Laser Tattoo Removal

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).