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Tens of millions of Americans have tattoos. Over time, many decide that they want the tattoo to be removed. Quality-switched (Q-switched) lasers are effective in removing most tattoo pigments safely (Figs. 63.163.3). The appropriate laser wavelength is determined by the tattoo ink’s absorption spectrum. It is believed that laser pulses in the nanosecond range target tattoo pigments and break them into smaller particles, thereby facilitating removal of the pigment transepidermally or via macrophages and local scavenger cells. In order to treat multicolored tattoos, several Q-switched laser wavelengths must be employed.

Figure 63.1

(A) Tattoo on left earlobe prior to therapy. (B) Resolution after six treatments with 1,064-nm Q-switched Nd:YAG laser

Figure 63.2

(A) Tattoo on arm with underlying port-wine stain. (B) Note the selective removal of the tattoo, while the port-wine stain persists. (C) Tattoo clearance

Figure 63.3

(A) Left shoulder tattoo with inferior scar resulting from prior treatment with dermabrasion. (B) Improvement after six treatments with 1,064-nm Q-switched Nd:YAG laser. While improvement is not complete, the cosmetic result is far superior to that of dermabrasion


  • Was the tattoo placed by an amateur or a professional tattoo artist?

  • Was the tattoo placed for the purpose of radiation therapy?

  • Is the tattoo the result of trauma or injury?

  • What colors are contained within the tattoo? (Table 63.1)

TABLE 63.1Laser Therapy by Tattoo Color

  • Previous treatments

  • Use of isotretinoin within 6 months

  • History of keloids/hypertrophic scars

  • Duration of tattoo

  • Skin phototype

  • History of HSV at site of treatment

  • History of allergic or granulomatous reaction to tattoo pigment

  • Is the tattoo placed over or covering another tattoo?

  • History of gold ingestion

  • Does the tattoo contain rust-colored or white pigment?


It is important to ask the patient who placed the tattoo. ...

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