A form of body art, tattooing, is the permanent pigmentation of skin that results from the introduction of exogenous substances.1 The Tahitian word ‘tatau’ meaning ‘to mark something’ is one of the etymological origins derived from tattooing.1 Tattoos can hold significant cultural meaning in certain societies within a specific social context. Subsequently, the art of tattooing among Ethiopian Christian women is well documented with tattoos predominately on their forehead, facial, and other bodily regions.2 Of significance, Ethiopian Jews who converted to Christianity engaged in these tribal carbon-based amateur tattoos so as to assimilate for fear of persecution.2 However, upon arrival to Israel, these distinctive tattoo markings have been socially and culturally problematic to this unique population, requiring removal by means of laser therapy. Removal of tattoos from dark skin patients is consider to be more problematic as the melanin pigment can compete with the tattoo and therefore, hypo and hyperpigmentation may occur.3 Subsequently, Q-switched neodymium:YAG (Nd:YAG) lasers are reported to be gold standard for laser tattoo removal. In particular, the Q-switched Nd:YAG laser at 1064 nm is widely recognized for the removal of blue/black carbon-based amateur tattoos.4 Therefore, in this case series, we present the use of the Q-Switched Nd:YAG laser as an effective and safe method for the removal of 45 carbon-based amateur tattoos in 25 patients with Fitzpatrick Type VI skin.
Study Sample Twenty-five patients with Fitzpatrick type VI skin from Ethiopian origins with facial amateur tattoos were included in this case series. Apart from one male patient, the study population was mostly women. The age of the patients ranged from 18 to 53 years with an average age of 21.3 years. Verbal and written informed consent for treatment and the use of digital images5 were obtained prior to treatment. All tattoos were black/blue tribal charcoal tattoos that were introduced into the skin by a hot needle during childhood. Usually, the tattoos are made by a family or tribal member during early childhood between the ages of ve to eight years, and the technique of injection is not uniform in all patients. The tattoos were drawn over the face and neck including the forehead, temples, cheeks, mandible angle, nose, and chin (Table 1) however, upper and lower limbs are also anatomical regions where these tribal tattoos are often also seen. The facial tattoos were composed of lines, spherical symbols and cross shapes.