Short-pulsed laser treatment achieves tattoo removal success

December 1, 2010

Tattoos are increasingly prevalent in Western society. One survey found that 24 percent of respondents had tattoos. While options for tattoo removal include excision, dermabrasion and CO2 laser vaporization, selective short-pulsed laser treatment is the preferred modality.

Key Points

Tattoos are increasingly prevalent in Western society. One survey found that 24 percent of respondents had tattoos (Laumann AE, Derick AJ. J Am Acad Dermatol. 2006;55(3):413-421).

The 2006 "Gen Next" Pew Research Center survey found that 40 percent of respondents age 26 to 40 have tattoos (http://people-press.org/reports/pdf/300.pdf). This number is expected to rise, and along with it a rising number of patients will consult dermatologists for tattoo removal.

Initially, dermatologists utilized carbon dioxide laser vaporization to remove tattoos. These ablative lasers were problematic because they removed the tattoo pigment as well as the surrounding tissue, often resulting in dyspigmentation and always causing scarring.

The green light 532 nm (potassium titanyl phosphate) Nd:YAG laser can be employed for red and orange tattoos. This laser effectively targets black and blue tattoos, and it has been suggested that newer-generation devices can improve recalcitrant cases (Karsai S, Pfirrmann G, Hammes S, et al. Lasers Surg Med. 2008;40(2)139-145). Patients should be cautioned that paradoxical darkening of white and cream-colored tattoos can occur, as the iron oxide- or titanium dioxide-containing pigment undergoes an oxidation-reduction reaction (Choudhary S, Elsaie ML, Leiva A, et al. Lasers Med Sci. 2010;25(5):519-627). It is best to avoid treating these light tattoo colors. If paradoxical darkening occurs, clearing can sometimes be achieved with additional treatments utilizing Q-switched lasers of different wavelengths (Fitzpatrick RE, Lupton JR. Lasers Surg Med. 2000;27(4):358-361).