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Successful Management of a Facial Traumatic Asphalt Tattoo Using Sequential Q-Switched Nd:YAG and Fractional CO₂
Eduarda Gregorio Arnaut Lima1, Eduardo Arnaut Dos Santos Lima1
1Department of Dermatology and Plastic Surgery, Plenna, Florianópolis, Brazil.
Objectives:
To describe a stepwise, non-invasive dual-laser approach for the treatment of a traumatic facial asphalt tattoo.
Methods:
A 30-year-old woman presented 18 months after a motor vehicle accident with a persistent dyschromic, atrophic plaque containing embedded asphalt particles on the right hemiface. A 12-session treatment strategy combining Q-switched Nd:YAG laser (1064 nm; 4-5 ns pulses; fluence escalated from 3 J/cm² at 6 mm spot to 23 J/cm² at 3 mm spot) and fractional CO₂ laser (10,600 nm; 20 W; 600 µm spacing; 1600 µs pulse) was implemented. Sessions were initially spaced at 2-month intervals and later extended to 6-month intervals to reduce the risk of melanocyte injury.
Results:
Complete pigment clearance and marked improvement in skin texture were achieved, as documented by standardized photography. Subsequently, 110 mL of autologous fat was grafted to restore facial contour. No adverse effects were observed.
Conclusions:
This scar-sparing, non-invasive approach, integrating sequential laser modalities, interval modulation, and soft-tissue reconstruction, offers an effective management of deep-dermal traumatic asphalt tattoos.
