Skip to main content

Laser Tattoo Removal

  • 2232 Accesses

Abstract

Tattooing of human skin dates back to prehistoric times, with evidence of tattoos present in artifacts from the Bronze Age and the Paleolithic period. Egyptian mummies have been discovered with tattoos on their bodies (Kent and Graber, Dermatol Surg 38(1):1–13, 2012). Tattoos have been placed for body decoration, as a form of expression, and for cosmetic and medical purposes. Traumatic tattoos can also result from injury resulting in implantation of particles in the skin (Bernstein, Clin Dermatol 24(1):43–55, 2006). In the United States, approximately 1 out of every 4 adults ages 18–24 has a tattoo (Armstrong et al., J Adolesc Health 35(1):58–61, 2004; Armstrong et al., Arch Dermatol 132(4):412–416, 1996). Historical methods for tattoo removal have been both mechanical and chemical. These methods have included abrading the skin followed by the application of salt (Manchester, Calif Med 118(3):10–12, 1973), the application of various concentrations of trichloroacetic acid, and dermabrasion, which involves using a wire brush or a diamond fraise wheel to remove skin to the level of the papillary dermis along with tattoo pigment (Kent and Graber, Dermatol Surg 38(1):1–13, 2012; Bernstein, Semin Plast Surg 21(3):175–192, 2007). Electrocautery and liquid nitrogen have been used to try to destroy the skin to remove tattoo pigment. Although tattoo pigment may be removed with the above methods, the rate of scarring and dyspigmentation is very high given that these methods are non-selectively destructive (Gupta, Plast Reconstr Surg 36(3):354–361, 1965; Ruiz-Esparza et al., J Dermatol Surg Oncol 14(12):1372–1376, 1988; Dvir and Hirshowitz, Plast Reconstr Surg 66(3):373–379, 1980; Colver and Dawber Int J Dermatol 24(9):567–568, 1985). Surgical excision of tattoos has also long been an option for removal, but may be difficult given that tattoos are often located on anatomical sites not optimally suited for linear repair, or may require several staged procedures (Buncke and Conway, Plast Reconstr Surg 20(1):67–77, 1957; Bailey, Plast Reconstr Surg 40(4):361–371, 1967; Fujimori, Treatment of nevus of Ota and nevus spilus. In: Kobayashi T, editor. Skin surface surgery. Tokyo: Kokuseido; 1990. p. 181–188; Kobyashi, J Dermatol Surg Oncol 17(12):936–941, 1991; Cosman et al., Ann Plast Surg 22(1):36–42, 1989). Laser tattoo removal began in the 1970s with the argon laser (488 and 514 nm), which was a continuous wave laser and therefore resulted in damage to surrounding tissue and scarring (Apfelberg et al., Br J Plast Surg 32(2):141–144, 1979; Maser et al., World J Surg 7(6):684–691, 1983; Brady et al., Ann Plast Surg 2(6):482–490, 1979; McBurney South Med J 71(7):795–797, 1978). The ablative CO2 laser (10,600 nm) has also been use for approximately the past 25 years for tattoo removal, and similarly results in scarring and dyspigmentation given that it non-specifically targets water in the skin (Bailin et al., J Dermatol Surg Oncol 6(12):997–1001, 1980; Reid and Muller Plast Reconstr Surg 65(6):717–721, 1980; Fitzpatrick et al., J Dermatol Surg Oncol 17(4):340–439, 1991; Ruiz-Esparza et al., J Dermatol Surg Oncol 14(12):1372–1376, 1989). Modern tattoo removal involves Q-switched (QS) lasers, which function based on the theory of selective photothermolysis (Anderson and Parrish Science 220(4596):524–527, 1983; Anderson et al., J Invest Dermatol 93(1):28–32).

Keywords

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Kent KM, Graber EM. Laser tattoo removal: a review. Dermatol Surg. 2012;38(1):1–13.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  3. Armstrong M, Roberts A, Owen D, Koch J. Contemporary college students and body piercing. J Adolesc Health. 2004;35(1):58–61.

    Article  PubMed  Google Scholar 

  4. Armstrong M, Stuppy D, Gabriel D, Anderson R. Motivation for tattoo removal. Arch Dermatol. 1996;132(4):412–6.

    Article  CAS  PubMed  Google Scholar 

  5. Manchester G. Tattoo removal. A new simple technique. Calif Med. 1973;118(3):10–2.

    CAS  PubMed Central  PubMed  Google Scholar 

  6. Bernstein E. Laser tattoo removal. Semin Plast Surg. 2007;21(3):175–92.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Gupta SC. An investigation into a method for the removal of dermal tattoos: a report on animal and clinical studies. Plast Reconstr Surg. 1965;36(3):354–61.

    Article  CAS  PubMed  Google Scholar 

  8. Ruiz-Esparza J, Goldman MP, Fitzpatrick RE. Tattoo removal with minimal scarring: the chemo-laser technique. J Dermatol Surg Oncol. 1988;14(12):1372–6.

    Article  CAS  PubMed  Google Scholar 

  9. Dvir E, Hirshowitz B. Tattoo removal by cryosurgery. Plast Reconstr Surg. 1980;66(3):373–9.

    Article  CAS  PubMed  Google Scholar 

  10. Colver GB, Dawber RP. The removal of digital tattoos. Int J Dermatol. 1985;24(9):567–8.

    Article  CAS  PubMed  Google Scholar 

  11. Buncke Jr HR, Conway H. Surgery of decorative and traumatic tattoos. Plast Reconstr Surg. 1957;20(1):67–77.

    Article  CAS  Google Scholar 

  12. Bailey BN. Treatment of tattoos. Plast Reconstr Surg. 1967;40(4):361–71.

    Article  CAS  PubMed  Google Scholar 

  13. Fujimori Y. Treatment of nevus of Ota and nevus spilus. In: Kobayashi T, editor. Skin surface surgery. Tokyo: Kokuseido; 1990. p. 181–8.

    Google Scholar 

  14. Kobyashi T. Microsurgical treatment of nevus of Ota. J Dermatol Surg Oncol. 1991;17(12):936–41.

    Article  Google Scholar 

  15. Cosman B, Apfelberg DB, Druker D. An effective cosmetic treatment for Ota’s nevus. Ann Plast Surg. 1989;22(1):36–42.

    Article  CAS  PubMed  Google Scholar 

  16. Apfelberg DB, Maser MR, Lash H. Argon laser treatment of decorative tattoos. Br J Plast Surg. 1979;32(2):141–4.

    Article  CAS  PubMed  Google Scholar 

  17. Maser MR, Apfelberg DB, Lash H. Clinical applications of the argon and carbon dioxide lasers in dermatology and plastic surgery. World J Surg. 1983;7(6):684–91.

    Article  CAS  PubMed  Google Scholar 

  18. Brady SC, Blokmanis A, Jewett L. Tattoo removal with the carbon dioxide laser. Ann Plast Surg. 1979;2(6):482–90.

    Article  CAS  PubMed  Google Scholar 

  19. McBurney EI. Carbon dioxide laser treatment of dermatologic lesions. South Med J. 1978;71(7):795–7.

    Article  CAS  PubMed  Google Scholar 

  20. Bailin PL, Ratz JR, Levine HL. Removal of tattoos by CO2 laser. J Dermatol Surg Oncol. 1980;6(12):997–1001.

    Article  CAS  PubMed  Google Scholar 

  21. Reid R, Muller S. Tattoo removal by CO2 laser dermabrasion. Plast Reconstr Surg. 1980;65(6):717–21.

    Article  CAS  PubMed  Google Scholar 

  22. Fitzpatrick RE, Ruiz-Esparza JN, Goldman MP. The depth of thermal necrosis using the CO2 laser: a comparison of the superpulsed mode and conventional modes. J Dermatol Surg Oncol. 1991;17(4):340–439.

    Article  CAS  PubMed  Google Scholar 

  23. Ruiz-Esparza J, Goldman MP, Fitzpatrick RE. Tattoo removal with minimal scarring: the chemo-laser technique. J Dermatol Surg Oncol. 1989;14(12):1372–6.

    Article  Google Scholar 

  24. Anderson R, Parrish J. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science. 1983;220(4596):524–7.

    Article  CAS  PubMed  Google Scholar 

  25. Anderson R, Margolis R, Watenabe S, Flotte T, et al. Selective photothermolysis of cutaneous pigmentation by Q-switched Nd: YAG laser pulses at 1064, 532, and 355 nm. J Invest Dermatol. 1989;93(1):28–32.

    Article  CAS  PubMed  Google Scholar 

  26. Ara G, Anderson R, Mandel K, Ottesen M, et al. Irradiation of pigmented melanoma cells with high intensity pulsed radiation generates acoustic waves and kills cells. Lasers Surg Med. 1990;10(1):52–9.

    Article  CAS  PubMed  Google Scholar 

  27. Choudhary S, Elsaie ML, Leiva A, Nouri K. Lasers for tattoo removal: a review. Lasers Med Sci. 2010;25(5):619–27.

    Article  PubMed  Google Scholar 

  28. Timko AL, Miller CH, Johnson FB, Ross EV. In vitro quantitative chemical analysis of tattoo pigments. Arch Dermatol. 2001;137(2):143–7.

    CAS  PubMed  Google Scholar 

  29. Achauer BM, Nelson JS, Vander Kam V, et al. Treatment of traumatic tattoos by Q-switched ruby laser. Plast Reconstr Surg. 1994;93(2):318–23.

    Article  CAS  PubMed  Google Scholar 

  30. Ashinoff R, Geronemus RG. Rapid response of traumatic and medical tattoos to treatment with the Q-switched ruby laser. Plast Reconstr Surg. 1993;91(5):841–5.

    Article  CAS  PubMed  Google Scholar 

  31. Levine V, Geronemus R. Tattoo removal with the Q-switched ruby laser and the Q-switched Nd:YAG laser: a comparative study. Cutis. 1995;55(5):291–6.

    CAS  PubMed  Google Scholar 

  32. Al-Mutairi N, Manchanda Y, Almutairi L. Tattooing in the Gulf region: a review of tattoo practices and response to treatment with the Q-switched ruby laser. J Cosmet Laser Ther. 2010;12(3):132–7.

    Article  PubMed  Google Scholar 

  33. Taylor C, Gange R, Dover J, Flotte TJ, et al. Treatment of tattoos by Q-switched ruby laser. A dose–response study. Arch Dermatol. 1990;126(7):893–9.

    Article  CAS  PubMed  Google Scholar 

  34. Leuenberger M, Mulas M, Hata T, Goldman MP, et al. Comparison of the Q-switched alexandrite, Nd:YAG, and ruby lasers in treating blue-black tattoos. Dermatol Surg. 1999;25(1):10–4.

    Article  CAS  PubMed  Google Scholar 

  35. Kilmer S, Anderson R. 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. 1993;19(4):330–8.

    Article  CAS  PubMed  Google Scholar 

  36. Zelickson B, Mehregan D, Zarrin A, Coles C, et al. Clinical, histologic, and ultrastructural evaluation of tattoos treated with three laser systems. Lasers Surg Med. 1994;15(4):364–72.

    Article  CAS  PubMed  Google Scholar 

  37. Ferguson J, August P. Evaluation of the Nd:YAG laser for treatment of amateur and professional tattoos. Br J Dermatol. 1996;135(4):586–91.

    Article  CAS  PubMed  Google Scholar 

  38. Antony FC, Harland CC. Red ink tattoo reactions: successful treatment with the Q-switched 532 nm Nd:YAG laser. Br J Dermatol. 2003;149(1):94–8.

    Article  CAS  PubMed  Google Scholar 

  39. Fitzpatrick RE, Goldman MP. Tattoo removal using the alexandrite laser. Arch Dermatol. 1994;130(12):1508–14.

    Article  CAS  PubMed  Google Scholar 

  40. Bernstein L, Geronemus R. Keloid formation with the 585-nm pulsed dye laser during isotretinoin treatment. Arch Dermatol. 1997;133(1):111–2.

    Article  Google Scholar 

  41. Alexiades-Armenakas MR, Dover JS, Arndt KA. Laser therapy. In: Bolognia J, editor. Dermatology. 2nd ed. London: Elsevier; 2008. p. 2107.

    Google Scholar 

  42. Alissa A. Concomitant use of laser and isotretinoin, how safe. Grapevine: American Society for Laser Medicine and Surgery; 2011.

    Google Scholar 

  43. Yun P, Arndt K, Anderson R. Q-switched laser-induced chrysiasis treated with long-pulsed laser. Arch Dermatol. 2002;138(8):1012–4.

    Article  PubMed  Google Scholar 

  44. Almoallium H, Klinkhofff A, Arthur A, Rivers J, et al. Laser induced chrysiasis: disfiguring hyperpigmentation following Q-switched laser therapy in a woman previously treated with gold. J Rheumatol. 2006;33(3):620–1.

    Google Scholar 

  45. Goldman MP. Cutaneous and cosmetic laser surgery. 1st ed. Philadelphia: Elsevier; 2006. p. 127–30.

    Google Scholar 

  46. Fitzpatrick RE, Lupton JR. Successful treatment of treatment-resistant laser-induced pigment darkening of a cosmetic tattoo. Lasers Surg Med. 2000;27(4):358–61.

    Article  CAS  PubMed  Google Scholar 

  47. Lee CN, Bae EY, Park JG, Lim SH. Permanent makeup removal using Q-switched Nd:YAG laser. Clin Exp Dermatol. 2009;34(8):e594–6.

    Article  CAS  PubMed  Google Scholar 

  48. Ho WS, Ying SY, Chan PC, Chan HH. 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. 2006;32(7):891–6.

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  50. Bhardwaj SS, Brodell RT, Taylor JS. Red tattoo reactions. Contact Dermatol. 2003;48(4):236–7.

    Article  Google Scholar 

  51. Ibrahimi OA, Syed Z, Sakamoto FH, Avram MM, Anderson RR. Treatment of tattoo allergy with ablative fractional resurfacing: a novel paradigm for tattoo removal. J Am Acad Dermatol. 2011;64(6):1111–4.

    Article  PubMed  Google Scholar 

  52. Vasold R, Naarmann N, Ulrich H, Fischer D, König B, Landthaler M, et al. Tattoo pigments are cleaved by laser light- the chemical analysis in vitro provide evidence for hazardous compounds. Photochem Photobiol. 2004;80(2):185–90.

    Article  CAS  PubMed  Google Scholar 

  53. 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(2):271–7.

    Article  PubMed  Google Scholar 

  54. Ross V, Naseef G, Lin G, Kelly M, et al. Comparison of responses of tattoos to picosecond and nanosecond Q-switched neodymium: YAG lasers. Arch Dermatol. 1998;134(2):167–71.

    Article  CAS  PubMed  Google Scholar 

  55. Vargas G, Chan K, Thomsen S, Welch A. Use of osmotically active agents to alter optical properties of tissue: effects on the detected fluorescence signal measured through skin. Lasers Surg Med. 2001;29(3):213–20.

    Article  CAS  PubMed  Google Scholar 

  56. McNichols R, Fox M, Gowda A, McNichols RJ, Fox MA, Gowda A, Tuya S, Bell B, Motamedi M. Temporary dermal scatter reduction: quantitative assessment and implications for improved laser tattoo removal. Lasers Surg Med. 2005;36(4):289–96.

    Article  PubMed  Google Scholar 

  57. Ramirez M, Magee N, Diven D, Colome-Grimmer M, Motamedi M, Oliveira G, Zamora JG, Uchida T, Wagner RF. Topical imiquimod as an adjuvant to laser removal of mature tattoos in an animal model. Dermatol Surg. 2007;33(3):319–25.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Omar A. Ibrahimi MD, PhD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

Pothiawala, S., Kilmer, S.L., Ibrahimi, O.A. (2014). Laser Tattoo Removal. In: Nouri, K. (eds) Handbook of Lasers in Dermatology. Springer, London. https://doi.org/10.1007/978-1-4471-5322-1_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-5322-1_9

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5321-4

  • Online ISBN: 978-1-4471-5322-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics