Skin: Laser tattoo removal

A tattoo is a permanent design or marking on the skin, created by inserting ink into the dermal layer to create decorative, symbolic, or meaningful body art. As tattoos have become more common, tattoo removal has also become increasingly common. Successful tattoo removal requires selective removal of each tattoo pigment, with minimal risk of scarring or textural and pigmentary alterations to the skin.

Of the five types of tattoos (amateur, professional, cosmetic, medicinal, and traumatic), amateur tattoos require fewer treatment sessions than professional multicolored tattoos. Factors to consider when evaluating tattoos for removal are: location, age, and the skin type of the patient.

With advances in Q-switched laser technology, tattoo removal can be achieved with a relatively quick procedure and minimal risk of scarring and permanent pigmentary alteration. Treatment with Q-switched lasers involves local anesthesia through lidocaine injection or a topical cream, followed by laser treatment. Topical broad-spectrum antibacterial ointment is applied immediately following the procedure. Three types of lasers currently used for tattoo removal are summarized Table 1.

Table 1 Q-switched laser type, wavelength, and pigments targeted

The most common adverse effects following laser tattoo treatment with Q-switched ruby lasers include textural change, scarring, and pigmentary alteration. Transient hypopigmentation and textural changes have been reported in fewer patients treated with Q-switched alexandrite lasers. Hyperpigmentation with textural changes is a unique effect of Q-switched Nd:YAG lasers, whereas the incidence of hypopigmentary changes is much lower than with ruby lasers. The development of localized and generalized allergic reactions is an unusual complication following tattoo removal with Q-switched ruby and Nd:YAG lasers.