Q-Switched Lasers, a Dermatologist’s Gold Standard for Tattoo Removal

(edited from the skintherapyletter.com article: The Use of Lasers for Decorative Tattoo Removal)

Tired of your tattoo? You are not alone, a significant amount of people who get tattoos go on to regret getting them later in life.

Some options for removal include surgical excision, skin abrasion techniques such as dermabrasion or salabrasion, but laser treatments offer the best results. Currently, Q-switched lasers are the gold standard used by practitioners.

Q-switched Lasers: Overview and Options

Tattoos consist of small particles of pigment (ink) situated in the dermis of the skin. With laser removal, tattoo pigment particles can be selectively destroyed without harming the surrounding tissue by means of selective photothermolysis (targeting of specific tissue with light.) Lasers emit intense pulses of light that pass through the upper layers of skin and specifically target the tattoo pigments by breaking them up into smaller particles, which are then carried away by scavenger cells of the body’s immune system.

High intensity, ultra-short pulse durations are provided only by a special laser technique known as “Q-switching”. At present, there are 4 different types of Q-switched lasers that are employed successfully in tattoo removal: Ruby, 532 nm Nd:YAG, 1064 nm Nd:YAG and the Alexandrite laser.

Ruby Laser
The Ruby laser creates a red light, which is highly effective for the removal of black, blue, and green inks. Because this wavelength is well absorbed by melanin, caution should be used, as injury to melanocytes can lead to loss of skin color as well as textural change. When compared to the other Q-switched lasers, the Ruby was shown to have the highest clearing rate after four and six treatments of blue-black tattoos.

Nd:YAG 532nm Laser
The 532nm laser creates a green light, which is effective for absorbing red, orange, and occasionally yellow ink. In 63% of red tattoos, a 75% clearance was achieved after one to five treatments. The 532nm wavelength (green light) is absorbed by hemoglobin, and as a result, purple skin discolorations on the skin lasting 1 week to 10 days frequently can occur after treatment. Some reports have detailed the paradoxical darkening of red tattoo pigment as well as other skin-toned, yellow, and pink tattoos.

Nd:YAG 1064nm Laser
The 1064nm wavelength has the deepest penetration and carries the least risk of loss of skin color, however, it is also the least effective in removing brightly colored pigments. Of all the laser systems, it is the one that is recommended for use in darker skin types. This wavelength may also be useful when residual, more deeply placed ink particles are all that remain, as well as in the treatment of eyeliner tattoos, because it is less likely to damage the hair follicle.

Alexandrite Laser
Similar to the Ruby, the Alexandrite creates red light that is suited for removing green, black and blue inks. However, the color of the Alexandrite’s light is slightly less absorbed by melanin, so there is a decreased chance of unwanted pigmentary changes compared to the ruby laser. Although this laser system has the least amount of tissue splatter, it is not as successful as the other models.


It is important to be aware of the risks involved with each of these procedures. Common risks include:

  • Scarring: Happens in less than 5% of patients and typically occurs on areas of the body such as the chest, outer upper arms, and ankles.
  • Pruritus (Itchy Skin): Itching and discomfort can be significant in the healing phase and minimized with topical corticosteroids.
  • Cobblestone texture: Seen within 2 weeks of treatment, is a sign of initial scarring, and is frequently reversed with the application of Class I topical steroids.
  • Hyperpigmentation and hypopigmentation: Can vary depending on skin phototype and is usually minimized with the 1064nm wavelength. If hyperpigmentation occurs, postoperative use of hydroquinone-containing compounds and UVA/UVB sun block can be beneficial, as can the avoidance of sun exposure.
  • Allergic reaction: Pre-existing allergic reactions can worsen after laser treatment resulting in urticaria, or a systemic allergic reaction. In these cases, Q-switched laser treatment should be used with extreme caution. It is best to either use an ablative CO2 laser or Nd:YAG to vaporize the tattoo or proceed with caution, cover with systemic corticosteroids, and consult an allergist before embarking on treatment.
  • Immediate pigment darkening: Frequently occurs in white, pink or skin-toned tattoos. Appropriate patient education should be provided prior to treatment of any at-risk tattoo. If and when darkening occurs, two treatment options remain: The tattoo can be excised or ablated, or multiple additional Q-switched laser treatments can be performed to eliminate the darker pigment. The best way to anticipate such darkening is to treat a test spot and evaluate after initial skin whitening has faded.



Treatment success is also technique dependent, so do your homework and find a professional with extensive expertise in tattoo removal. The downside to laser therapy is that the cost is often expensive and the multiple treatment sessions can be very painful for some.

Depending on the tattoo, you will need several treatment sessions spaced at four to eight-week intervals. People with lighter skin tend to experience better results.

Other factors that determine the effectiveness of laser therapy include colors in the tattoo (blue-black is easiest to remove, whereas lighter or brighter colors are more difficult); the location, depth and age of the tattoo also influence the outcome.

While no single laser system holds the answer for tattoo removal, Q-switched lasers can successfully fade most tattoos with minimal adverse effects.