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Given that the pigment particles in tattoos have a relaxation time of <10 ns, picosecond lasers would be expected to be more effective than nanosecond lasers in tattoo removal. To systematically review the evidence regarding the effectiveness and safety of picosecond lasers for tattoo removal, Pubmed, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and reference lists were searched for relevant trials. The primary outcome was >70 % clearance of tattoo pigment. Secondary outcomes were 90-100 % clearance of tattoo pigment, number of laser sessions required, and adverse effects. Eight trials were included, six with human participants (160 participants) and 2 with animal models. Seven of the eight trials explored the usage of either 755, 758, 795, 1064, or 1064/532-nm picosecond lasers for black and blue ink tattoos. In the human trials, 69-100 % of tattoos showed over 70 % clearance of pigment after 1-10 laser treatments. Reported side effects included pain, hyperpigmentation and hypopigmentation, blister formation and transient erythema, edema, and pinpoint bleeding. Included articles varied in type of laser investigated, mostly non-comparative studies and with a medium to high risk of bias. There is sparse evidence that picosecond lasers are more effective than their nanosecond counterparts for mainly black and blue ink tattoo removal, with minor side effects. [ABSTRACT FROM AUTHOR]

Background: Tattooing has become increasingly popular, particularly among young people. However, little is known about the tattoo practices in North-East India. Objectives: The primary objective of this study was to know the reasons and motivations of tattoo application and tattoo removal in individuals asking for tattoo removal. The secondary objective was to identify the demography, methods and safety of tattoo practices in these tattooed individuals. Materials and Methods: A hospital-based cross-sectional study was carried out in 212 consecutive individuals seeking tattoo removal. Chi-square and Fisher's exact tests were performed for intergroup comparisons. Results: There were 178 (84%) males and 34 (16%) females. The mean ± standard deviation (SD) age of individuals seeking tattoo removal was 21.8 ± 4 years. The mean ± SD age of doing tattoo was 15.8 ± 3 years. Most individuals possessed an amateur tattoo (94.3%), 4.2% a professional one and 1.4% had a combination. Sewing needle was the most common instrument used for making tattoos in 51.4%. The individuals made their tattoos in an unsterile manner in 49.1%. The most common reason for doing tattoo was for fashion in 87.7%. The participants wanted tattoo removal to qualify for jobs, especially in armed forces in 49.5% and due to regret in 21.7%. Black was the most preferred colour in 37.3% followed by green in 28.3%. The fabric ink was the choice of ink in maximum number of individuals, i.e. 93.9%. Limitations: It was a hospital-based study done only on individuals seeking tattoo removal. It needs caution to generalise the findings in population. In addition, there may be recall bias in the participants. Conclusion: The tattoo was done mostly below 18 years of age in a crude unsterile way. The individuals had poor risk perceptions about various infections and complications of tattooing. There is an urgent need to caution and educate the youngsters and school-going children about safe tattooing and consequences of tattooing. [ABSTRACT FROM AUTHOR]

Background: Laser tattoo removal using quality switched technology is widely accepted as the standard of care. Determining the risk of hypertrophic scarring and keloid formation more precisely delineates the safety of this procedure and improves patient education regarding the risk of scarring.Objective: To investigate the incidence of hypertrophic scarring and keloids in a large patient population following treatment with a Q-switched neodymium-doped:yttrium-aluminum-garnet laser.Design: In November 2012, after a single Institutional Review Board approved retrospective chart review, 1,041 charts demonstrating greater than five treatment sessions were analyzed. All patients in the current retrospective study were treated under one study protocol.Results: An overall incidence of 0.28 percent (3/1,041) of patients receiving a minimum of five laser tattoo treatments with a Q-switched neodymium-doped:yttrium-aluminum-garnet laser developed clinical evidence of hypertrophic scarring. None of the 1,041 patients in this study developed keloid scars.Conclusion: With the Q-switched neodymium-doped:yttrium-aluminum-garnet laser utilizing accurate, protocol-based settings, the incidence of hypertrophic scarring following laser tattoo removal treatments was 0.28 percent (3/1,041) and the incidence of keloid scarring was 0.00 percent (0/1,041). [ABSTRACT FROM AUTHOR]

69% (34/49) of physician members had treated 9 or fewer patients with radiation tattoos, 25% (12/49) had treated 10 to 24 patients with radiation tattoos, 2% (1/49) had treated 25 to 44 patients with radiation tattoos, and 4% (2/49) had treated greater than 45 patients with radiation tattoos. Survey questions aimed to (1) determine approximately how many patients have been treated in the New Beginnings Program, (2) determine the average number of treatment sessions required to adequately remove radiation tattoos, and (3) determine the most common laser used for the treatment of radiation tattoos. Before radiation treatment, patients often receive skin markings with permanent ink.[1] Patients generally receive multiple tattoos, often in cosmetically sensitive areas, surrounding the area to be irradiated. [Extracted from the article]

Other attempts to enhance the clearance of unwanted tattoos include the use of nonablative fractional resurfacing, ablative fractional resurfacing, and combining these techniques with QS lasers in the same treatment session.12-14 More recently, picosecond lasers have been used successfully for the treatment of tattoos and have gained great popularity for this application.15,16 However, even with the use of these shorter pulse duration lasers, laser-assisted tattoo removal has remained challenging. It is important to note that these authors included subjects with Fitzpatrick skin type ranging from I to V with 9/45 (20%) classified as either IV or V. This is important because the initial studies performed with a QS 755-nm laser-emitting nanosecond duration pulses included only patients with Fitzpatrick skin Types I to III. Treatment of tattoos with a 755-nm Q-switched alexandrite laser and novel 1064 nm and 532 nm Nd:YAG laser handpieces pumped by the alexandrite treatment beam. [Extracted from the article]

Q-switched Nd:YAG laser remains the gold standard for tattoo removal, but still some tattoos are not completely removed in a specified period as desired by the patient. Herein, we present a case report of 23-year-old patient who came to the outpatient department for tattoo removal. The tattoo measured around 20 cm × 18 cm and was located on the back. Nine to 12 sessions of 1064-nm Q-switched Nd:YAG laser were planned at 4- to 6-week interval. After the completion of nine sessions, all the shades of the tattoo disappeared, but the lines persisted. A trial of increased laser energy and multiple-pass R20 treatment was performed, which rather increased the scarring and no improvement in tattoo clearance was noticed. We tried mini-punch skin excision for clearing the remnant tattoo lines. The tattoo was cleared successfully without significant scarring. Mini-punch skin excision is a very promising technique, similar to the follicular unit extraction technique of hair transplant, for tattoo removal of the patients who want immediate results as compared to lasers that take almost a year, provided the patient accepts the risk of scarring. [ABSTRACT FROM AUTHOR]

Unwanted diffusion of pigment past the original margins of a tattoo, termed "tattoo blowout," appears as a blurred rim classically surrounding the original tattoo borders. The darkened skin is visibly noted within hours to days following the tattooing procedure. Although this complication is not largely covered in literature, in prior cases, blowout has been shown to occur in areas of thin skin such as the dorsum of the foot. We present a rare presentation of tattoo blowout in a possible gravity-dependent pattern of pigment migration, occurring years after tattoo application. This atypical presentation highlights the knowledge gap that exists in the medical literature surrounding the mechanism of tattoo blowout and reinforces that physicians should be aware of these potentially poor aesthetic outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Cao et al.)

Objective The aim of the study was to evaluate the efficacy of tattoo removal treatments using the 1064-nm Q-switched (QS) Nd:YAG laser. Background data Today, QS lasers appear to be the most common, effective, and safest methods to treat unwanted markings. Material and methods A total of 64 patients with 75 unwanted tattoos were enrolled in the study. Tattoo clearance was evaluated according to the color intensity - concentration of pigment: group I (34) - black; group II (41) - gray. Consideration included methods of tattooing and tattoo techniques. Results In group I, after the first treatment session the median of clearance was 30% (10-50%), while in group II, the median was 50% (40-70%). After the second treatment session, median in group I increased to 40% (30-50%). Median of group II increased to 70% (50-80%). The highest number of treatment in group I was 7. After that, the median grew to 75%, while the highest amount of treatment in group II was 5 and a median of 90% was achieved. Conclusions Effects were dependent upon the amount of ink deposited in the tissue. Old amateur tattoos and tattoos containing small quantities of ink (technique: shading and lines) demonstrated the quickest and the most efficacious results. Tattoos with large quantities of ink, obtained by filling, required the greatest number of treatment sessions. The final outcome in tattoo clearing can only be assessed following treatment completion, which may in some cases take 2-3 years. Presumably, in some cases, complete clearance is impossible. [ABSTRACT FROM AUTHOR]

Red pigment tattoos are known to cause pseudoepitheliomatous hyperplasia in the skin, frequently simulating squamous cell carcinoma or keratoacanthoma. Herein, the authors present two additional cases of red pigment tattoo pseudoepitheliomatous hyperplasia in which they noted a lichenoid tissue reaction. They reviewed the previously published cases and observed a lichenoid reaction in the histopathological images similar to hypertrophic lichen planus. The authors suggest that these reactions might best be referred to as "lichenoid reaction with pseudoepitheliomatous hyperplasia" or "hypertrophic lichen planus-like reaction." Accordingly, recognition of an inflammatory component may allow additional treatment options. [ABSTRACT FROM AUTHOR]

Background/aims: Chronic tattoo reactions requiring treatment have increased. Laser removal is not ideal for removal of allergic reactions. Surgical removal of culprit pigment situated in the outer dermis by dermatome shaving is rational and need to be revisited.Materials/methods: Fifty four tattoos with chronic reactions in 50 patients were treated with dermatome shaving. Tattoos with red/red nuances dominated the material. In total, 52 operations were performed in infiltration and 2 in general anaesthesia. Shaving was performed to the level in the dermis free of tattoo pigment as assessed visually by the surgeon.Results: Operative complications were few. Healing occurred over weeks as normal for this procedure. On a rating scale from 0 to 4, 4 as most severe, the patient’s severity rating of symptoms in their tattoo declined from 3.2 pre-operatively to 1.0, 0.8 and 0.7 after 3, 6 and 12 months, respectively. Burden of operation was rated low. Patient satisfaction was high.Discussion/conclusion: Dermatome shaving is efficient and with few complications, and is proposed as first line treatment of chronic tattoo reactions. Shaving of such reactions apparently has been neglected during enthusiastic introduction of laser approaches, which in the treatment of allergic tattoo reactions may be relatively contra indicated and of special risk. [ABSTRACT FROM PUBLISHER]

Background:Tattoo removal has evolved over the years and though Q-switched laser is the ‘workhorse’ laser, it invariably requires multiple sittings, which are dependent on numerous factors, including the skin colour, location of the tattoo, age of the tattoo, colour of pigment used, associated fibrosis and the kind of tattoo treated. Though ablative lasers, both pulsed CO2 and Er:YAG, have been used for recalcitrant tattoos, very few studies have been done comparing them with pigment-specific lasers. Our study was based on the premise that ablating the epidermis overlying the tattoo pigment with Er:YAG could help in gaining better access to the pigment which would enable the Q-switched laser to work effectively with less beam scattering.Objective: A study of rapid tattoo removal (RTR) technique using a combination of pulsed Er:YAG and Q-Switched Nd:YAG in a split lesion protocol.Materials and methods:This prospective study was undertaken during 2010–13 at a laser Clinic in the Maulana Azad Medical College, New Delhi. A total of 10 patients were recruited, 5 of amateur tattoo and 5 of professional tattoo. After informed consent each tattoo was arbitrarily ‘split’ into two parts. One part was treated with QS Nd:YAG laser(1064 nm) and the other part with Er:YAG laser immediately followed by the QS Nd:YAG. The laser treatments were repeated at 6-week intervals until the tattoo pigment had cleared. On the combination side in subsequent sittings only the QS Nd:YAG was used, to minimize repetitive ablation. To ensure consistency in the intervention methods a trained dermatologist who was independent of the treatment delivery randomly rated 10% of the procedures.Results:The mean improvement achieved by the Q-switched laser (2.93) was less than the combination laser (3.85) side (p =0.001) and needed more sessions (3.8 vs. 1.6;p =0.001). There was a statistically significant difference in the improvement on the combination side till the second session. On the combination side patients required a maximum of 2 sessions, while the Q-switched laser required 3–5 sessions for appreciable lightening.Conclusion:From our study it was concluded that use of a pulsed ablative laser may help in rapid removal of tattoos in conjunction with QS lasers with minimal side effects and can be used as a RTR. [ABSTRACT FROM AUTHOR]

Lasers have been widely used for tattoo removal, but the limited light penetration depth caused by high skin scattering property restricts the therapeutic outcome of deep tattoo. Skin optical clearing method, by introducing optical clearing agent (OCA) into skin, has shown some improvement in the effect of laser tattoo removal. In this study, the enhanced laser tattoo removal has been quantitatively assessed. OCA was applied to the skin of tattoo animal model and Q-switched Nd:YAG laser (1064 nm) irradiation was used to remove the tattoo. The skin evaluation instrument (Mexameter probe, MPA580) was applied to measure the content of tattoo pigment before and after laser treatment, and then the clearance rate of pigment was calculated. Further, Monte Carlo (MC) method was utilized to simulate the effect of skin optical clearing on light transmission in tattoo skin model. By comparing the pigment change of tattoo areas respectively treated with OCA plus laser and single laser, it was found that pigment clearance of the former tattoo area was increased by 1.5-fold. Further, the MC simulation verified that the reduced light scattering in skin could increase the effective dose of luminous flux reaching to the deep tattoo regions. It can be concluded from both experiment and theoretical simulations that skin optical clearing technique could improve the outcome of laser tattoo removal, which should be beneficial for clinical laser tattoo removal and other laser pigment elimination. [ABSTRACT FROM AUTHOR]

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Background: The eyebrow tattoo removal using Q-switched lasers is usually prolonged. Other modalities may be required to enhance the efficacy and shorten the treatment course. Objective: To compare the efficacy of Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser alone versus combination of Q-switched Nd:YAG and Ultrapulse CO2 lasers for eyebrow tattoo removal after a single session. Patients and methods: After local anesthesia, the right eyebrow of 20 patients was treated with Ultrapulse CO2 laser with the parameters of 4 J/cm2 and 3.2 J/cm2 for the first and the second passes. Both eyebrows were then treated with 1064-nm and 532-nm Q-switched Nd:YAG laser. The spot size and pulse duration were 3 mm and 5 nanoseconds for both wavelengths, and the fluence was 7 J/cm2 for 1064 nm and 3 J/cm 2 for 532 nm. Results: The side treated with combination of Q-switched Nd:YAG and CO2 lasers improved 75-100% in 6 of 20 patients versus only 1 of 20 in the side treated with Q-switched Nd:YAG alone. Similarly, the right side in 13 of 20 patients showed more than 50% improvement with combination therapy versus the left side (the monotherapy side), where only 6 of 20 cases showed more than 50% improvement. The Mann-Whitney test was 2.85 for the right side and 1.95 for the left side ( P value = 0.007). Conclusion: Using Ultra pulse CO2 laser enhances the efficacy of Q-switched Nd:YAG laser in eyebrow tattoo removal. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 19-year-old white man with keloidal scarring of his right shoulder due to the treatment with an intense pulsed light device marketed for tattoo removal and mentions Q-switched laser devices enhance thermal confinement of laser energy.

Tattoos are increasingly gathering attention in the young population, especially in second to fourth decade of life. With such trends, rate of its removal also has been on the rise. Treatment options for tattoo removal besides lasers are surgery, radiofrequency, infrared light, cryotherapy, dermabrasion and salabrasion. Unfortunately, none of these procedures are associated with satisfactory cosmetic results due to adverse effects such as scarring and dyspigmentation. Although laser treatment has become the gold standard for tattoo removal, it is also associated with some limitations. Some tattoo inks are resistant to laser, and multiple sessions and multiple wavelengths may be required for its complete removal. Considering these limitations, other treatment modalities for tattoo removal must be explored. This article highlights the non-laser treatment options for tattoo removal. We reviewed all published literature identified from electronic databases (MEDLINE and PubMed) till August 2021 to highlight the non-laser treatment options for tattoo removal., (© 2022 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: There is no method that can guarantee effective, quick, and noninvasive removal of tattoo dyes. Laser methods are considered to be the method of choice. In this study, an attempt was made to determine the in vitro spectral characteristics of selected dyes used in permanent makeup and tattoos and to analyze the obtained parameters in terms of laser treatments optimization., Materials and Methods: Hyperspectral analysis was performed to determine the spectral characteristics of the dye on the entire surface of the slide. Seven dyes used in permanent makeup and tattoos were analyzed in vitro. The maximum reflectance and the wavelength for a given dye were determined for the maximum reflectance in the studied wavelength range: 400-1000 nm. The optical properties of the dyes were determined based on visible light imaging using camera., Results: The maximum radiation reflectance ranges from 634 to 732 nm for the tested dyes. Visually very similar colors may differ significantly in the wavelength for which the maximum absorption of the radiation occurs. White and yellow dyes are characterized by the highest reflectance value. The black dye is characterized by the lowest reflectance coefficient. Low reflectance of black dye results in more safe and effective removal treatments., Conclusion: The homogeneity of radiation absorption can be identified using methods of analysis and processing of images in visible light. Optimization of the wavelength of which the maximum absorption/reflectance of radiation occurs may allow us to increase the effectiveness of laser treatments for removing permanent makeup and tattoos., (© 2022 The Authors. Skin Research and Technology published by John Wiley & Sons Ltd.)

The goal of this study is to describe reasons for desiring removal of unwanted tattoos and self-reported outcomes among justice-involved adults (JIA) receiving free laser tattoo removal in Southern California. Between 2016 and 2021, JIA completed voluntary anonymous surveys at baseline ( n  = 53) and follow-up ( n  = 113) visits. Descriptive analyses were generated for quantitative items. Themes were identified from open-ended questions. Patients were predominantly male (74%) and most (81%) reported tattoo-related discrimination. Adjusted multivariate analyses showed that a higher number of domains in which patients reported tattoo-related discrimination was associated with having more tattoos to remove and citing reasons for removal related to employment and stigma by association (e.g., gang membership and police interactions). At follow-up, 48% of patients felt they were treated better in their community, and nearly a quarter of patients (25%) reported greater confidence and self-esteem. JIA seek tattoo removal due to stigma and discrimination. While JIA reported diverse benefits, tattoo removal should likely be considered as one element of comprehensive programing that addresses JIA's diverse emotional, social, and economic needs. Longitudinal research is needed to clarify the long-term effects of tattoo removal for JIA.

Objectives: Sex trafficking involves the use of force, fraud, or coercion to compel another person to engage in commercial sex acts. In 2020, 16,658 individuals were identified as sex trafficking victims in the United States, with thousands more not reported. Many victims are branded by their traffickers with tattoos conveying ownership, including names, symbols, and barcodes. We have partnered with local non-profits in Houston supporting sex trafficking survivors by providing pro bono laser tattoo removal, however we believe there is a greater need at a national level to support these survivors, allowing them to reclaim their bodies., Methods: An online survey aimed at assessing the need and potential impact for pro bono branding tattoo laser removal services was distributed to United States organizations that support sex trafficking survivors., Results: Forty organizations based in the Northeast (15%), Midwest (20%), South (45%), and West (20%) responded. Organizations support on average 81 survivors annually, ranging from 3 to 600 survivors, and estimate that 47% of survivors have branding tattoos. Among survivors with branding tattoos, approximately 67% were identified at an appropriate recovery stage to undergo laser removal. On a scale of 1-10 with 10 being the most impactful on recovery, removal of branding tattoos received an average impact score of 9.2. On a scale of 1-10, with 10 being the most need, pro bono services for laser removal received an average need score of 9.1. Qualitative responses provided several insights: laser removal may be associated with enhanced healing compared to tattoo cover-up, and survivors frequently move during their recovery process thus a successful removal campaign would require a nationwide network of partnering laser surgeons., Conclusions: Approximately 1 in 2 sex trafficking survivors are estimated to have branding tattoos and the removal of these tattoos is recognized as highly impactful on recovery. We propose a philanthropic campaign which involves the American Society for Laser Medicine and Surgery (ASLMS) establishing a national directory to connect sex trafficking survivors seeking removal of branding tattoos with interested ASLMS board-certified physician members., (© 2022 Wiley Periodicals LLC.)

There are limited data about the tattoo removal process in formerly gang-involved and incarcerated people of color. This single center retrospective study was conducted on patients treated at Homeboy Industries' Ya'Stuvo Tattoo Removal Clinic between January 2016-December 2018. It reviewed data on 2,118 tattoos, and a representative sample of 502 patients was used to conduct our analysis. Treatment on 118 of the tattoos (5.57%) resulted in at least one complication (hypo-or hyper-pigmentation, keloids, or scarring). Patients who experienced tattoo removal complications (7.3%) were less likely to return to complete the removal process. More complications were experienced with higher fluences of energy, on tattoos placed by professional artists, on colored tattoos, and tattoos on clients who had a greater number of treatments. The study highlights complications and best practices in tattoo removal in people of color, a process critical to the reintegration and gang disengagement of this vulnerable population.

The tattoo removal market has boomed over the years following the increased prevalence of tattooed individuals around the world. Surgery and laser are currently the gold standards for tattoo removal. However, both of them have drawbacks. Surgery is better suited for small tattoos in areas of adequate skin laxity but leave a scar, while laser removal is a long and painful procedure, with no guarantee of a complete efficacy. Both are expensive procedures, and not all individuals are ready to fund them privately. Consequently, some individuals are in the search of faster, easier, and cheaper procedures that can be performed either by themselves or by laypeople. The unregulated market of internet provides a favorable ground for many websites to offer various tattoo removal methods. Besides, some tattooists and other non-medical laypeople have started to get interested by such a growing market, especially as some laser devices manufactured in Asia are now available at competitive prices, and due to weaknesses in the EU legislation regarding the use of lasers for cosmetic procedures by non-medical laypeople. We review here different do-it-yourself and over-the-counter tattoo removal methods. We discuss the potential risks for tattooed individuals and stress the importance of a better regulation of such a market. [ABSTRACT FROM AUTHOR]

Tattooing is a process of implantation of permanent pigment granules in the skin. Tattoos can be decorative, medical or accidental. There has been a exponential increase in decorative tattooing as a body art in teenagers and young adults. Unfortunately there are no legislations to promote safe tattooing, hence complications are quite common. Superficial and deep local infections, systemic infections, allergic reactions, photodermatitis, granulomatous reactions and lichenoid reactions may occur. Skin diseases localised on the tattooed area, such as eczema, psoriasis, lichen planus, and morphea can be occasionally seen. When used as a camouflage technique, colour mismatch and patient dissatisfaction are common complications. On the other hand, regrets after a tattoo are also seen and requests for tattoo removal are rising. Laser tattoo removal using Q-switched lasers are the safest; however, complications can occur. Acute complications include pain, blistering, crusting and pinpoint hemorrhage. Among the delayed complications pigmentary changes, hypopigmentation and hyperpigmentation, paradoxical darkening of cosmetic tattoos and allergic reactions can be seen. Another common complication is the presence of residual pigmentation or ghost images. Scarring and textural changes are potential irreversible complications. In addition, tattoo removal can be a prolonged tedious procedure, particularly with professional tattoos, which are difficult to erase as compared to amateur tattoos. Hence the adage, stop and think before you ink holds very much true in the present scenario. [ABSTRACT FROM AUTHOR]

Q switched lasers are the current gold standard for laser tattoo removal. Though these systems are generally quite effective in clearing tattoos & have an established safety record, certain limitations exist while following the standard protocol. To overcome these limitation newer techniques such as multipass method, combination treatments with chemical agent and other laser have been introduced. These methods help in faster, less painful and complication free tattoo removal. [ABSTRACT FROM AUTHOR]

Lasers are the standard modality for tattoo removal. Though there are various factors that determine the results, we have divided them into three logical headings, laser dependant factors such as type of laser and beam modifications, tattoo dependent factors like size and depth, colour of pigment and lastly host dependent factors, which includes primarily the presence of a robust immune response. Modifications in the existing techniques may help in better clinical outcome with minimal risk of complications. This article provides an insight into some of these techniques along with a detailed account of the factors involved in tattoo removal. [ABSTRACT FROM AUTHOR]