Removal of tattoos by q-switched laser: variables influencing outcome and sequelae in a large cohort of treated patients.

OBJECTIVE To analyze variables affecting the treatment course and prognosis of Q-switched laser tattoo removal. DESIGN Observational prospective cohort study. SETTING The study was carried out in a referral center for surgery and laser surgery in Milan. PARTICIPANTS Of 397 consecutive patients initially enrolled from January 1, 1995, to December 31, 2010, 352 patients (201 men and 151 women; median age, 30 years) were included in the analysis. INTERVENTION All patients were treated by the same investigator with Q-switched 1064/532-nm Nd:YAG laser and Q-switched 755-nm alexandrite laser according to tattoo colors. Laser sessions were scheduled at 6-week or longer intervals. MAIN OUTCOME MEASURES Successful therapy was defined as removal of the tattoo, with no adverse effects other than transient hypochromia or darkening. RESULTS The cumulative rates of patients with successful tattoo removal were 47.2% (95% CI, 41.8%-52.5%) after 10 sessions and 74.8% (95% CI, 68.9%-80.7%) after 15 sessions. Smoking, the presence of colors other than black and red, a tattoo larger than 30 cm2, a tattoo located on the feet or legs or older than 36 months, high color density, treatment intervals of 8 weeks or less, and development of a darkening phenomenon were associated with a reduced clinical response to treatment. CONCLUSIONS To our knowledge, this study is the first to formally assess prognostic factors for effective tattoo removal by Q-switched laser. Several variables influence response rates and should be considered when planning tattoo removal treatments.