Crescent-Shaped Incisional Cuts: An Unusual Complication with Q-Switched Nd:YAG 1064 Laser Tattoo Removal

The document reports an unusual case of crescent-shaped incisional cuts as a complication following Q-switched Nd:YAG 1064 nm laser tattoo removal on a 24-year-old male with a professional tattoo. The patient underwent five sessions without issue, but during the sixth session, using the same laser parameters as the fifth, he experienced these cuts immediately post-lasing. The issue was managed with a pressure bandage, topical mupirocin cream, and oral paracetamol, resulting in complete healing without scarring within a month. The complication was attributed to a technical issue known as the half-moon beam profile problem, caused by uneven optics and resulting in higher fluence at one margin of the laser beam. This was resolved by correcting the optical alignment of the laser. The authors suggest that operators should always be vigilant for technical issues during laser treatments and recommend checking the uniformity of the QS Nd:YAG 1064/532 laser beam on black paper before patient application to prevent such adverse events.