Removal of Artistic and Cosmetic Tattoos Using Q-Switched Nd:YAG Laser

Background: Q-switched 1064/532-nm Nd:YAG laser therapy for tattoo removal is common but yields variable results across patients and tattoos. Identifying factors related to poor clearance in clinical practice may be more valuable than simply describing overall efficacy. Methods: A multicenter retrospective analysis was conducted among 111 adult participants who received artistic/cosmetic tattoo removal using a 1064/532-nm Q-switched Nd:YAG protocol. Retreatment tattoos were included in the main cohort, while resistant tattoos could be combined with an additional fractional CO₂ procedure during the same treatment session. The proportion of patients receiving adjunctive fractional CO₂ rescue treatment was recorded, and a sensitivity analysis was performed after excluding these patients. All participants received 1–8 sessions (average ± SD, 2.5 ± 1.55 sessions). Percentage clearance, assessed by independent blinded physicians using standardized pre- and post-treatment photographs, served as the dependent variable. Associations between clearance and different patient-, tattoo-, and treatment-related parameters were evaluated in both univariable and multivariable linear regression models. Adverse events were analyzed descriptively. Results: Average photographic clearance was 64.1% ± 18.1%. After controlling for confounders, tattoo localization on the trunk (+16.3%, p < 0.001) and face/neck (+16.1%, p = 0.002) was associated with higher clearance, while smaller size was observed for tattoos on the trunk, but not face/neck and limbs. Most patients (88.3%) did not experience any adverse events; those that occurred were rare and mostly included inflammatory hyperpigmentation, prolonged erythema, hypopigmentation, and scar formation. Conclusion: Q-switched Nd:YAG laser-centered tattoo removal treatment provided effective photo-clearance accompanied by minor adverse events. Anatomic location was found to be the factor with the greatest impact on treatment effectiveness, as limb tattoos had lower clearance than those on the trunk and face/neck.