Advertisement

Tattoo Removal: Techniques and Devices

  • Evelien Verhaeghe
  • Christa De Cuyper
Chapter

Abstract

About one in five of the tattooed individuals regrets their tattoo(s) and considers removal. Some make an unwise decision and try chemical and thermal methods which mostly result in permanent disfiguring scars. Nowadays treatment with specific lasers offers the best solution. Q-switched lasers have become the first choice. However, laser tattoo removal is painful, tedious, expensive, and not always successful. To avoid dissatisfaction, good knowledge of the devices and patient selection is needed. Professional advice, correct information of the potential side effects, and good aftercare are required.

Keywords

Tattoo removal Selective photothermolysis Pigment laser Q-switched lasers Picosecond lasers Ablative laser Dermatome shaving Dermabrasion 

Notes

Acknowledgment

Dr. Bieke Heykants, Da Vinci Clinic, Beerse, Belgium (film picosecond)

Dr. Els Wittouck, AZ Sint-Jan Brugge-Oostende, Belgium

Supplementary material

162088_2_En_8_MOESM1_ESM.mp4 (117 mb)
Video 8.1 Laser tattoo removal. Part 1 laser tattoo removal black panther; Dr. De Cuyper, Dr. Wittouck. Part 2 laser tattoo removal by Bieke Heykants: picosecond laser to treat spontaneous darkening of a nipple-areola tattoo. Part 3 laser tattoo removal, black tattoo; Dr. Verhaeghe, Dr. De Cuyper (MP4 119770 kb)

References

  1. 1.
    Burris K, Kim K (2007) Tattoo removal. Clin Dermatol 25:388–392CrossRefPubMedGoogle Scholar
  2. 2.
    Strong AM, Jackson IT (1979) The removal of amateur tattoos by salabrasion. Br J Dermatol 101:693–696CrossRefPubMedGoogle Scholar
  3. 3.
    Kilmer S, Fitzpatrick R (2008) Tattoo lasers. http://www.emedicine.com/derm/topic563.html. Accessed 25 June 2008
  4. 4.
    Sepehri M, Jorgensen B, Serup J (2015) Introduction of dermatome shaving as first line treatment of chronic tattoo reactions. J Dermatolog Treat 26:451–455CrossRefPubMedGoogle Scholar
  5. 5.
    Naeyaert C, De Cuyper C (2013) Rood Pigment de grote boosdoener in Tattoos. Ned Tijdschr Dermatol Venerol 29:563–564Google Scholar
  6. 6.
    Wollina U, Kostler E (2007) Tattoos: surgical removal. Clin Dermatol 25:393–397CrossRefPubMedGoogle Scholar
  7. 7.
    Sepehri M, Jorgensen B (2017) Surgical treatment of tattoo complications. Curr Probl Dermatol 52:82–93CrossRefPubMedGoogle Scholar
  8. 8.
    Piggot TA, Norris RW (1988) The treatment of tattoos with trichloroacetic acid: experience with 670 patients. Br J Plast Surg 41:112–117CrossRefPubMedGoogle Scholar
  9. 9.
    Kluger N (2015) The risks of do-it-yourself and over-the-counter devices for tattoo removal. Int J Dermatol 54:13–18CrossRefPubMedGoogle Scholar
  10. 10.
    Wollina U (2015) Depigmentation and hypertrophic scars after application of a fluid lactic acid tattoo eraser. Wien Med Wochenschr 165:195–198CrossRefPubMedGoogle Scholar
  11. 11.
    Kluger N, Koljonen V (2014) Chemical burn and hypertrophic scar due to misuse of a wart ointment for tattoo removal. Int J Dermatol 53:e9–11CrossRefPubMedGoogle Scholar
  12. 12.
    Li Z, Zhang H, Li SH et al (2016) Fatal phenol toxicity following attempted tattoo removal. J Forensic Sci 61:1143–1145CrossRefPubMedGoogle Scholar
  13. 13.
    Saini R, Winhoven SM, Kaufman J (2008) Hypertrophic scar after chemical tattoo removal. Dermatol Surg 34:1599–1602PubMedGoogle Scholar
  14. 14.
    Serup J (2017) Atlas of illustrative cases of tattoo complications. Curr Probl Dermatol 52:139–229CrossRefPubMedGoogle Scholar
  15. 15.
    Colver GB (1989) The infrared coagulator in dermatology. Dermatol Clin 7:155–167CrossRefPubMedGoogle Scholar
  16. 16.
    Manstein D, Herron GS, Sink RK et al (2004) Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med 34:426–438CrossRefPubMedGoogle Scholar
  17. 17.
    Ibrahimi OA, Syed Z, Sakamoto FH et al (2011) Treatment of tattoo allergy with ablative fractional resurfacing: a novel paradigm for tattoo removal. J Am Acad Dermatol 64:1111–1114CrossRefPubMedGoogle Scholar
  18. 18.
    Meesters AA, De Rie MA, Wolkerstorfer A (2016) Generalized eczematous reaction after fractional carbon dioxide laser therapy for tattoo allergy. J Cosmet Laser Ther 18:456–458CrossRefPubMedGoogle Scholar
  19. 19.
    Vanarase M, Gautam RK, Arora P et al (2017) Comparison of Q-switched Nd:YAG laser alone versus its combination with ultrapulse CO2 laser for the treatment of black tattoo. J Cosmet Laser Ther 19(5):1–7CrossRefGoogle Scholar
  20. 20.
    Anderson RR, Geronemus R, Kilmer SL et al (1993) Cosmetic tattoo ink darkening. A complication of Q-switched and pulsed-laser treatment. Arch Dermatol 129:1010–1014CrossRefPubMedGoogle Scholar
  21. 21.
    Mafong EA, Kauvar AN, Geronemus RG (2003) Surgical pearl: removal of cosmetic lip-liner tattoo with the pulsed carbon dioxide laser. J Am Acad Dermatol 48:271–272CrossRefPubMedGoogle Scholar
  22. 22.
    Solis RR, Diven DG, Colome-Grimmer MI et al (2002) Experimental nonsurgical tattoo removal in a guinea pig model with topical imiquimod and tretinoin. Dermatol Surg 28:83–86, discussion 86–87PubMedGoogle Scholar
  23. 23.
    Ramirez M, Magee N, Diven D et al (2007) Topical imiquimod as an adjuvant to laser removal of mature tattoos in an animal model. Dermatol Surg 33:319–325PubMedGoogle Scholar
  24. 24.
    Elsaie ML, Nouri K, Vejjabhinanta V et al (2009) Topical imiquimod in conjunction with Nd:YAG laser for tattoo removal. Lasers Med Sci 24:871–875CrossRefPubMedGoogle Scholar
  25. 25.
    Ricotti CA, Colaco SM, Shamma HN et al (2007) Laser-assisted tattoo removal with topical 5% imiquimod cream. Dermatol Surg 33:1082–1091PubMedGoogle Scholar
  26. 26.
    Cozzi SJ, Le TT, Ogbourne SM et al (2017) Tattoo removal with ingenol mebutate. Clin Cosmet Investig Dermatol 10:205–210CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Anderson RR, Parrish JA (1983) Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 220:524–527CrossRefPubMedGoogle Scholar
  28. 28.
    Adatto MA, Halachmi S, Lapidoth M (2011) Tattoo removal. Curr Probl Dermatol 42:97–110CrossRefPubMedGoogle Scholar
  29. 29.
    Beute TC, Miller CH, Timko AL et al (2008) In vitro spectral analysis of tattoo pigments. Dermatol Surg 34:508–515, discussion 515–516PubMedGoogle Scholar
  30. 30.
    Parrish JA, Anderson RR, Harrist T et al (1983) Selective thermal effects with pulsed irradiation from lasers: from organ to organelle. J Invest Dermatol 80(Suppl):75s–80sCrossRefPubMedGoogle Scholar
  31. 31.
    Goldman L, Wilson RG, Hornby P et al (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 44:69–71CrossRefPubMedGoogle Scholar
  32. 32.
    Kilmer SL (2002) Laser eradication of pigmented lesions and tattoos. Dermatol Clin 20:37–53CrossRefPubMedGoogle Scholar
  33. 33.
    Taylor CR, Gange RW, Dover JS et al (1990) Treatment of tattoos by Q-switched ruby laser. A dose-response study. Arch Dermatol 126:893–899CrossRefPubMedGoogle Scholar
  34. 34.
    Grevelink JM, Duke D, Van Leeuwen RL et al (1996) Laser treatment of tattoos in darkly pigmented patients: efficacy and side effects. J Am Acad Dermatol 34:653–656CrossRefPubMedGoogle Scholar
  35. 35.
    Jacques SL (1993) Role of tissue optics and pulse duration on tissue effects during high-power laser irradiation. Appl Opt 32:2447–2454CrossRefPubMedGoogle Scholar
  36. 36.
    Adatto MA, Amir R, Bhawalkar J et al (2017) New and advanced picosecond lasers for tattoo removal. Curr Probl Dermatol 52:113–123CrossRefPubMedGoogle Scholar
  37. 37.
    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 134:167–171CrossRefPubMedGoogle Scholar
  38. 38.
    Ho DD, London R, Zimmerman GB et al (2002) Laser-tattoo removal--a study of the mechanism and the optimal treatment strategy via computer simulations. Lasers Surg Med 30:389–397CrossRefPubMedGoogle Scholar
  39. 39.
    Pinto F, Grosse-Buning S, Karsai S et al (2017) 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 176:457–464CrossRefPubMedGoogle Scholar
  40. 40.
    Alabdulrazzaq H, Brauer JA, Bae YS et al (2015) Clearance of yellow tattoo ink with a novel 532-nm picosecond laser. Lasers Surg Med 47:285–288CrossRefPubMedGoogle Scholar
  41. 41.
    Bernstein EF, Schomacker KT, Basilavecchio LD et al (2015) A novel dual-wavelength, Nd:YAG, picosecond-domain laser safely and effectively removes multicolor tattoos. Lasers Surg Med 47(7):539–612.  https://doi.org/10.1002/lsm.22391CrossRefGoogle Scholar
  42. 42.
    Brauer JA, Reddy KK, Anolik R et al (2012) Successful and rapid treatment of blue and green tattoo pigment with a novel picosecond laser. Arch Dermatol 148:820–823CrossRefPubMedGoogle Scholar
  43. 43.
    Saedi N, Metelitsa A, Petrell K et al (2012) Treatment of tattoos with a picosecond alexandrite laser: a prospective trial. Arch Dermatol 148:1360–1363CrossRefPubMedGoogle Scholar
  44. 44.
    Bae YS, Alabdulrazzaq H, Brauer J et al (2016) Successful treatment of paradoxical darkening. Lasers Surg Med 48:471–473CrossRefPubMedGoogle Scholar
  45. 45.
    Kim HR, Shin JM, Lee JH et al (2017) Primary cutaneous Aspergillosis after tattoo removal using a 1,064-nm Q-switched Nd:YAG laser in an immunocompetent patient. Ann Dermatol 29:241–243CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Friedmann DP, Mishra V, Buckley S (2017) Keloidal scarring from the at-home use of intense pulsed light for tattoo removal. Dermatol Surg 43(8):1112–1114CrossRefPubMedGoogle Scholar
  47. 47.
    Hammes S, Karsai S, Metelmann HR et al (2013) Treatment errors resulting from use of lasers and IPL by medical laypersons: results of a nationwide survey. J Dtsch Dermatol Ges 11:149–156PubMedGoogle Scholar
  48. 48.
    Radmanesh M, Rafiei Z (2015) Combination of CO2 and Q-switched Nd:YAG lasers is more effective than Q-switched Nd:YAG laser alone for eyebrow tattoo removal. J Cosmet Laser Ther 17:65–68CrossRefPubMedGoogle Scholar
  49. 49.
    Sardana K, Ranjan R, Kochhar AM et al (2015) A rapid tattoo removal technique using a combination of pulsed Er:YAG and Q-switched Nd:YAG in a split lesion protocol. J Cosmet Laser Ther 17:177–183CrossRefPubMedGoogle Scholar
  50. 50.
    Sardana K, Garg VK, Bansal S et al (2013) A promising split-lesion technique for rapid tattoo removal using a novel sequential approach of a single sitting of pulsed CO(2) followed by Q-switched Nd: YAG laser (1064 nm). J Cosmet Dermatol 12:296–305CrossRefPubMedGoogle Scholar
  51. 51.
    Hutton CK, Esmann J, Serup J (2017) Laser surgeon, client education, and satisfaction with tattoo removal. Curr Probl Dermatol 52:124–131CrossRefGoogle Scholar
  52. 52.
    Bunert N, Homey B, Gerber PA (2014) Successful treatment of a professional tattoo with the R20 method. Hautarzt 65:853–855CrossRefPubMedGoogle Scholar
  53. 53.
    Kossida T, Rigopoulos D, Katsambas A et al (2012) Optimal tattoo removal in a single laser session based on the method of repeated exposures. J Am Acad Dermatol 66:271–277CrossRefPubMedGoogle Scholar
  54. 54.
    Biesman BS, Costner C (2017) Evaluation of a transparent perfluorodecalin-infused patch as an adjunct to laser-assisted tattoo removal: a pivotal trial. Lasers Surg Med 49:335–340CrossRefPubMedGoogle Scholar
  55. 55.
    Zelickson BD, Mehregan DA, Zarrin AA et al (1994) Clinical, histologic, and ultrastructural evaluation of tattoos treated with three laser systems. Lasers Surg Med 15:364–372CrossRefPubMedGoogle Scholar
  56. 56.
    Karsai S, Krieger G, Raulin C (2010) Tattoo removal by non-professionals—medical and forensic considerations. J Eur Acad Dermatol Venereol 24:756–762CrossRefPubMedGoogle Scholar
  57. 57.
    Schreiver I, Hutzler C, Laux P et al (2015) Formation of highly toxic hydrogen cyanide upon ruby laser irradiation of the tattoo pigment phthalocyanine blue. Sci Rep 5:1291CrossRefGoogle Scholar
  58. 58.
    Eklund Y, Rubin AT (2015) Laser tattoo removal, precautions, and unwanted effects. Curr Probl Dermatol 48:88–96CrossRefPubMedGoogle Scholar
  59. 59.
    Wilken R, Ho D, Petukhova T et al (2015) Intraoperative localized urticarial reaction during Q-switched Nd:YAG laser tattoo removal. J Drugs Dermatol 14:303–306PubMedGoogle Scholar
  60. 60.
    Willardson HB, Kobayashi TT, Arnold JG et al (2017) Diffuse urticarial reaction associated with titanium dioxide following laser tattoo removal treatments. Photomed Laser Surg 35:176–180CrossRefPubMedGoogle Scholar
  61. 61.
    Hibler BP, Rossi AM (2015) A case of delayed anaphylaxis after laser tattoo removal. JAAD Case Rep 1:80–81CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Yorulmaz A, Onan DT, Artuz F et al (2015) A case of generalized allergic contact dermatitis after laser tattoo removal. Cutan Ocul Toxicol 34:234–236CrossRefPubMedGoogle Scholar
  63. 63.
    Bernstein EF (2015) A widespread allergic reaction to black tattoo ink caused by laser treatment. Lasers Surg Med 47:180–182CrossRefPubMedGoogle Scholar
  64. 64.
    Ashinoff R, Levine VJ, Soter NA (1995) Allergic reactions to tattoo pigment after laser treatment. Dermatol Surg 21:291–294PubMedGoogle Scholar
  65. 65.
    Geist DE, Phillips TJ (2006) Development of chrysiasis after Q-switched ruby laser treatment of solar lentigines. J Am Acad Dermatol 55:S59–S60CrossRefPubMedGoogle Scholar
  66. 66.
    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 26:1057–1059CrossRefPubMedGoogle Scholar
  67. 67.
    Izikson L, Avram M, Anderson RR (2008) Transient immunoreactivity after laser tattoo removal: report of two cases. Lasers Surg Med 40:231–232CrossRefPubMedGoogle Scholar
  68. 68.
    Bernstein EF (2007) Laser tattoo removal. Semin Plast Surg 21:175–192CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Laux P, Tralau T, Tentschert J et al (2016) A medical-toxicological view of tattooing. Lancet 387:395–402CrossRefPubMedGoogle Scholar
  70. 70.
    Vasold R, Engel E, Konig B et al (2008) Health risks of tattoo colors. Anal Bioanal Chem 391:9–13CrossRefPubMedGoogle Scholar
  71. 71.
    Vasold R, Naarmann N, Ulrich H et al (2004) Tattoo pigments are cleaved by laser light-the chemical analysis in vitro provide evidence for hazardous compounds. Photochem Photobiol 80:185–190CrossRefPubMedGoogle Scholar
  72. 72.
    Karsai S (2017) Removal of tattoos by Q-switched nanosecond lasers. Curr Probl Dermatol 52:105–112CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of DermatologyGhent University HospitalGentBelgium
  2. 2.DermatologyBlankenbergeBelgium
  3. 3.AZ Sint-Jan Brugge-Oostende AVBruggeBelgium

Personalised recommendations