Lasers for tattoo removal: a review


Tattoos have existed and have been used as an expression of art by man for ages—and so have the techniques to remove them. Lasers based on the principle of selective photothermolysis are now being used to remove black as well as colorful tattoos with varying successes. The commonly used lasers for tattoo removal are the Q-switched 694-nm ruby laser, the Q-switched 755-nm alexandrite laser, the 1,064-nm Nd:YAG laser, and the 532-nm Nd:YAG laser. Newer techniques and methods are evolving in tattoo removal with lasers. Choosing the right laser for the right tattoo color is necessary for a successful outcome. Our review aims to understand the principles of laser tattoo removal and their applications for different types and colors of tattoos. The review also highlights the complications that can occur such as dyspigmentation, allergic reactions, epidermal debris, ink darkening, and so on, in this process and how to prevent them.

This is a preview of subscription content, access via your institution.


  1. 1.

    Gilbert S (2000) Tattoo history: a source book. Juno Books, New York

    Google Scholar 

  2. 2.

    Pequart M, Pequart SJ (1962) Grotte du Mas d'Azil (Ariege), Une nouvelle galerie magdalenienne. Ann Paleontol 48(167–296):211–214

    Google Scholar 

  3. 3.

    Scutt RWB, Gotch C (1985) Art, sex and symbol. Cornwall Books, London

    Google Scholar 

  4. 4.

    Laumann AE, Derick AJ (2006) Tattoos and body piercings in the United States: a national data set. J Am Acad Dermatol 55(3):413–421

    Article  PubMed  Google Scholar 

  5. 5.

    Timko AL, Miller CH, Johnson FB, Ross EV (2001) In vitro quantitative chemical analysis of tattoo pigments. Arch Dermatol 137:143–147

    CAS  PubMed  Google Scholar 

  6. 6.

    Achauer BM, Nelson JS, Vander Kam V et al (1994) Treatment of traumatic tattoos by Q-switched ruby laser. Plast Reconstr Surg 93:318–323

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Ashinoff R, Geronemus RG (1993) Rapid response of traumatic and medical tattoos to treatment with the Q-switched ruby laser. Plast Reconstr Surg 91:841–845

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Kazandjieva J, Tsankov N (2007) Tattoos: dermatological complications. Clin Dermatol 25:375–382

    Article  PubMed  Google Scholar 

  9. 9.

    Chave TA, Mortimer NJ, Johnston GA (2004) Simultaneous pseudolymphomatous and lichenoid tattoo reactions triggered by re-tattooing. Clin Exp Dermatol 29:197–199

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Muñoz C, Guilabert A, Mascaró JM Jr, Lopez-Lerma I, Vilaplana J (2006) An embossed tattoo. Clin Exp Dermatol 31:309–310

    Article  PubMed  Google Scholar 

  11. 11.

    Gutermuth J, Hein R, Fend F, Ring J, Jakob T (2007) Cutaneous pseudolymphoma arising after tattoo placement. J Eur Acad Dermatol Venereol 21:566–567

    CAS  PubMed  Google Scholar 

  12. 12.

    Shin JB, Seo SH, Kim BK, Kim IH, Son SW. Cutaneous T cell pseudolymphoma at the site of a semipermanent lip-liner tattoo. Dermatology 2008 Nov 13

  13. 13.

    Kluger N, Vermeulen C, Moguelet P, Cotten H, Koeb MH, Balme B, Fusade T (2009) Cutaneous lymphoid hyperplasia (pseudolymphoma) in tattoos: a case series of seven patients. J Eur Acad Dermatol Venereol. Jun 2 [Epub ahead of print]

  14. 14.

    Sangueza OP, Yadav S, White CR Jr, Braziel RM (1992) Evolution of B-cell lymphoma from pseudolymphoma. A multidisciplinary approach using histology, immunohistochemistry, and Southern blot analysis. Am J Dermatopathol 14:408–413

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Zinberg M, Heilman E, Glickman F (1982) Cutaneous pseudolymphoma from a tattoo. J Dermatol Surg Oncol 8:955–958

    CAS  PubMed  Google Scholar 

  16. 16.

    Bailin PL, Ratz JR, Levine HL (1980) Removal of tattoos by CO2 laser. J Dermatol Surg Oncol 6:997–1001

    CAS  PubMed  Google Scholar 

  17. 17.

    Reid R, Muller S (1980) Tattoo removal by CO2 laser dermabrasion. Plast Reconstr Surg 65:717–721

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Anderson RR, Margolis RJ, Watenabe S, Flotte T, Hruza GJ, Dover JS (1989) Selective photothermolysis of cutaneous pigmentation by Q-switched Nd:YAG laser pulses at 1064, 532 and 355 nm. J Invest Dermatol 93(1):28–32

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Kilmer SL, Lee MS, Grevelink JM, Flotte TJ, Anderson RR (1993) The Q-switched Nd:YAG laser effectively treats tattoos. A controlled, dose-response study. Arch Dermatol 129(8):971–978

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Kilmer SL (1997) Laser treatment of tattoos. Dermatol Clin 15(3):409–417

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Leuenberger ML, Mulas MW, Hata TR, Goldman MP, Fitzpatrick RE, Grevelink JM (1999) Comparison of the Q-switched alexandrite, Nd:YAG, and ruby lasers in treating blue-black tattoos. Dermatol Surg 25(1):10–14

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Bernstein EF, Kornbleuth S, Brown DB, Black J (1999) Treatment of spider veins using a 10 millisecond pulse-duration frequency-doubled neodymium YAG laser. J Dermatol Surg 25:316–320

    CAS  Article  Google Scholar 

  23. 23.

    Ho DD, London R, Zimmerman GB, Young DA (2002) Laser-tattoo removal–a study of the mechanism and the optimal treatment strategy via computer simulations. Lasers Surg Med 30(5):389–397

    Article  PubMed  Google Scholar 

  24. 24.

    Herd RM, Alora MB, Smoller B, Arndt KA, Dover JS (1999) 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 40(4):603–606

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Bernstein EF (2006) Laser treatment of tattoos. Clin Dermatol 24(1):43–55

    Article  PubMed  Google Scholar 

  26. 26.

    Antony FC, Harland CC (2003) Red ink tattoo reactions: successful treatment with the Q-switched 532 nm Nd:YAG laser. Br J Dermatol 149(1):94–98

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Goldman L, Blaney DJ, Kindel DJ Jr, Richfield D, Franke EK (1965) Pathology of the effect of the laser beam on the skin. Nature 197:912

    Article  Google Scholar 

  28. 28.

    Goldman L, Wilson RG, Hornby P, Meyer RG (1965) Radiation from a Q-switched ruby laser. Effect of repeated impacts of power output of 10 megawatts on a tattoo of man. J Invest Dermatol 44:69–71

    CAS  PubMed  Google Scholar 

  29. 29.

    Levine VJ, Geronemus RG (1995) Tattoo removal with the Q-switched ruby laser and the Q-switched Nd:YAG laser: a comparative study. Cutis 55(5):291–296

    CAS  PubMed  Google Scholar 

  30. 30.

    Anderson RR, Parrish JA (1983) Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 220:524–527

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    Taylor CR, Gange RW, Dover JS et al (1990) Treatment of tattoos by Q-switched ruby laser. A dose-response study. Arch Dermatol 126:893–899

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Scheibner A, Kenny G, White W, Wheeland RG (1990) A superior method of tattoo removal using the Q-switched ruby laser. J Dermatol Surg Oncol 16:1091–1098

    CAS  PubMed  Google Scholar 

  33. 33.

    Kilmer SL, Anderson RR (1993) Clinical use of the Q-switched ruby and the Q-switched Nd:YAG (1064 nm and 532 nm) lasers for treatment of tattoos. J Dermatol Surg Oncol 19:330–338

    CAS  PubMed  Google Scholar 

  34. 34.

    El Sayed F, Ammoury A, Dhaybi R (2005) Treatment of fireworks tattoos with the Q-switched ruby laser. Dermatol Surg 31(6):706–708

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    Fusade T, Toubel G, Grognard C et al (2000) Treatment of gunpowder traumatic tattoo by Q-switched Nd:YAG laser: an unusual adverse effect. Dermatol Surg 26:1057–1059

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Taylor CR (1998) Laser ignition of traumatically embedded firework debris. Lasers Surg Med 22:157–857

    CAS  Article  PubMed  Google Scholar 

  37. 37.

    Fitzpatrick RE, Goldman MP (1994) Tattoo removal using the alexandrite laser. Arch Dermatol 130:1508–1514

    CAS  Article  PubMed  Google Scholar 

  38. 38.

    Alster TS (1995) Q-switched alexandrite laser treatment (755 nm) of professional and amateur tattoos. J Am Acad Dermatol 33:69–73

    CAS  Article  PubMed  Google Scholar 

  39. 39.

    Zelickson BD, Mehregan DD, Zarrin AA et al (1994) Clinical, histologic, and ultrastructural evaluation of tattoos treated with three laser systems. Lasers Surg Med 15:364–372

    CAS  Article  PubMed  Google Scholar 

  40. 40.

    Kilmer SL, Lee MS, Grevelink JM, Flotte TJ, Anderson RR (1993) The Q-switched Nd:YAG laser effectively treats tattoos. A controlled, dose-response study. Arch Dermatol 129:971–978

    CAS  Article  PubMed  Google Scholar 

  41. 41.

    Karsai S, Pfirrmann G, Hammes S, Raulin C (2008) Treatment of resistant tattoos using a new generation Q-switched Nd:YAG laser: influence of beam profile and spot size on clearance success. Lasers Surg Med 40(2):139–145

    Article  PubMed  Google Scholar 

  42. 42.

    Lapidoth M, Aharonowitz G (2004) Tattoo removal among Ethiopian Jews in Israel: tradition faces technology. J Am Acad Dermatol 51(6):906–909

    Article  PubMed  Google Scholar 

  43. 43.

    Tan OT, Morelli JG, Kurban AK (1992) Pulsed dye laser treatment of benign cutaneous pigmented lesions. Lasers Surg Med 12:538–542

    Article  PubMed  Google Scholar 

  44. 44.

    Ross V, Naseef G, Lin G et al (1998) Comparison of responses of tattoos to picosecond and nanosecond Q-switched neodymium:YAG lasers. Arch Dermatol 134:167–171

    CAS  Article  PubMed  Google Scholar 

  45. 45.

    Goldman MP (2006) Cutaneous and cosmetic laser surgery, 1st edn. Elsevier, Philadelphia, pp 127–130

    Google Scholar 

  46. 46.

    Torok HM, Jones T, Rich P, Smith S, Tschen E (2005) Hydroquinone 4%, tretinoin 0.05%, fluocinolone acetonide 0.01%: a safe and efficacious 12-month treatment for melasma. Cutis 75(1):57–62

    PubMed  Google Scholar 

  47. 47.

    Ramirez M, Magee N, Diven D, Colome-Grimmer M, Motamedi M, Oliveira G, Zamora JG, Uchida T, Wagner RF (2007) Topical imiquimod as an adjuvant to laser removal of mature tattoos in an animal model. Dermatol Surg 33(3):319–325

    CAS  Article  PubMed  Google Scholar 

  48. 48.

    Ricotti CA, Colaco SM, Shamma HN, Trevino J, Palmer G, Heaphy MR Jr (2007) Laser-assisted tattoo removal with topical 5% imiquimod cream. Dermatol Surg 33(9):1082–1091

    CAS  Article  PubMed  Google Scholar 

  49. 49.

    Elsaie ML, Nouri K, Vejjabhinanta V, Patricia Rivas M, Magaly Villafradez-Diaz L, Martins A, Rosso R (2009) Topical imiquimod in conjunction with Nd:YAG laser for tattoo removal. Lasers Med Sci Jul 15. [Epub ahead of print]

  50. 50.

    Ho WS, Ying SY, Chan PC, Chan HH (2006) Use of onion extract, heparin, allantoin gel in prevention of scarring in Chinese patients having laser removal of tattoos: a prospective randomized controlled trial. Dermatol Surg 32(7):891–896

    CAS  Article  PubMed  Google Scholar 

  51. 51.

    Weiss ET, Chapas A, Brightman L, Hunzeker C, Hale EK, Karen JK, Bernstein L, Geronemus RG (2010) Successful treatment of atrophic postoperative and traumatic scarring with carbon dioxide ablative fractional resurfacing: quantitative volumetric scar improvement. Arch Dermatol 146(2):133–140

    Article  PubMed  Google Scholar 

  52. 52.

    Trelles MA, Mordon S, Velez M, Urdiales F, Levy JL (2009) Results of fractional ablative facial skin resurfacing with the erbium:yttrium-aluminium-garnet laser 1 week and 2 months after one single treatment in 30 patients. Lasers Med Sci 24(2):186–194, Epub 2008 Feb 19

    Article  PubMed  Google Scholar 

  53. 53.

    Jones A, Roddey P, Orengo I, Rosen T (1996) The Q-switched ND:YAG laser effectively treats tattoos in darkly pigmented skin. Dermatol Surg 22(12):999–1001

    CAS  Article  PubMed  Google Scholar 

  54. 54.

    Gundogan C, Greve B, Hausser I, Raulin C (2004) Repigmentation of persistent laser-induced hypopigmentation after tattoo ablation with the excimer laser. Hautarzt 55(6):549–552

    CAS  Article  PubMed  Google Scholar 

  55. 55.

    Rokhsar CK, Fitzpatrick RE (2005) The treatment of melasma with fractional photothermolysis: a pilot study. Dermatol Surg 31(12):1645–1650

    CAS  Article  PubMed  Google Scholar 

  56. 56.

    Handley JM (2006) Adverse events associated with nonablative cutaneous visible and infrared laser treatment. J Am Acad Dermatol 55(3):482–489

    Article  PubMed  Google Scholar 

  57. 57.

    Bhardwaj SS, Brodell RT, Taylor JS (2003) Red tattoo reactions. Contact Dermat 48(4):236–237

    Article  Google Scholar 

  58. 58.

    Antony FC, Harland CC (2003) Red ink tattoo reactions: successful treatment with the Q-switched 532 nm Nd:YAG laser. Br J Dermatol 149:94–98

    CAS  Article  PubMed  Google Scholar 

  59. 59.

    Dave R, Mahaffey PF (2002) Successful treatment of an allergic reaction in a red tattoo with the Nd-YAG laser. Br J Plast Surg 55:456

    CAS  Article  PubMed  Google Scholar 

  60. 60.

    Fitzpatrick RE, Lupton JR (2000) Successful treatment of treatment-resistant laser-induced pigment darkening of a cosmetic tattoo. Lasers Surg Med 27:358–361

    CAS  Article  PubMed  Google Scholar 

  61. 61.

    Lee CN, Bae EY, Park JG, Lim SH (2009) Permanent makeup removal using Q-switched Nd:YAG laser. Clin Exp Dermatol. Jul 2. [Epub ahead of print]

  62. 62.

    Jimenez G, Weiss E, Spencer JM (2002) Multiple color changes following laser therapy of cosmetic tattoos. Dermatol Surg 28:177–179

    Article  PubMed  Google Scholar 

  63. 63.

    Tattoo lasers at Last accessed on 10/15/2009

  64. 64.

    Vasold R, Naarmann N, Ulrich H, Fischer D, König B, Landthaler M, Bäumler W (2004) Tattoo pigments are cleaved by laser light-the chemical analysis in vitro provide evidence for hazardous compounds. Photochem Photobiol 80(2):185–190

    CAS  Article  PubMed  Google Scholar 

  65. 65.

    Beute TC, Miller CH, Timko AL, Ross EV (2008) In vitro spectral analysis of tattoo pigments. Dermatol Surg 34(4):508–515

    CAS  Article  PubMed  Google Scholar 

  66. 66.

    Bukhari IA (2005) Removal of amateur blue-black tattoos in Arabic women of skin type (III–IV) with Q-switched alexandrite laser. J Cosmet Dermatol 4(2):107–110

    Article  PubMed  Google Scholar 

  67. 67.

    Cambier B, Rogge F (2006) Traumatic tattoo: use of the variable pulsed erbium:YAG laser. Photomed Laser Surg 24(5):605–609

    Article  PubMed  Google Scholar 

  68. 68.

    McNichols RJ, Fox MA, Gowda A et al (2005) Temporary dermal scatter reduction: quantitative assessment and implications for improved laser tattoo removal. Lasers Surg Med 36:289–296

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None of the authors has a conflict of interest.

Author information



Corresponding author

Correspondence to Sonal Choudhary.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Choudhary, S., Elsaie, M.L., Leiva, A. et al. Lasers for tattoo removal: a review. Lasers Med Sci 25, 619–627 (2010).

Download citation


  • Lasers
  • Tattoos
  • Q-switched ruby laser
  • Q-switched alexandrite laser
  • Ink darkening