In the middle of the last century still as a stigma of sailors, criminals or fringe groups verschrannt, tattoos are now an integral part of fashion and pop culture. In the course of destigmatizing body art and its popularity among celebrities, there has also been a steady increase in the number of tattooed people in the general population over the past decades. Current data indicate the proportion of tattooed people in the German population at nine to twelve percent.

Interestingly, the proportion of tattooed in the age group of 25 to 34 years, the “Generation Tattoo”, is already over twenty percent. Motivation for getting a tattoo? The most common reason is the desire for an individual statement, followed by the memory of a special person or a fashionable self-realization. Between five and twenty percent regret their tattoo, an estimated ten percent would have their tattoo removed again. With approx. six million tattooed in Germany that corresponds thus to a potential market of 60,000 customers – with approximately 540 million tattooed persons world-wide still a comparatively small number. Germany is still running behind the international trend here – a further increase in demand is to be expected.  The ban on laser tattoo removal by medical laypersons should also be reflected promptly by a dynamic increase in demand for corresponding services in medical laser practice.

Goldstandard of scarless tattoo removal is treatment by QS laser systems. The principle of laser tattoo removal is selective photothermolysis. The laser emits an extremely short pulse in the nanosecond or picosecond range, which heats the tattoo pigment to an extremely high temperature in a fraction of a second, shatters it through the so-called photoacoustic effect and releases it from its cellular encapsulations. Pigment particles are then transported away via the immune system or discharged epidermally. After a break of four to twelve weeks, the next laser session can then take place. For the complete removal of a tattoo stung professionally, i.e. by means of a tattoo machine, an estimated ten to fifteen or often more sessions are required. The process of removal is therefore connected with a considerable time and usually financial effort. The active principle of selective photothermolysis also means that different wavelengths and consequently different laser systems are required for different tattoo colors, such as 1,064 nm for blue or black but 532 nm for red. Some colors – especially light colors – can only be removed very poorly or not at all, according to the current state of the art.

Compared to laser, any alternative technique for tattoo removal is inferior or even hazardous to health. Surgical removal using a scalpel or diamond burr (dermabrasion) is effective and often allows removal in a single or a few sessions (e.g. serial or multi-stage excision), but is always accompanied by scarring. On the other hand, the injection of lactic acid, salabrasion or comparable procedures, which are usually advertised by non-medical providers or can be ordered on the Internet for self-application, are not recommended. The risk of serious complications such as burns, ulcerations, infections, scarring or keliod formation is incalculable here. The Federal Institute for Risk Assessment (BfR) also warns in detail in this context and reports on reports of poisoning in accordance with Section 16e of the Chemicals Act.

Beyond the mere removal of tattoos, the pigment laser is also used for the gentle removal of benign pigment lesions (lentigines solares, lentigines seniles, seborrheic keratoses, etc.). In our practice, for example, this is a much more popular indication compared to tattoo removal. In addition, modern picosecond systems offer the possibility of scar treatment or rejuvenation via so-called focus lenses: the picosecond pulse generates micro-injuries in the dermal compartment, so-called Laser-Induced Optical Breakdowns (LIOBs), which then trigger wound healing processes and thus improve the skin or scar quality.

Taken together, then, tattoo or pigment lasers represent a basic investment for modern laser practice, capable of serving not only the increasing demand for tattoo removal but also a wide range of other indications from the removal of benign pigment lesions to skin quality improvement and rejuvenation. Current legal innovations should also noticeably increase the demand for qualified medical providers in the near future.