1. Purpose

This policy establishes an evidence-based, end-to-end framework for safe laser tattoo removal at Newcastle Cosmetic Doctor (NCD). It standardises clinical assessment, consent, patch testing, treatment delivery, complication management, documentation, and follow‑up while ensuring compliance with Australian medical, radiation safety, infection control, consumer, and privacy requirements. ^{1 2 3}

2. Scope & Applicability

Applies to all NCD personnel involved in laser tattoo removal, including clinicians, laser operators, and administrative staff. It covers pre-consultation screening, consent, test-spot procedures, treatment protocols, aftercare, complication escalation, and record-keeping across all skin types and tattoo characteristics, excluding non-laser removal methods. ^{1 3 5}

3. Legislative & Regulatory Framework

Laser systems used for tattoo removal are regulated as medical devices under the Therapeutic Goods Act and must be lawfully supplied and maintained; adverse events are reportable to the TGA where indicated. Laser use is governed by ARPANSA-aligned standards (AS/NZS IEC 60825) and local workplace safety controls. Clinical practice and advertising follow AHPRA/Medical Board guidance; infection control and skin penetration obligations follow NSW Health policy; privacy and photography compliance follow the Australian Privacy Principles. ^{4 5 1 5 6 7 8}

4. Roles & Responsibilities

The Responsible Medical Practitioner provides governance, approves protocols, reviews complications, and ensures emergency preparedness. Only trained, credentialed operators may deliver treatments, with a designated Laser Safety Officer overseeing controlled‑area setup, eyewear, signage, plume control, and incident logs. Admin staff manage privacy notices, consent storage, and appointment triage to escalate risk factors to the prescriber. ^{1 3 5}

5. Pre‑Consultation Assessment

Collect medical history (keloid tendency, photosensitivity disorders, HSV), medications (isotretinoin, anticoagulants), allergies, pregnancy/lactation status, and Fitzpatrick skin type. Characterise the tattoo (age, professional vs amateur, colours, layering, location, scarring) and prior removal attempts. Screen psychosocial factors, expectations, and sun exposure; obtain and securely store baseline photographs with consent. ^{1 3 9}

6. Informed Consent (Process)

Consent is a staged process: verbal discussion, written consent, and cooling‑off where appropriate for cosmetic procedures. Explain mechanism of laser clearance, likely need for multiple sessions, partial clearance, potential pigment changes (hypo/ hyperpigmentation), textural change, scarring risk, blistering, infection, paradoxical darkening in some pigments, and pain management options. Provide take‑home instructions and confirm understanding via teach‑back. ^{1 2 10}

7. Contraindications & Precautions

Absolute contraindications include active infection at the site, suspicious pigmented lesions requiring dermatologic assessment, and inability to wear appropriate ocular protection. Relative contraindications include pregnancy, recent isotretinoin use, photosensitising drugs, uncontrolled medical conditions, recent tanning, and keloid or PIH-prone skin—requiring modified parameters, test spots, or deferral. ^{9 1}

8. Patch Testing / Test Spot Protocol

Perform a test spot on representative tattoo colour(s) and skin area to assess tissue response and risk of dyspigmentation, especially in darker skin types or mixed pigments. Use conservative initial parameters with strict eye protection and plume evacuation. Document lattice location, pulse characteristics, immediate endpoint, and photograph the site; review at 6–8 weeks before full treatment planning. ^{9 3 5}

9. Laser Device Types & Selection

Appropriate systems include Q‑switched or picosecond lasers with wavelengths targeting specific pigments (e.g., 1064 nm for black/dark, 532 nm for red/orange, 755 nm for green/blue with appropriate platforms). Device selection considers skin type, depth, and ink composition; operators adhere to manufacturer IFU, ARPANSA‑aligned controls, and clinic protocols rather than fixed “one‑size” settings. ^{4 5 11}

10. Treatment Technique & Safety Controls

Establish a laser‑controlled area with warning signage, door interlocks or spotter, non‑reflective surfaces, and appropriate eyewear for patient, operator, and observers matched to wavelength/OD. Employ smoke/plume evacuation with appropriate filters to reduce bioaerosol risk. Cleanse and shave the area if needed; provide eye shields when periorbital. Use test‑spot informed parameters, overlapping minimally, monitoring for desired immediate endpoints with conservative passes as tolerated. ^{5 10 11 12}

11. Analgesia & Patient Comfort

Offer topical anaesthesia where appropriate following medication safety standards and observe maximum dose calculations. Consider cold air analgesia, ice, contact cooling, or vibration. Provide opportunities for breaks, utilise calming communication, and document analgesia method and tolerance. ^{3 13}

12. Downtime & Recovery Expectations

Set expectations for transient whitening, erythema, oedema, blistering or crusting lasting several days, and cumulative recovery across sessions typically spaced 6–10 weeks apart. Counsel strict photoprotection and avoidance of trauma or occlusive dressings unless indicated. Explain that clearance is gradual and that ghosting or residual ink may persist. ^{1 9}

13. Aftercare Instructions

Provide written aftercare: gentle cleansing, non‑occlusive dressing as needed, bland emollient, and SPF 50+ daily. Advise against picking crusts, hot tubs, vigorous exercise, or sun exposure for 7–14 days. Instruct patients to report severe pain, spreading erythema, purulence, fever, or visual changes immediately. ^{3 9}

14. Adverse Effects & Complication Management

Anticipated reactions include oedema, blistering, and pinpoint bleeding; manage with cooling, non‑adherent dressings, and review. Complications include secondary infection (consider swab and antibiotics), scarring, textural change, PIH/hypopigmentation, allergic reactions to pigment release, and paradoxical darkening (e.g., ferric oxide or titanium dioxide). Significant incidents are documented and, where related to device malfunction or serious outcomes, may be reported to the TGA; workplace incidents are addressed with SafeWork NSW as applicable. ^{4 9 3}

15. Follow‑Up Schedule & Evaluation

Schedule review at 2 weeks for wound check if blistering occurred and at 6–10 weeks to assess clearance, dyspigmentation, and plan next session. Use consistent photography and, when helpful, dermoscopy to evaluate pigment evolution. Adjust parameters conservatively based on response and patient goals. ^{1 3}

16. Infection Prevention & Skin Penetration Standards

Prepare skin with appropriate antisepsis when epidermal disruption is expected; adhere to standard precautions. Manage linens, hand hygiene, and environmental cleaning per policy. Plume management is mandatory; disposable eye shields for patients are preferred where feasible. Any suspected infection is promptly treated and documented. ^{3 6 2 12}

17. Laser Safety Governance

The Laser Safety Officer maintains the laser safety manual, eyewear inventory with optical density specs, calibration/servicing records, room audits, signage, and staff training logs. Access is restricted to credentialed personnel; a “laser on” checklist is completed each session. Near-miss and incident reports are logged and reviewed for system improvements. ^{5 10 11}

18. Documentation, Advertising & Privacy

Maintain comprehensive records of assessment, consent, device, wavelength, pulse characteristics, endpoint, complications, aftercare, and follow-up. Ensure advertising and digital content avoid testimonials and misleading claims, comply with AHPRA Advertising Guidelines, and distinguish cosmetic from therapeutic claims. Photographs are stored securely with specific consent for clinical or marketing use compliant with APPs. ^{2 7 1}

19. Training, Credentialing & Competency

All operators complete recognised laser safety training referencing ARPANSA/AS‑NZS standards and device‑specific credentialing. Competency is assessed by supervised procedures and annual refreshers including emergency response drills. Scope-of-practice boundaries are enforced by the Responsible Medical Practitioner. ^{5 10 1}

20. Audit, Review & Continuous Improvement

This policy is audited annually for compliance with Australian standards and device guidance. Data from complications, patient feedback, and incident reports inform iterative updates. Regulatory updates from AHPRA, TGA, ARPANSA, and NSW Health trigger interim revisions and staff briefings. ^{1 4 5 6}

Sources

1. Medical Board of Australia / AHPRA, Guidelines for practitioners who perform cosmetic medical and surgical procedures (2025)., viewed 22 October 2025, https://www.medicalboard.gov.au/ ↩
2. AHPRA, Advertising a regulated health service – Guidelines (2024)., viewed 22 October 2025, https://www.ahpra.gov.au/Resources/Advertising-hub/Advertising-guidelines-and-other-guidance/Advertising-guidelines.aspx ↩
3. ACSQHC, NSQHS Standard 4: Medication Safety; Standard 8: Recognising and Responding to Acute Deterioration; Standard 3: Preventing and Controlling Infections., viewed 22 October 2025, https://www.safetyandquality.gov.au/ ↩
4. TGA, Medical devices regulation (lasers and accessories) & adverse event reporting., viewed 22 October 2025, https://www.tga.gov.au/ ↩
5. ARPANSA, Laser safety and radiation protection guidance (including AS/NZS IEC 60825 series)., viewed 22 October 2025, https://www.arpansa.gov.au/ ↩
6. NSW Health, Skin Penetration and Infection Control guidance (Public Health Act/Regulations)., viewed 22 October 2025, https://www.health.nsw.gov.au/ ↩
7. OAIC, Australian Privacy Principles – health records, photography and consent., viewed 22 October 2025, https://www.oaic.gov.au/privacy/your-privacy-rights/health-and-medical-research/guide-to-health-privacy ↩
8. RACGP, Clinical risk management and emergency preparedness in office-based practice., viewed 22 October 2025, https://www.racgp.org.au/ ↩
9. Australasian College of Dermatologists (ACD), Laser and dermatologic surgery clinical resources., viewed 22 October 2025, https://www.dermcoll.edu.au/ ↩
10. Standards Australia, AS/NZS IEC 60825 Laser safety series (control measures and eyewear)., viewed 22 October 2025, https://www.standards.org.au/ ↩
11. SafeWork NSW, Managing risks of laser use in the workplace., viewed 22 October 2025, https://www.safework.nsw.gov.au/ ↩
12. WHO, Laser and light-based device safety – patient safety and risk communication guidance., viewed 22 October 2025, https://www.who.int/publications ↩
13. FDA (USA), Laser products and medical devices – safety and adverse events (MedWatch)., viewed 22 October 2025, https://www.fda.gov/ ↩
14. EMA / EU Commission, Medical device vigilance and cosmetic claims principles (EU)., viewed 22 October 2025, https://health.ec.europa.eu/ ↩
15. NHMRC, National Statement on Ethical Conduct (consent principles) and clinical photography ethics., viewed 22 October 2025, https://www.nhmrc.gov.au/ ↩