The Q-switched neodymium: YAG laser and tattoos: a microscopic analysis of laser-tattoo interactions

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Abstract
The Nd:YAG laser effectively removes or lightens amateur and professional tattoos. The biomechanics of the removal of tattoo particles at the cellular level are incompletely understood. We examined biopsies obtained from 35 amateur and professional tattoos (including coloured tattoos), treated on three or more occasions with the Nd:YAG laser. Biopsies taken immediately after laser treatment showed vacuolation with complete clearance of tattoo particles in the most superficial layers of the dermis, as assessed by light and electron microscopy. We propose that the 'disappearance' of the tattoo particle arises from the formation of atomic species and gaseous products, which are rapidly dissolved in the extracellular fluid. Residual fragmented particles that are commonly found in the mid- and lower dermis are rephagocytosed. The interaction between the Nd:YAG laser and black tattoo particles at 1064 nm, and red tattoo particles at 532 nm, appears to be specific, as there was little evidence of thermal damage to adjacent cells or stromal collagen.