Laser Treatment of Tattoos: Basic Principles.

Tattooing has become very popular worldwide during the past decades, and millions of people have one or many tattoos at different anatomical sites. The color of tattoos is mainly black, followed by red, green, blue, and other colors. A part of the tattooed people regret tattooing or have permanent problems with tattoos and therefore seek for tattoo removal. Tattoos consist of solid pigment particles in the skin. Thus, tattoo removal requires fragmentation of these permanently incorporated particles. The gold standard of tattoo removal is laser therapy. Short light pulses at high intensities are applied to the tattooed skin surface. The laser light penetrates the skin and is selectively absorbed in the pigment particles. The absorbed laser light leads to heat-up and fragmentation of the particles. Due to the complex chemistry of the various tattoo pigments, the efficacy of this fragmentation process is frequently unpredictable. Due to the short and intense pulses, nonlinear effects of light and thermal properties of tattoo particles may play a role, and the assumptions of selective photothermolysis may not reflect the real process of tattoo particle fragmentation as a whole. In case fragmentation occurs, the concentration of pigment particles in the skin decreases, yielding a fading of the tattoo color in the skin. Laser therapy is most effective in black tattoos and less effective for colored tattoos. The rate of side effects is low due to the selectivity of the treatment. Laser light may change the chemistry of the tattoo pigments and hence provoke toxic decomposition products.