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Comparison of Two Q‐Switched Lasers and a Short‐Pulse Erbium‐Doped Yttrium Aluminum Garnet Laser for Treatment of Cosmetic Tattoos Containing Titanium and Iron in an Animal Model

BACKGROUND Cosmetic tattoos contain titanium and ferric oxide and darken through reduction after Q‐switched laser irradiation. The optimal treatment for removing these pigments remains unknown. OBJECTIVE To compare the effects of two Q‐switched lasers and a short‐pulse erbium‐doped yttrium aluminum garnet (SP Er:YAG) laser to remove cosmetic tattoos in an animal model. MATERIALS AND METHODS Rats were tattooed using white, flesh‐colored, and brown inks (4 bands of each color) on their backs. For each color, one band was left untreated, and one each was treated with a Q‐switched neodymium‐doped YAG laser, a Q‐switched alexandrite laser, and a SP Er:YAG laser every 3 weeks until the pigments were clear. RESULTS The two Q‐switched lasers were equally effective; all three pigments darkened initially and then resolved gradually. Up to 20, 18, and 10 sessions were required to remove white, flesh‐colored, and brown tattoos, respectively. Only six sessions were required with the SP Er:YAG laser. Minimal scarring was observed with all lasers. Skin biopsies confirmed pigment granule fragmentation after Q‐switched laser treatment and a decrease in the amount of pigment after SP Er:YAG laser treatment. CONCLUSION The SP Er:YAG laser was superior to the Q‐switched lasers for removing cosmetic tattoos. The authors have indicated no significant interest with commercial supporters.