Laser Tattoo Removal in Dark Skin Types

The principal of tattoo removal is destruction of unwanted pigment with minimal collateral damage. This concept is particularly challenging when treating darker skin types as the melanosomes act as competing targets with thc potential to cause epidermal damage. The 1,064-nm wavelength has the least absorption by melanoclyles and is therefore the host choice for laser tattoo removal in darker skin types. There is less risk for hypopigmentation, scarring or textural change. However, the 1,0644-nm wavelength will not treat all tattoo colors. Therefore, one must employ alternate methods for multicolored or densely colored tattoos in dark skin types.

Fractional ablation of tattoos in dark skin types will allow extraction of tattoo pigment particles with minimal risk of scarring or pigmentary change. This concept is particularly useful in dark skin types with in a patient that has demonstrated allergic reaction to the tattoo pigment. For instance, red pigment is the most common known tattoo allergen and can result in a granulomatous reaction. If targeted with a 532-nm wavelength for removal, the pigment can shatter into many smaller particles followed by uptake systemically with the potential for anaphylaxis. To avoid this issue, fractional CO₂ laser can be used for sloughing of the pigment through epidermal loss with limited systemic elimination. Non-fractional CO₂ laser has limited use in this circumstance as it has significant potential to permanently depigment or scar the skin. This was the case in the patient show below:

a) Noted depigmentation after CO2 laser treatment for tattoo removal

b) Noted depigmentation of prior treated area, accomplished with fractional CO2 laser treatment

Benefits of the Use of Q-Switched Lasers for Tattoo Removal

It is well established that the Q-switched lasers are the gold standard in lasers to remove tattoos. Four wavelenghts are now available with Q-switching: frequency-doubled Nd:YAG at 532 nm (5-10 ns), ruby at 694 nm (25-40 ns), alexandrite: at 755 11m (50-100 ns), and Nd:YAG at 1,064 nm (5-10 ns). Comparative studies of the four Q-switched lasers have been reported. Though ruby, alexandrite, and Nd:YAG at 1,064 nm are all effective in dark tattoos, the ruby and the alexandrite have been reported to be somewhat more efficient than Nd:YAG. It is generally thought that Nd:YAG at 1,064 nm may be preferable in darker skin types due to its lower absorption by melanin and its greater tissue penetration. However, a study of Q-switched ruby and Nd:YAG lasers used in treating carbon based tattoos in Fitzpatrick V-VI patients showed mild transient hyperpigmentation with both lasers and mild texture changes with the Q-switched Nd:YAG laser. The alexandrite is most effective in treating blue and green tattoos and the frequency-doubled Nd:YAG may be effective in red tattoos, though the removal of red tattoos in general is challenging due to lack of appropriately selective wavelengths that are not absorbed by endogenous chromophores.

Before (a) and after (b) 5 laser treatments with QS-YAG 1,064 nm.

	Tattoo colors	Pulse duration (ns)	Wavelength (nm)	Q-switched lasers
	Red	510	532	Nd:YAG
	Black, blue, green	25-40	694	ruby
	Black, blue, green	50-100	755	alexandrite
	Black, blue	510	1064	frequency-doubled Nd:YAG

Blue-black carbon-based amateur tattoos respond best, requiring on the order of 5 sessions of Q-switched ruby, alexandrite, or Nd:YAG at 1,064 nm. In contrast, professional tattoos containing greater pigment density could require 10-15 sessions. Traumatic tattoos, such as gravel particles can also be treated, though their response is less predictable due to the heterogeneous nature of the impacted particles. Caution must be taken with traumatic tattoos induced by gunpowder or fireworks, as the laser impact can cause microexplusions and provoke pox-like scars.

Angelina Jolie Tattoo Removal Before and After Pictures

Actress Angelina Jolie is seen here in 2001 alongside her then husband Billy Bob Thornton, whose first name she had tattooed on her arm.

Jolie and Thornton marriage did not last. After they divorced, Jolie had his name removed from her tattoo, as seen here.

By 2010, Jolie had decided to remove her entire old tattoos and get a new one. The new tattoo lists the latitudes and longitudes of the birthplaces of her children. The old dragon tattoo is still barely visible beneath the new tattoo.