title: Combination of CO2 and Q-switched Nd:YAG lasers is more effective than Q-switched Nd:YAG laser alone for eyebrow tattoo removal.
abstract: BACKGROUND
  The eyebrow tattoo removal using Q-switched lasers is usually prolonged. Other modalities may be required to enhance the efficacy and shorten the treatment course.
  
  
  OBJECTIVE
  To compare the efficacy of Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser alone versus combination of Q-switched Nd:YAG and Ultrapulse CO2 lasers for eyebrow tattoo removal after a single session.
  
  
  METHODS
  After local anesthesia, the right eyebrow of 20 patients was treated with Ultrapulse CO2 laser with the parameters of 4 J/cm(2) and 3.2 J/cm(2) for the first and the second passes. Both eyebrows were then treated with 1064-nm and 532-nm Q-switched Nd:YAG laser. The spot size and pulse duration were 3 mm and 5 nanoseconds for both wavelengths, and the fluence was 7 J/cm(2) for 1064 nm and 3 J/cm (2) for 532 nm.
  
  
  RESULTS
  The side treated with combination of Q-switched Nd:YAG and CO2 lasers improved 75-100% in 6 of 20 patients versus only 1 of 20 in the side treated with Q-switched Nd:YAG alone. Similarly, the right side in 13 of 20 patients showed more than 50% improvement with combination therapy versus the left side (the monotherapy side), where only 6 of 20 cases showed more than 50% improvement. The Mann-Whitney test was 2.85 for the right side and 1.95 for the left side (P value = 0.007).
  
  
  CONCLUSIONS
  Using Ultra pulse CO2 laser enhances the efficacy of Q-switched Nd:YAG laser in eyebrow tattoo removal.
authors.affiliation: Department of Dermatology, Ahvaz Jundishapur University of Medical Sciences , Ahvaz , Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Radmanesh
authors.forename: Zohreh
authors.initials: Z
authors.lastname: Rafiei
mesh_terms: D000328:Adult; D003357:Cosmetic Techniques / Q000009:adverse effects / Q000295:instrumentation*; D005138:Eyebrows; D005260:Female; D006801:Humans; D054020:Lasers, Gas / Q000009:adverse effects / Q000627:therapeutic use*; D053844:Lasers, Solid-State / Q000009:adverse effects / Q000627:therapeutic use*; D028022:Low-Level Light Therapy / Q000009:adverse effects / Q000295:instrumentation*; D008875:Middle Aged; D013653:Tattooing
keywords: CO2 laser; Q-switched Nd:YAG Laser; eyebrow tattoo; tattoo removal