title: Multiple color changes following laser therapy of cosmetic tattoos.
abstract: OBJECTIVE
  To emphasize the wisdom of small test areas when treating cosmetic tattoos and the need for multiple laser systems.
  
  
  METHODS
  A 48-year-old woman requested removal of permanent makeup (cosmetic tattoos) of her eyebrows and around her lips. Physical examination revealed a brown tattoo of both eyebrows and dark red lip liner around both lips. A test area was performed on the red tattoo of the lips. A frequency-doubled Nd:YAG laser (532 nm, 2.0 J/cm2, 2 mm spot size) was used for the lip area, while the same laser at 1064 nm, 3.9 J cm2, 2 mm spot size was utilized for the eyebrows. The lip area immediately turned black. The patient returned for follow-up 1 month later; the black ink on the lip was treated with the same laser at 1064 nm, 3 mm spot size, 4.2 J/cm2, with satisfactory resolution in two monthly treatments. Both brown eyebrow turned bright orange and were treated with 532 nm, 3 mm, 3.0 J/cm2. One month later the eyebrows were a mixture of yellow ink and dark green. The yellow area was treated with 532 nm, 3 mm, 2.3 J/cm2, while the dark green was treated with the 1064 nm, 3 mm spot size, 4.2 J/cm2. One month later little improvement was noted, so Q-switched ruby laser at 694 nm, 6 mm spot size, 16 J/cm2 was utilized. An additional four monthly treatments were given utilizing a combination of both ruby and 532 nm ND:YAG lasers for green and yellow pigment, respectively.
  
  
  RESULTS
  Significant but incomplete resolution of the tattoo ink was achieved.
  
  
  CONCLUSIONS
  Multiple laser systems are needed to remove cosmetic tattoos. Test areas must be done before treatment.
authors.affiliation: Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida 33136, USA.
authors.forename: Gloria
authors.initials: G
authors.lastname: Jimenez
authors.forename: Eduardo
authors.initials: E
authors.lastname: Weiss
authors.forename: James M
authors.initials: JM
authors.lastname: Spencer
mesh_terms: D005138:Eyebrows; D005260:Female; D006801:Humans; D008046:Lip; D028022:Low-Level Light Therapy; D008875:Middle Aged; D010860:Pigments, Biological / Q000528:radiation effects*; D013653:Tattooing / Q000009:adverse effects*
chemical_list: D010860:Pigments, Biological