Some of this free ink is eliminated by lymphatic and transepidermal transport, but most of it is rephagocytosed by somatic dermal cells within a few days. Lymphatic transport seems to account for most of the ink removed, although ink is sometimes shed in a scale-crust after each treatment. Some of these ideas have been briefly examined. In a small controlled study, Ort et al 7 removed the epidermis before laser treatment in an attempt to increase the elimination of ink. Unfortunately, there was no evidence of improved efficacy compared with tattoo treatment in adjacent intact skin.
Massage is known to greatly increase lymphatic transport.
In a pilot study Dierickx et al 8 created a delayed-type hypersensitivity reaction to Candida antigen before laser tattoo treatment, with the intent of increasing phagocytosis by mobile inflammatory cells. Again unfortunately, this did not improve efficacy. However, corticosteroids, specific cytokines, and drugs affecting phagocytosis have not been examined in the context of tattoo removal. However, it is also possible to confine pressure in the target by inertial confinement. Extreme stresses in the target can be created this way.