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Tattoo removal

Authors
Nazanin Saedi, MD
Jared Jagdeo, MD, MS
Section Editor
Jeffrey S Dover, MD, FRCPC
Deputy Editor
Abena O Ofori, MD

INTRODUCTION

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".)

TATTOO PRINCIPLES

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 [1]:

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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Literature review current through: Apr 2017. | This topic last updated: May 17, 2017.
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References
Top
  1. Choudhary S, Elsaie ML, Leiva A, Nouri K. Lasers for tattoo removal: a review. Lasers Med Sci 2010; 25:619.
  2. Laumann AE, Derick AJ. Tattoos and body piercings in the United States: a national data set. J Am Acad Dermatol 2006; 55:413.
  3. Armstrong ML, Roberts AE, Koch JR, et al. Motivation for contemporary tattoo removal: a shift in identity. Arch Dermatol 2008; 144:879.
  4. Taylor CR, Gange RW, Dover JS, et al. Treatment of tattoos by Q-switched ruby laser. A dose-response study. Arch Dermatol 1990; 126:893.
  5. Ferguson JE, August PJ. Evaluation of the Nd/YAG laser for treatment of amateur and professional tattoos. Br J Dermatol 1996; 135:586.
  6. Alster TS. Q-switched alexandrite laser treatment (755 nm) of professional and amateur tattoos. J Am Acad Dermatol 1995; 33:69.
  7. 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.
  8. Bencini PL, Cazzaniga S, Tourlaki A, et al. Removal of tattoos by q-switched laser: variables influencing outcome and sequelae in a large cohort of treated patients. Arch Dermatol 2012; 148:1364.
  9. Naga LI, Alster TS. Laser Tattoo Removal: An Update. Am J Clin Dermatol 2017; 18:59.
  10. Leuenberger ML, Mulas MW, Hata TR, et al. Comparison of the Q-switched alexandrite, Nd:YAG, and ruby lasers in treating blue-black tattoos. Dermatol Surg 1999; 25:10.
  11. Taylor CR. Laser ignition of traumatically embedded firework debris. Lasers Surg Med 1998; 22:157.
  12. Fusade T, Toubel G, Grognard C, Mazer JM. Treatment of gunpowder traumatic tattoo by Q-switched Nd:YAG laser: an unusual adverse effect. Dermatol Surg 2000; 26:1057.
  13. Bernstein EF. A widespread allergic reaction to black tattoo ink caused by laser treatment. Lasers Surg Med 2015; 47:180.
  14. Kossida T, Rigopoulos D, Katsambas A, Anderson RR. Optimal tattoo removal in a single laser session based on the method of repeated exposures. J Am Acad Dermatol 2012; 66:271.
  15. Reddy KK, Brauer JA, Anolik R, et al. Topical perfluorodecalin resolves immediate whitening reactions and allows rapid effective multiple pass treatment of tattoos. Lasers Surg Med 2013; 45:76.
  16. Biesman BS, O'Neil MP, Costner C. Rapid, high-fluence multi-pass q-switched laser treatment of tattoos with a transparent perfluorodecalin-infused patch: A pilot study. Lasers Surg Med 2015; 47:613.
  17. Kent KM, Graber EM. Laser tattoo removal: a review. Dermatol Surg 2012; 38:1.
  18. 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.
  19. 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.
  20. 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.
  21. Ross V, Naseef G, Lin G, et al. Comparison of responses of tattoos to picosecond and nanosecond Q-switched neodymium: YAG lasers. Arch Dermatol 1998; 134:167.
  22. 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.
  23. Saedi N, Metelitsa A, Petrell K, et al. Treatment of tattoos with a picosecond alexandrite laser: a prospective trial. Arch Dermatol 2012; 148:1360.
  24. 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.
  25. 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.
  26. 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.
  27. Clabaugh WA. Tattoo removal by superficial dermabrasion. Five-year experience. Plast Reconstr Surg 1975; 55:401.
  28. Reid R, Muller S. Tattoo removal by CO laser dermabrasion. Plast Reconstr Surg 1980; 65:717.
  29. 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.
  30. 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.
  31. 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.
  32. 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.
  33. Weiss ET, Geronemus RG. Combining fractional resurfacing and Q-switched ruby laser for tattoo removal. Dermatol Surg 2011; 37:97.
  34. 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.
  35. 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.
  36. 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.
  37. Ricotti CA, Colaco SM, Shamma HN, et al. Laser-assisted tattoo removal with topical 5% imiquimod cream. Dermatol Surg 2007; 33:1082.