laser tattoo removal, this duration should be on the order of nanoseconds. Sufficient energy must be delivered during each laser pulse to heat the pigment to fragmentation. If the energy is too low, the pigment will not fragment and no removal will take place. Q-switched lasers are the only commercially available devices that can meet these requirements. Although they occur infrequently, mucosal tattoos can be successfully treated with Q-switched lasers as well. A novel method for laser tattoo removal using a fractionated or Er:YAG laser, alone or in combination with Q-switched lasers, was reported by Ibrahimic and coworkers from the Wellman Center of Photomedicine at the Massachusetts General Hospital in 2011. This new approach to laser tattoo removal may afford the ability to remove colors such as yellow and white, which have proven to be resistant to traditional Q-switched laser therapy. Laser parameters that affect results Several colors of laser light (quantified by the laser wavelength) are used for tattoo removal, from visible light to near-infrared radiation. Different lasers are better for different tattoo colors. Consequently, multi-color tattoo removal almost always requires the use of two or more laser wavelengths. Tattoo removal lasers are usually identified by the lasing medium used to create the wavelength (measured in nanometers (nm)): Q-switched Frequency-doubled Nd: YAG: 532 nm. This laser creates a green light which is highly absorbed by red, yellow, and orange targets. Useful primarily for red and orange tattoo pigments, this wavelength is also highly absorbed by melanin (the chemical which gives skin color or tan) which makes the laser wavelength effective for age spot or sun spot removal. Nd:YAG lasers may cause hemoglobin absorption, leading to purpura (collection of blood under tissue in large areas), pinpoint bleeding, or whitening of the skin. Q-switched Ruby: 694 nm. This laser creates a red light which is highly absorbed by green and dark tattoo pigments. Because it is more highly absorbed by melanin this laser may produce undesirable side effects such as pigmentary changes for patients of all but white skin. This is the best wavelength for blue ink. Q-switched Alexandrite: 755 nm. The weakest of all the q-switched devices and somewhat similar to the Ruby laser in that the Alexandrite creates a red light which is highly absorbed by green and dark tattoo pigments. However, the alexandrite laser color is slightly less absorbed by melanin, so this laser has a slightly lower