Laser Removal of Cosmetic Tattoos of Eyebrow and Eyeline

Cosmetic eyebrow and eyeline tattoos have gained popularity, yet patients often seek removal due to dissatisfaction or complications. Laser therapy is the gold standard for eliminating unwanted pigment in these sensitive areas. This chapter reviews periorbital anatomy—the thinnest skin in the body—and essential safety considerations. Unlike traditional metallic pigment tattoos, modern microblading deposits non-metallic pigments more superficially, influencing treatment approach. Q-switched lasers operate via selective photothermolysis, fragmenting ink through thermal expansion. Treatment requires 2–10 sessions, with parameters tailored to pigment color. Paradoxical darkening occurs in ~25% of cases but responds to subsequent 1064 nm treatment. Picosecond lasers offer enhanced photoacoustic effects with fewer sessions and reduced dyspigmentation risk. Combination approaches with ablative fractional lasers may benefit persistent tattoos. Complications include erythema, blistering, dyspigmentation, scarring, and hair loss. Protective corneal shields are mandatory during eyelid procedures. Understanding pigment composition and anatomy is essential for optimal outcomes.