Chapter 63: Tattoo Removal

INTRODUCTION

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. 63.1–63.3). 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.

KEY CONSULTATIVE QUESTIONS

• 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)

• 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?

MANAGEMENT

It is important to ask the ...