title: Tattoo removal by Q-switched yttrium aluminium garnet laser: client satisfaction.
abstract: BACKGROUND
  Tattoo removal by Q-switched yttrium aluminium garnet (YAG) lasers is golden standard; however, clients' satisfaction with treatment is little known.
  
  
  OBJECTIVE
  To determine clients' satisfaction with tattoo removal.
  
  
  METHODS
  One hundred and fifty-four tattoo removal clients who had attended the private clinic 'Centre for Laser Surgery', Hellerup, Denmark, from 2001 to 2013 completed a questionnaire concerning outcome expectations, level of pain experiences and satisfaction with tattoo removal. The laser surgeon and his team were blinded from data handling. The study design included a minimum 2-year postlaser treatment observation period from 2013 to 2015.
  
  
  RESULTS
  Overall, clients were satisfied with their laser treatment; 85% assessed their treatment and results to be acceptable to superb, while 15% assessed their treatment and results to be inferior to unacceptable. Effectiveness relative to colour of tattoo on a scale from 0 (no effect) to 10 (complete removal) scored a mean of blue 9.5, black 9.4, yellow 8.9, red 8.8 and green 6.5. Clients were dissatisfied with green pigment remnants, which could mimic bruising. One hundred and twenty-nine clients (84%) experienced moderate to extreme pain during treatment. Twenty-eight (20%) developed minor scarring. There were many reasons for tattoo removal; e.g. stigmatisation (33%), conspicuousness (29%) and poor artistic quality (22%). One hundred and two clients had expected complete removal of tattoos without a blemish, expectations that were only partly fulfilled. During the treatment period, clients adjusted expectations and adapted more realistic views of outcomes.
  
  
  CONCLUSIONS
  The majority of clients were satisfied with Q-switched YAG laser removal of tattoos despite high pretreatment expectations which were only partly met. The study supports YAG lasers for tattoo removal as acceptable therapy of today, with room for new approaches.
authors.affiliation: Department of Dermatology, The "Tattoo Clinic", Bispebjerg University Hospital, Copenhagen, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Hutton Carlsen
authors.affiliation: Department of Laser Surgery, Centre for Laser Surgery, Hellerup, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Esmann
authors.affiliation: Department of Dermatology, The "Tattoo Clinic", Bispebjerg University Hospital, Copenhagen, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Serup
mesh_terms: D000293:Adolescent; D000328:Adult; D003718:Denmark; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013653:Tattooing; D055815:Young Adult