Laser tattoo removal

Abstract

Tattooing has been a part of human culture since the earliest beginnings of modern civilization. What has changed over the millennia are the myriad of colors with which we can now express our thoughts, feelings, and desires through body art. What has not changed is human nature, and our propensity to change our minds about what it is we think, feel, and wish to express on the canvas of our skin. Our fickle nature results in the desire to change what has been placed as a permanent reminder of a friend, spouse, or as a work of art. The technology used to remove tattoos began with destructive methods of removal, which wreaked havoc not only on the tattoo but more prominently on the skin containing that tattoo. The discovery of selective photothermolysis, the ability to selectively remove target structures without disrupting the surrounding skin, made it at least possible to remove tattoos without destroying the surrounding skin and leaving a scar. Theory predicted that pulse durations in the nanosecond domain would be optimal for tattoo removal, and the Q-switched neodymium:yttrium-aluminum-garnet, alexandrite, and ruby lasers operate in this range and are the key tools for modern tattoo removal. Too often, the wrong devices operating in the millisecond range, such as intense pulsed light sources, or lasers that are nonselective, such as the carbon dioxide laser, are used to treat tattoos, resulting in significant scarring without complete removal of the tattoo. Although the Q-switched lasers are capable of removing tattoos without harming the skin, removal often takes numerous treatments and still can be incomplete, especially when attempting to remove multicolored tattoos. Developments leading to removable tattoo inks, feedback systems to detect the absorbance characteristics of tattoo inks, dermal clearing agents, and perhaps even shorter pulse-duration lasers should result in improvements in tattoo removal in the near future.

Keywords: Laser; Nd:YAG; Q-switched; alexandrite; pigment; ruby; skin; tattoo.

Figure 1

A patient attempted to remove her tattoo one evening in a bar with a lighted cigar. She was able to achieve complete removal in a given area in a single treatment, with little textural change. Unfortunately, the odds of performing this feat again are small, and the associated pain must have been a deterrent.

Figure 2

Tattoos removed with the carbon dioxide laser demonstrate significant scarring and residual tattoo pigment. This laser is not specific for tattoo particles and merely targets the water in skin.

Figure 3

A modern, multicolored tattoo.

Figure 4

A tattoo treated with an intense pulsed light device that emits a millisecond-domain pulse, with resultant keloidal scarring and significant residual tattoo.

Figure 5

Black tattoos before (A, C, E), and after (B, D, F) a series of treatments with the Q-switched ruby laser.

Figure 6

A multicolored tattoo containing red immediately after treatment with a Q-switched ruby laser is shown. Although the entire tattooed area was treated, the red pigment appears as if it was intentionally avoided.

Figure 7

Tattoos containing green before (A, C), and after (B) multiple treatments with Q-switched Nd:YAG and alexandrite lasers, or the Nd:YAG and ruby lasers (D). Residual green pigment can be seen in both cases.

Figure 8

(A) The first Freedom-2 tattoo is being placed in the arm of the CEO of Freedom-2, Martin Schmieg. (B) Orange is normally one of the hardest colors to remove by laser. This tattoo has been removed with a single treatment.

Figure 9

Blistering in the tattoo of a patient treated 3 days earlier with the Q-switched ruby laser. The treatment site healed without any scarring.

Figure 10

A patient who properly covered their tattoo with a bandage while lying in the sun in a tropical setting.

Figure 11

An allergic reaction to red tattoo pigment is evident by the raised appearance of the red pigment within this tattoo. In addition, the patients in each case reported pruritus in the red area that was treated with intralesional corticosteroids.

Figure 12

An unusual tattoo containing white was treated with a single test spot to determine if it would turn black or gray after treatment with the Q-switched ruby laser. The single gray spot in the center of the middle “leaf” of this strange-looking flower indicates that it will. This darkening response is usually seen immediately after laser treatment in tattoos containing zinc or titanium oxides.