Acoustic Shock Waves Associated with Lasers to Accelerate Tattoo Removal Procedures: A Real-World Study

Background: The combination of lasers and acoustic shock waves has shown promising results in accelerating tattoo removal. Objective: To assess the effectiveness of treatments combining lasers and shock waves regarding the number of sessions required for successful tattoo removal. Methods: A prospective, observational, real-world, single-center study including adults (>18 years) with ≥one professional tattoo of any color on any body part, excluding the head, partially removed or not. Devices were the QS laser RevLite® SI (Cynosure Lutronic, USA), the picosecond laser PicoWay® (Candela, USA), the CO 2 laser DUOGlide® with a SCAR 3 scanner (DEKA M.E.L.A. srl, Italy), and the GENTLE Pro® shock waves system (Zimmer MedizinSysteme GmbH, Germany). Treatment protocols consisted of QS/picosecond laser passes alternated with shock wave passes (three each) (classic protocol) and one QS/picosecond laser and one shock wave pass, a QS/picosecond second laser pass, and a final fractional CO 2 laser pass (reinforced protocol). Sessions were performed at two-month intervals. Results: We included 22 patients (68.2% women and 68.2% Fitzpatrick phototype III) with a mean (range) age of 42 (22–68) years and 25 tattoos in total. Most tattoos were black (92.0%) and were removed using the picosecond laser (80.0%) and following the classic (40.0%) and the reinforced (60.0%) protocols in a total of 66 treatment sessions. In 22 tattoos undergoing more than one session, results were good or excellent in 68.2% of them after 2–4 sessions, with no adverse effects. Conclusion: Acoustic shock wave therapy constitutes a safe adjuvant treatment to accelerate laser-based tattoo removal.