Jordan V. Wang

Macrene Alexiades

Nazanin Saedi


Tattoo removal using laser devices has gained in popularity, especially as the medical technology continues to advance. According to the American Society for Dermatologic Surgery (ASDS), nearly 70 000 laser, light, and energy-based tattoo removal procedures were performed by members in 2016 alone.1 With the increased demand by consumers and the availability of several light-based devices in the market, it is crucial for practitioners to be well-versed in laser tattoo removal.

Laser tattoo removal was first performed with argon and CO2 lasers.2 However, they led to significant adverse events because of their nonselective nature. With the advent of devices based on the theory of selective photothermolysis, the concept of targeting specific chromophores with matched wavelengths, the tattoo removal field evolved.3 Application of a wavelength of light that is selectively absorbed by a tattoo pigment causes a rapid rise in temperature leading to a pressure wave that exceeds the tensile strength of the pigment particles and shattering them into smaller fragments. The use of quality-switched (QS) nanosecond lasers subsequently became the standard of care for tattoo removal.2 The short pulse durations allow for photoacoustic and photomechanical destruction of pigment without significant collateral thermal damage.

In comparison with other pigments, tattoo pigments have a significantly short thermal relaxation time (TRT), which means that delivering energy in shorter pulse durations—measured in picoseconds—may prove more efficacious.4,5,6 The newest development of picosecond (PS) lasers has now taken advantage of this phenomenon, which has begun to show a trend toward increased effectiveness for tattoo removal.7,8,9 For improved cosmetic outcome and reduction of adverse effects, the approach to tattoo removal should involve the appropriate choice of laser devices and treatment settings.


Patients present expressing a desire to remove a tattoo.

In laser tattoo removal, the target chromophore in the skin is the deposited tattoo pigment. In order
to produce different colors, tattoo pigments are composed of unique ingredients10 (Table 1.3.1). Different pigments preferentially absorb different wavelengths of light. Therefore, the laser of choice should emit a wavelength that is tailored to the targeted pigment. In cases of multicolored tattoos, multiple lasers may be required.

TABLE 1.3.1 Tattoo Pigments and Their Common Ingredients

Tattoo Pigments

Common Ingredients


India ink, ferrous oxide, magnetite, carbon, logwood


Cobalt aluminum oxide, chromium oxide, copper phthalocyanine


Iron oxides


Chromium oxide, lead chromate, copper or aluminum phthalocyanine, malachite, ferrocyanides and ferricyanides


Manganese ammonium pyrophosphate, aluminum salts, quinacridone, dioxazine/carbazole


Mercuric sulfide, cadmium selenide, ferric hydrate, sandalwood, brazilwood, aromatic azo compounds, quinacridone


Zinc oxide, titanium dioxide, lead carbonate, barium sulfate


Cadmium sulfide, curcuma, chrome yellow


Tattoo pigments are deposited into the dermis using sterilized needles dipped in various pigments that repeatedly puncture the skin. The needles are soldered together in groups ranging from 1 to 100 individual needles and in various shape arrangements depending on the intended tattoo technique (eg, outlining vs shading). The needles vary in diameter from 0.2 to 0.4 mm and typically penetrate 1 to 2 mm into the dermis.

Jun 29, 2020 | Posted by in Dermatology | Comments Off on Tattoos
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