Tattoos are placed for different reasons. A technique for
tattoo removal which produces selective removal of each
tattoo pigment, with minimal risk of
scarring, is needed. Nonspecific methods have a high incidence of
scarring, textural, and pigmentary alterations compared with the use of
Q-switched lasers. With new advances in
Q-switched laser technology,
tattoo removal can be achieved with minimal risk of
scarring and permanent pigmentary alteration. There are five types of
tattoos: amateur, professional, cosmetic, medicinal, and traumatic. Amateur
tattoos require less treatment sessions than professional multicolored
tattoos. Other factors to consider when evaluating
tattoos for removal are: location, age and the skin type of the patient. Treatment should begin by obtaining a pre-operative history. Since treatment with the
Q-switched lasers is painful, use of a local injection with
lidocaine or topical anaesthesia cream may be used prior to
laser treatment. Topical broad-spectrum antibacterial
ointment is applied immediately following the procedure. Three types of
lasers are currently used for
tattoo removal: Q-switched
ruby laser (694 nm), Q-switched
Nd:YAG laser (532 nm, 1064 nm), and Q-switched
alexandrite laser (755 nm). The Q-switched ruby and
alexandrite lasers are useful for removing black, blue and green pigments. The Q-switched 532 nm
Nd:YAG laser can be used to remove red pigments and the 1064 nm
Nd:YAG laser is used for removal of black and blue pigments. The most common adverse effects following
laser tattoo treatment with the Q-switched
ruby laser include textural change,
scarring, and pigmentary alteration. Transient
hypopigmentation and textural changes have been reported in up to 50 and 12%, respectively, of patients treated with the Q-switched
alexandrite laser.
Hyperpigmentation and textural changes are infrequent adverse effects of the Q-switched
Nd:YAG laser and the incidence of hypopigmentary changes is much lower than with the
ruby laser. The development of localized and generalized
allergic reactions is an unusual complication following
tattoo removal with the Q-switched ruby and
Nd:YAG lasers. Since many wavelengths are needed to treat multicolored
tattoos, not one
laser system can be used alone to remove all the available inks and combination of inks. While
laser tattoo removal is not perfect, we have come a long way since the advent of
Q-switched lasers. Current research is focusing on newer picosecond
lasers, which may be more successful than the
Q-switched lasers in the removal of the new vibrant
tattoo links.