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BACKGROUND: Laser beam diameter affects the depth of laser penetration. Q-switched lasers tend to have smaller maximum spot sizes than other dermatologic lasers, making beam diameter a potentially more significant factor in treatment outcomes. OBJECTIVE: To compare the clinical effect of using the maximum-size treatment beam available for each delivered fluence during laser tattoo removal to a standard 4-mm-diameter treatment beam. METHOD: Thirteen tattoos were treated in 12 subjects using a Q-switched Nd:YAG laser equipped with a treatment beam diameter that was adjustable in 1 mm increments and a setting that would enable the maximally achievable diameter ("MAX-ON" setting) with any fluence. Tattoos were randomly bisected and treated on one side with the MAX-ON setting and on the contralateral side with a standard 4-mm-diameter spot ("MAX-OFF" setting). Photographs were taken 8 weeks following each treatment and each half-tattoo was evaluated for clearance on a 10-point scale by physicians blinded to the treatment conditions. RESULTS: Tattoo clearance was greater on the side treated with the MAX-ON setting in a statistically significant manner following the 1st through 4th treatments, with the MAX-OFF treatment site approaching the clearance of the MAX-ON treatment site after the 5th and 6th treatments. CONCLUSIONS: This high-energy, Q-switched Nd:YAG laser with a continuously variable spot-size safely and effectively removes tattoos, with greater removal when using a larger spot-size.
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