- Nazanin Saedi, MD
Nazanin Saedi, MD
- Associate Professor - Department of Dermatology and Cutaneous Biology
- Thomas Jefferson University
- Jared Jagdeo, MD, MS
Jared Jagdeo, MD, MS
- Associate Professor of Dermatology
- University of California, Davis
Tattoo removal is an increasingly common office procedure often performed by dermatologists with special training in tattoo removal. A variety of procedures have been used to remove tattoos, such as laser therapy, surgical excision, and dermabrasion. Quality-switched (Q-switched, QS) lasers are the standard of care for tattoo removal based upon demonstrated efficacy and safety and an extensive history of use for this indication. QS laser treatment can result in good cosmetic outcomes and complete or near-complete removal of many unwanted tattoos.
The approach to tattoo removal will be reviewed here. The epidemiology of tattoos, tattoo placement process, and health risks of tattooing are reviewed separately. (See "Tattooing in adolescents and young adults".)
A tattoo is visible and permanent pigmentation of the skin secondary to the deliberate or accidental deposition of exogenous pigment within the dermis. There are five major subtypes of tattoo :
●Professional tattoos: Professional tattoos are decorative tattoos placed by professional tattoo artists and are typically placed with a vibrating needle. Pigment is deposited more deeply and extensively in the dermis than most amateur tattoos, which can make professional tattoos more difficult to remove.
●Amateur tattoos: Amateur tattoos are decorative tattoos performed by nonprofessionals. Amateur tattoos are often placed by hand with a needle or other improvised devices. Amateur tattoos are most often black and may contain ingredients such as charcoal, soot, or pen ink.
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- Kilmer SL, Lee MS, Grevelink JM, et al. The Q-switched Nd:YAG laser effectively treats tattoos. A controlled, dose-response study. Arch Dermatol 1993; 129:971.
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- Wilken R, Ho D, Petukhova T, Jagdeo J. Intraoperative localized urticarial reaction during Q-switched Nd:YAG laser tattoo removal. J Drugs Dermatol 2015; 14:303.
- Willardson HB, Kobayashi TT, Arnold JG, et al. Diffuse Urticarial Reaction Associated with Titanium Dioxide Following Laser Tattoo Removal Treatments. Photomed Laser Surg 2017; 35:176.
- Herd RM, Alora MB, Smoller B, et al. A clinical and histologic prospective controlled comparative study of the picosecond titanium:sapphire (795 nm) laser versus the Q-switched alexandrite (752 nm) laser for removing tattoo pigment. J Am Acad Dermatol 1999; 40:603.
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- Brauer JA, Reddy KK, Anolik R, et al. Successful and rapid treatment of blue and green tattoo pigment with a novel picosecond laser. Arch Dermatol 2012; 148:820.
- Saedi N, Metelitsa A, Petrell K, et al. Treatment of tattoos with a picosecond alexandrite laser: a prospective trial. Arch Dermatol 2012; 148:1360.
- Bernstein EF, Schomacker KT, Basilavecchio LD, et al. A novel dual-wavelength, Nd:YAG, picosecond-domain laser safely and effectively removes multicolor tattoos. Lasers Surg Med 2015.
- Alabdulrazzaq H, Brauer JA, Bae YS, Geronemus RG. Clearance of yellow tattoo ink with a novel 532-nm picosecond laser. Lasers Surg Med 2015; 47:285.
- Pinto F, Große-Büning S, Karsai S, et al. Neodymium-doped yttrium aluminium garnet (Nd:YAG) 1064-nm picosecond laser vs. Nd:YAG 1064-nm nanosecond laser in tattoo removal: a randomized controlled single-blind clinical trial. Br J Dermatol 2017; 176:457.
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- Bregnhøj A, Haedersdal M. Q-switched YAG laser vs. punch biopsy excision for iatrogenic radiation tattoo markers--a randomized controlled trial. J Eur Acad Dermatol Venereol 2010; 24:1183.
- Ibrahimi OA, Syed Z, Sakamoto FH, et al. Treatment of tattoo allergy with ablative fractional resurfacing: a novel paradigm for tattoo removal. J Am Acad Dermatol 2011; 64:1111.
- Wang CC, Huang CL, Lee SC, et al. Treatment of cosmetic tattoos with nonablative fractional laser in an animal model: a novel method with histopathologic evidence. Lasers Surg Med 2013; 45:116.
- Wang CC, Huang CL, Sue YM, et al. Treatment of cosmetic tattoos using carbon dioxide ablative fractional resurfacing in an animal model: a novel method confirmed histopathologically. Dermatol Surg 2013; 39:571.
- Weiss ET, Geronemus RG. Combining fractional resurfacing and Q-switched ruby laser for tattoo removal. Dermatol Surg 2011; 37:97.
- Meesters AA, De Rie MA, Wolkerstorfer A. Generalized eczematous reaction after fractional carbon dioxide laser therapy for tattoo allergy. J Cosmet Laser Ther 2016; 18:456.
- Au S, Liolios AM, Goldman MP. Analysis of incidence of bulla formation after tattoo treatment using the combination of the picosecond Alexandrite laser and fractionated CO2 ablation. Dermatol Surg 2015; 41:242.
- Ramirez M, Magee N, Diven D, et al. Topical imiquimod as an adjuvant to laser removal of mature tattoos in an animal model. Dermatol Surg 2007; 33:319.
- Ricotti CA, Colaco SM, Shamma HN, et al. Laser-assisted tattoo removal with topical 5% imiquimod cream. Dermatol Surg 2007; 33:1082.
- TATTOO PRINCIPLES
- TREATMENT PRINCIPLES
- FIRST-LINE TREATMENT
- Q-SWITCHED LASERS
- Mechanism and efficacy
- Pretreatment measures
- - Patient evaluation
- - Patient counseling
- - Photography
- Post-treatment care
- Adverse effects
- EMERGING THERAPY
- Picosecond lasers
- OTHER THERAPIES
- Surgical excision and destructive therapies
- Fractionated lasers
- SUMMARY AND RECOMMENDATIONS