Treatment of cosmetic tattoos using carbon dioxide ablative fractional resurfacing in an animal model: A novel method confirmed histopathologically

Background Treating cosmetic tattoos using quality-switched lasers is difficult. Objective 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. Methods and Materials 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. Results 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. Conclusion CO₂ AFR successfully removes cosmetic tattoos.