be in the hands of a board-certified professional.
“As complications may arise even in experienced hands, it is important for patients receiving laser tattoo removal to seek the care of a board-certified physician with an intimate knowledge of treatment mechanism, device-tissue interaction and clinical endpoints,” Dr. Friedman explains. “The tattoo color, location, and patient skin type must be accounted for when determining procedure and device parameters to obtain the optimal outcome for the removal of the tattoo.”
Patient Experience Is Priority Number-One
Once a patient has decided they want their tattoo removed, Dr. Day explains that most of the experience will be the same as an every-day patient. “They’re like every other patient in that we want them to have the best experience,” Dr. Day says. “They’re treated as family, as all our patients are.”
It’s important for Dr. Day that the patient is in the driver’s seat when it comes to their treatment. “We’re very respectful of their story and what, if anything, they want to share with us,” Dr. Day explains. “It’s all very open-ended and in their control, so they know we are here for them.”
Dr. Friedman notes that training volunteering physicians is a key part of the program for ensuring the best treatment possible. “Trauma-informed training is part of the program to support the survivor experience during this treatment process,” Dr. Friedman says.
In addition to the informed care they can provide, a board-certified physician is also vital for the healing process. “Patients also require proper pre- and post-care guidance to help prevent adverse events such as scarring, hypo or hyperpigmentation, and paradoxical darkening of the tattoo,” Dr. Friedman explains.
