Treatment of Cosmetic Tattoos Using Carbon Dioxide Ablative Fractional Resurfacing in an Animal Model: A Novel Method Confirmed Histopathologically

Treating cosmetic tattoos using quality-switched lasers is difficult.We used carbon dioxide ablative fractional resurfacing (CO2 AFR) to remove cosmetic tattoos and examined the pathophysiologic mechanisms involved in this technique in an animal model.Twelve rats were tattooed on their backs with white and flesh-colored pigments. Half of each tattoo was treated with CO2 AFR (5 sessions at 1-month intervals), and the other half was the untreated control. An independent observer reviewed photographic documentation of clinical response. Serial skin samples obtained at baseline and at various times after laser treatment were evaluated using histologic and immunohistochemical methods.Four rats had excellent responses to laser treatment and eight had good responses. White and flesh-colored tattoos had similar clearance rates and tissue reactions. Histologic analysis showed immediate ablation of tattoo pigments in the microscopic ablation zones. Tattoo pigments in the microscopic coagulation zones migrated to the epidermis and became part of the microscopic exudative necrotic debris appearing on day 2 that was exfoliated after 5 days. Increased fibronectin expression around the microscopic treatment zones during the extrusion of tattoo pigments indicated that wound healing facilitates this action.CO2 AFR successfully removes cosmetic tattoos.