Continuous-wave lasers used a high energy beam that ablated the target area and destroyed surrounding tissue structures as well as tattoo ink.

[6][1][7] Many other methods for removing tattoos have been suggested historically, including the injection or application of tannic acid, lemon juice, garlic, and pigeon dung.

[16] Celebrities that have had these kinds of tattoos removed include Angelina Jolie, Eva Longoria, Marc Anthony, and Denise Richards.

A tattoo laser must be capable of emitting adequate energy within the given absorption spectrum of the pigment to provide an effective treatment.

[citation needed] The energy density (fluence), expressed as joules/cm2, is determined prior to each treatment as well as the spot size and repetition rate (hertz).

[29][6][30][2] In the early 1980s, a new clinical study began in Canniesburn Hospital's Burns and Plastic Surgery Unit, in Glasgow, Scotland, into the effects of Q-switched ruby laser energy on blue/black tattoos.

[32] Research at the University of Strathclyde, Glasgow also showed that there was no detectable mutagenicity in tissues following irradiation with the Q-switched ruby laser.

[35][36] One of the first American published articles describing laser tattoo removal was authored by a group at Massachusetts General Hospital in 1990.

Q-switched lasers produce bursts of infrared light at specific frequencies that target a particular spectrum of color in the tattoo ink.

[39] However, unlike treatments for blood vessels or hair, the mechanism required to shatter tattoo particles uses the photomechanical effect.

The surface temperature of the ink particles can rise to thousands of degrees but this energy profile rapidly collapses into a shock wave.

As tattoos fade clinicians may recommend that patients wait many months between treatments to facilitate ink resolution and minimize unwanted side effects.

Some have postulated that the reason for slow resolution of green ink in particular is due to its significantly smaller molecular size relative to the other colors.

One small Greek study showed that the R20 method—four passes with the laser, twenty minutes apart—caused more breaking up of the ink than the conventional method without more scarring or adverse effects.

The combination of the patch and liquid reduce the epidermal scatter, which can limit the predicted side effects typically seen in aggressive laser tattoo removal treatments (hyper and hypopigmentation, blistering, etc.).

[51] Additionally, the liquid reduces the laser frosting very quickly, allowing for faster re-treatment, limiting the time of treatment while still improving efficacy.

Early studies have been performed to indicate improved clearance with the use of this patch in 3-4 passes, in a single session, utilizing more energy than typically allowable with a traditional treatment methodology.

[52] All these physical properties of the patch work to substantially reduce the total number of laser treatments required for ink clearance.

Early studies have shown anecdotally that there isn't necessarily increased risks with Fitzpatrick Skin Types IV-VI, though still not FDA cleared as an indication.

Pre-treatment might include the application of an anesthetic cream under occlusion for 45 to 90 minutes or cooling by ice or cold air prior to the laser treatment session.

This white color change is thought to be the result of rapid, heat-formed steam or gas, causing dermal and epidermal vacuolization.

Pinpoint bleeding represents vascular injury from photoacoustic waves created by the laser's interaction with tattoo pigment.

Fading of the tattoo will be noted over the next eight weeks and re-treatment energy levels can be tailored depending on the clinical response observed.

[58] About half of the patients treated with Q-switched lasers for tattoo removal will show some transient changes in the normal skin pigmentation.

Treatment consists of strict sunlight avoidance, sunscreen, interlesional steroid injections, or in some cases, surgical removal.

Unlike the destructive modalities described, Q-switched lasers mobilize the ink and may generate a systemic allergic response.

With the mechanical or salabrasion method of tattoo removal, the incidence of scarring, pigmentary alteration (hyper- and hypopigmentation), and ink retention are extremely high.

However, if patients follow post care directions to elevate, rest, and apply intermittent icing, it should minimize the chances of bulla and other adverse effects.

While the infrequent bulla development is a possible side effect of Q-switched laser tattoo removal, if treated appropriately and quickly by the health care practitioner, it is unlikely that long term consequences would ensue.

[65] When these pigments are broken down via laser pyrolysis, the potential release of aromatic amine rings, a known carcinogen,[66] into the body, could occur.