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Laser Removal of Tattoos
Abstract
Tattoos are placed for different reasons. A technique for tattoo removal which produces selective removal of each tattoo pigment, with minimal risk of scarring, is needed. Nonspecific methods have a high incidence of scarring, textural, and pigmentary alterations compared with the use of Q-switched lasers. With new advances in Q-switched laser technology, tattoo removal can be achieved with minimal risk of scarring and permanent pigmentary alteration.
There are five types of tattoos: amateur, professional, cosmetic, medicinal, and traumatic. Amateur tattoos require less treatment sessions than professional multicolored tattoos. Other factors to consider when evaluating tattoos for removal are: location, age and the skin type of the patient.
Treatment should begin by obtaining a pre-operative history. Since treatment with the Q-switched lasers is painful, use of a local injection with lidocaine or topical anaesthesia cream may be used prior to laser treatment. Topical broad-spectrum antibacterial ointment is applied immediately following the procedure.
Three types of lasers are currently used for tattoo removal: Q-switched ruby laser (694nm), Q-switched Nd:YAG laser (532nm, 1064nm), and Q-switched alexandrite laser (755nm). The Q-switched ruby and alexandrite lasers are useful for removing black, blue and green pigments. The Q-switched 532nm Nd:YAG laser can be used to remove red pigments and the 1064nm Nd:YAG laser is used for removal of black and blue pigments.
The most common adverse effects following laser tattoo treatment with the Q-switched ruby laser include textural change, scarring, and pigmentary alteration. Transient hypopigmentation and textural changes have been reported in up to 50 and 12%, respectively, of patients treated with the Q-switched alexandrite laser. Hyperpigmentation and textural changes are infrequent adverse effects of the Q-switched Nd:YAG laser and the incidence of hypopigmentary changes is much lower than with the ruby laser. The development of localized and generalized allergic reactions is an unusual complication following tattoo removal with the Q-switched ruby and Nd:YAG lasers.
Since many wavelengths are needed to treat multicolored tattoos, not one laser system can be used alone to remove all the available inks and combination of inks. While laser tattoo removal is not perfect, we have come a long way since the advent of Q-switched lasers. Current research is focusing on newer picosecond lasers, which may be more successful than the Q-switched lasers in the removal of the new vibrant tattoo inks.
... Tattooing of the face for cosmetic purposes is generally done to conceal a scar on the face, to make one's lips look fuller, to create a line on the eyes or lips, and in recent years, to establish a permanent shape of the eyebrows [1]. However, despite the popularization of tattooing, people often seek tattoo removal if the tattoo is not to their liking, is not in line with current fashion, or for other reasons. ...
... Previously, procedures such as dermabrasion, cryosurgery, and classical excision were performed for the removal of tattoos. More recently, carbon dioxide lasers have been introduced; however, this technique can leave a scar [1]. Selective photothermolysis with la-sers, as a newer technique, effectively removes the tattoo pigment [2]. ...
... Selective photothermolysis with la-sers, as a newer technique, effectively removes the tattoo pigment [2]. The tattoo pigment functions as a target chromophore that responds to a particular wavelength [1]. For the target chromophore to be adequately obliterated, the pulse duration must be shorter than the thermal release time; however, the thermal release time of the tattoo pigment is less than 10 nanoseconds, and since the tattoo particles are small, a short pulse duration is required [3,4]. ...
Tattoos, which people choose to have performed for various reasons, can have multiple colors, ranging from conventional black to red, yellow, blue, and others. As tattoos have become increasingly popular, the need for tattoo removal has also grown, and the most commonly used method for removal is a laser. However, the extent to which various types of lasers remove different tattoo pigments is clearly important. Although extensive research has been done on black tattoos, red tattoos have not been adequately studied, and there are few case reports on red tattoos. We present a case of effective removal of a red tattoo from the lips using a picosecond laser.
... The most common adverse effects following laser tattoo treatment with the Q-switched ruby laser include textural change, scarring, and pigmentary alteration. Other types of Q-switched nanosecond lasers have less risk of scarring or hyperpigmentation [16]. Ultra-pulse CO2 lasers remain a second-line treatment option. ...
... In cases where it's not, laser-assisted tattoo removal remains the gold standard for treatment. Since many wavelengths are needed to treat multicolored tattoos, not single laser will be enough to remove all variety of inks and their combinations [16]. In case laser removal therapy proves to be ineffective, systemic treatment with corticosteroids may be initiated with scheduled monitoring of patient's condition. ...
As tattooing becomes more and more popular, growing numbers of skin reactions caused by tattoos are also becoming frequently encountered by medical professionals. We present a generic case of a tattoo-induced allergic reaction and explore its’ immunological mechanism. This paper also highlights components of tattoo inks, their allergenic potential, and possible options for treatment. There can be different types of allergens in tattoo inks. Some are biodegradable, while others are not. Examples of biodegradable components include natural dyes and preservatives. Allergic reactions caused by such agents may resolve with simple therapy since after a short period they will be cleared from the skin. On the other hand, synthetic molecules and other non-degradable dyes will need invasive therapy, such as surgery, dermatome shaving and most commonly used - laser removal therapy. Most notable in this regard is red ink with the highest incidence. There are no current regulations on tattoo inks, which puts tattoo enthusiasts at a higher risk of developing allergic reactions. There are certain preventive measures, such as patch and dot tests. Because the specificity of these tests is mediocre, despite negative results, an allergic reaction may develop weeks or months later. There are no strict treatment guidelines and each case must be assessed individually. Our patient was a young woman, who developed a local allergic reaction due to the red pigment used in her tattoo. Initial treatment, in this case, was anti-inflammatory to reduce inflammation. The only way to get full resolution in such cases is to remove the allergen (red pigment) from the dermis. The patient was prescribed topical treatment with corticosteroids. Once irritation subsided tattoo removal therapy with Q-switched Nd 532 nm laser was initiated. The inflammation returned after the first session, for which local anti-inflammatory medications were started. Due to the ineffectiveness of laser removal and local treatments systemic therapy with corticosteroids was prescribed with gradually decreasing the dosage and controlling the disease. After two months of this treatment, the patient's condition improved. She is still undergoing therapy with systemic corticosteroids.
... The primary mechanism underlying the QS laser-mediated tattoo removal is as follows: once the laser energy is absorbed by the tattoo, the ink particles are rapidly blasted. Subsequently, the residual particles and their host cells are eliminated by the lymphatic system (3). In addition to the QS lasers, certain nonselective lasers, such as carbon dioxide lasers (4) and erbium lasers (5), have been used to treat tattoos. ...
... The clearance rate increased gradually as the number of treatments increased. At the end of the follow-up period, excellent tattoo clearance was achieved in 71.05% of the cases, and the median number of treatment sessions was 3 (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]). An average of 3.78 treatments was conducted to obtain excellent tattoo clearance. ...
Background and objective:
Q-switched (QS) lasers are the gold standard for tattoo removal. The purpose of the present study was to gain a more comprehensive understanding of the factors that influence the efficacy of QS lasers and their associated complications in the removal of tattoos in China.
Patients and methods:
Clinical data of 266 patients were analyzed retrospectively. The tattoo clearance rate was evaluated using the 4-point scale. The Cox regression model was applied to analyze the factors that affected the efficacy of QS lasers in tattoo removal. In addition, treatment-related adverse reactions were analyzed.
Results:
The results showed that several variables had a statistically significant effect (p < 0.05) on the efficacy of QS laser-mediated tattoo removal treatment, including the patients' age, the tattoo's age, type, color or ink density and the number of treatments. A variety of adverse responses occurred during the laser treatment. The overall incidence of adverse responses was approximately 24.06%, including pigmentation, hypopigmentation, bulla formation, allergic reactions and skin texture changes or hypertrophic scarring.
Conclusion:
Some factors may influence the efficacy of QS lasers in the treatment of tattoos and certain adverse reactions may occur during this process.
... The mode and method of tattoo application can also aid choice of tattoo removal method as tattoos done by amateurs are easier to remove than a professionally applied tattoo. 32 There are tattoo inks made with nanoparticle technology, and these are finely delivered into the melanosomes, making it difficult to fragment them by the laser beam. The age of the tattoo is also a consideration as the older tattoos are easier to remove than a freshly applied one. ...
... The age of the tattoo is also a consideration as the older tattoos are easier to remove than a freshly applied one. 32 The removal of tattoo ink invariably comes to the dermatologists, although they are usually not consulted before tattoo application. Historically, nonselective destructive techniques were employed in tattoo removal such as heat burns with iron, embers, and cigars/cigarette which literally destroys the skin with resultant disappearance of the tattoo but residual scars. ...
Tattoo, a Polynesian word meaning ‘to mark’, is a form of body modification done by inserting indelible ink into the dermis to change its pigmentation. Tattoos are done for social, cultural, and religious purposes. It has been in existence since the 18th century and was associated with sailors, lower class individuals, and criminals. However, since the late 20th century, tattooing has undergone a redefinition and shifted to an acceptable form of expression all over the world, including Nigeria, cutting across almost all age groups and socioeconomic class. This review is aimed at highlighting the indication, complications arising from the procedure as well as removal, and how to manage them. The dermatological complications associated with tattoos can occur either during inking or attempts at removal. Most times, tattoos are obtained through unsafe means by unauthorized personnel, and this is associated with numerous health risks. Of particular importance to the dermatologists are the hypersensitivity reactions, granulomatous skin disease, and formation of both keloid and hypertrophic scars. Treatment options vary and include use of silicone gel and intralesional steroids for hypertrophic and keloid scars, topical medication for hyperpigmentation, and use of LASER for tattoo removal. In conclusion, the trend of tattooing has become a widely accepted form of social expression all over the world and is gradually gaining ground in Nigeria. Patients frequently present to the dermatologists and physicians for solutions to the complications. It is important to proffer solutions and educate patients on the various health risks associated with tattooing.
... [2] Following the treatment, macrophages engulf the particle debris by endocytosis and the tattoo is gradually removed. [3][4][5] Nevertheless, laser treatment of tattoos can occasionally result in adverse side effects and complications such as transient or permanent hypopigmentation, hyperpigmentation, scarring, infection, bleeding -or simply ineffective partial removal or even darkening of tattoo ink. [3][4][5] Therefore, new laser systems and treatment protocols are being continuously developed to increase the efficacy and reduce complications of laser tattoo removal. ...
... [3][4][5] Nevertheless, laser treatment of tattoos can occasionally result in adverse side effects and complications such as transient or permanent hypopigmentation, hyperpigmentation, scarring, infection, bleeding -or simply ineffective partial removal or even darkening of tattoo ink. [3][4][5] Therefore, new laser systems and treatment protocols are being continuously developed to increase the efficacy and reduce complications of laser tattoo removal. In addition, subjective visual assessment of therapy progress is inaccurate, which makes the planning of individual laser therapies difficult. ...
Pulsed photothermal radiometry (PPTR) enables noninvasive determination of temperature depth profiles induced in strongly scattering biological tissues and organs, including human skin, by pulsed laser irradiation. In the present study, we evaluate the potential of this technique for objective characterization of a laser tattoo removal procedure.
The study involved 5 healthy volunteers (age 20-30 years) undergoing tattoo removal treatment using a Q-switched Nd:YAG laser. Four measurement and treatment sessions were performed over a time period of 10 months. Prior to each treatment, PPTR measurements were performed on several tattoo sites and one nearby healthy site in each patient, using a 5 μs Nd:YAG laser at low radiant exposure values and a dedicated PPTR setup. The laser-induced temperature profiles were reconstructed using a custom numerical optimization code. In addition, each tattoo site was documented with a digital camera and measured with a custom colorimetric system (in tristimulus color space), providing an objective evaluation of the therapeutic efficacy to be correlated with our PPTR results.
The laser-induced temperature rise in previously untreated tattoos was maximal at a subsurface depth of µ300 μm. In tattoo sites that responded well to laser therapy, a significant drop of the temperature peak was observed in the subsequent temperature depth profiles. In several sites which appeared much less responsive according to photography and the colorimetric record, a progressive shift of the laser-induced temperature profile deeper into the dermis was observed over the course of consecutive laser treatments, indicating that the tattoo removal procedure was nevertheless effective.
... Over the last few decades there has been a tremendous surge in the practice of tattooing as a cosmetic, decorative and social body art form (Khunger et al., 2015). As a corollary of this surge, the number of people seeking to have tattoos removed has grown significantly (Kuperman-Beade et al., 2001). ...
... Currently, the most efficient removal techniques rely on the use of Q-switched lasers which work on the principle of selective photothermolysis (Choudhary et al., 2010;Kuperman-Beade et al., 2001). The tattoo pigments are destroyed by targeting their absorption wave length with a laser pulse duration shorter that the thermal relaxation time (i.e. the time required for a structure to cool down to half of its heating temperature). ...
The modelling and computation of the coupled thermal and mechanical response of human skin at finite deformations is considered. The model extends current thermal models to account for thermally-and mechanically-induced deformations. Details of the solution of the highly nonlin-ear system of governing equations using the finite element method are presented. A representative numerical example illustrates the importance of considering the coupled response for the problem of a rigid, hot indenter in contact with the skin.
... Topical anesthetics (TAs) have also been shown to be effective in controlling pain during the application of various types of lasers such as Nd:YAG for laser hair removal, 8 Q-switched lasers for tattoo removal, 9 and other lasers for the treatment of vascular and pigmented lesions. [10][11][12] Despite the success of TAs, their use is limited by the area due to the risk of anesthetic intoxication, often making it challenging to treat large areas like the lower limbs. ...
Introduction
Transdermal laser is an option for varicous veins treatment, yet it may be painful. In this study, we will present a technique for performing tumescent anesthesia associated to transdermal laser (TTL) to reduce pain during treatment.
Objective
The study compares pain during treatment of telangiectasias in lower limb with and without tumescent anesthesia to offer a less painful procedure.
Methods
50 CEAP C1 patients with bilateral telangiectasias on thighs underwent transdermal laser treatment, using tumescent anesthesia on one side and standard technique on the other. Pain was assessed via the Visual Analogue Scale. The outcomes were compared with Student's t-test. Significance was set at p < .05.
Results
Laser treatment without tumescent anesthesia resulted in a VAS pain score of 7.9, versus 0.0 with anesthesia, showing a significant statistical difference.
Conclusion
Tumescent anesthesia and transdermal laser (TTL) is capable of reducing pain in laser treatment of telangiectasias and reticular veins.
... This enables specialized cells (called macrophages) to engulf the particle debris and remove it through the lymphatic system, which leads to gradual fading of the tattoo in the following weeks and months. [1][2][3] However, the described tattoo removal treatment may sometimes cause adverse side effects, such as hypo-and hyperpigmentation, scarring, or infection. On the other hand, a too-conservative treatment protocol can reduce the effectiveness of each treatment session, thus prolonging the therapy to several years and/or limiting its ultimate effectiveness. ...
Objectives:
Assess the suitability of the technique for objective monitoring of laser tattoo removal by an extended treatment protocol.
Materials and methods:
One half of the tattoo in the first volunteer was treated with nanosecond and the other half with picosecond laser pulses at 1064 nm. In the second subject, four test areas were treated repeatedly using different radiant exposures from 1.5 to 6 J/cm2 . Measurements of diffuse reflectance spectra and photothermal radiometric transients were performed 4-20 weeks after each treatment session. Inverse Monte Carlo analysis based on a three-layer model of tattooed skin was applied to assess the tattoo characteristics and analyze their changes.
Results:
The results clearly indicate a gradual reduction of the ink content and an increase of the subsurface depth of the tattoo layer with all treatments at a radiant exposure of 3 J/cm2 or higher. The observed dependences on laser pulse duration, radiant exposure, and a number of treatments are in excellent agreement with visual fading of the tattoo.
Conclusions:
The presented methodology enables noninvasive characterization of tattoos in human skin and objective monitoring of the laser removal treatment.
... Tattoos can be differentiated into five types: professional, amateur, cosmetic (permanent makeup), traumatic, and medical. 3 The type of tattoo has an immediate influence on the efficacy of the laser tattooremoval. Additional factors that influence the selection of the ideal type of laser and the efficacy of the treatment include colour, location, age, and skin-type of the patient. ...
Quality-switched (q-switched) laser systems are the gold standard for the treatment of benign pigmented lesions and tattoo removal. A frequently used system is the q-switched ruby laser that emits monochromatic light at the wavelength of 694 nm. This system is used for the removal of age spots (senile lentigines), seborrhoeic keratosis, tattoos, and other dyschromatoses. The increasing need for the removal of, for example, age spots and unwanted tattoos, reflects both the wish of our ageing society to preserve a youthful appearance and the steadily growing prevalence of tattoos. This review highlights the potential, limitations, and novel treatment concepts of using q-switched ruby laser systems.
... Increased skin pigmentation results in decreases the depth of laser light penetration [31]. QS lasers, including the QS neodymium-doped yttrium aluminum garnet (Nd:YAG), QS Ruby, QS KTP, and QS Alexandrite, have historically been the mainstay in laser tattoo removal [32]. However, the picosecond laser is rapidly becoming the laser of choice in tattoo removal. ...
Tattoos have become ingrained in our society and have served varied purposes throughout human civilization. So long as tattoos have existed, there has been demand for their removal. Lasers are currently the modality of choice in the removal of tattoos, as they are more efficacious than previously used methods. The most common lasers are the 532 nm and 1064 nm neodymium-doped yttrium aluminum garnet lasers, the quality-switched 694 nm Ruby laser, and the quality-switched 755 nm alexandrite laser. However, picosecond lasers are rapidly gaining favor in tattoo removal. An in-depth understanding of laser principles and how they can be applied in the setting of tattoo removal is key. Also, a greater understanding of the origin of and colors within a tattoo, the presence of tattoo layering, and a patient’s Fitzpatrick skin type increase the odds of satisfactory results. This review provides dermatologists with a comprehensive summary on laser fundamentals, an overview on treatment principles, and recent developments in the field of laser tattoo removal.
... Amateur tattoos are easy to remove. 7 In 1999, Shannon Bell gives statement in "Tattooed: A participant observer's exploration of meaning" that there are two types of people, people that got tattoos are usually those who have usually 1 or 2 tattoos and the people who are tattooed are those who got greater size, multicoloured and observable tattoos. She declared that now it is impossible for the person who are tattooed to get back to their natural appearance. ...
Background:The trend of tattoos increases day-by-day in many of the countries but unfortunately there is no evaluation of this practice in Pakistan.The term “tattoo” is the art of making colourful designs beneath the skin. There are different types of tattoos with different colour of inks. This practice is done for many reasons including fashion, beauty, to hide skin marks, addiction to pain, to memorize something or due to any personal reasons. Some people hide their tattoos due to some restrictions. Tattooed people may face restriction in jobs. They may cause different type of skin infections and other medical conditions. Objective:Our motive of research is to evaluate the relation of tattoos with disease conditions and reasons for adaptation of tattoos in Pakistan. Methodology:The data was collected by online interviews and face-to-face interactions with participants and tattoo artists. All the participants (N=181) with permanent tattoos were asked about different questions regarding age, gender, motivations for being tattooed, opinions and side effects following tattooing etc. Results: In Pakistan, tattooing is more common among males (74.03%) than females (25.96%). The highest motivation of being tattooed was found to be fashion (31.57%) and beauty (36.31%). Greater number of participants considered tattooing as harmless (66%) and less considered it as harmful (28%), while few (N=6%) have mixed opinions. Common side effect experienced by participants was inflammation (23.36%) and then allergy (11.41%) but majority of the participants did not experience any severe side effects. People belonging to any occupation were equally influenced by tattooing but it is more common in teenagers. Conclusion:In Pakistan, tattoos trend seems to be increasing day-by-day. Most people regardless of age, occupation, religion and side effects got tattoos because of fashion and beauty and there were no severe side effects of tattooing in Pakistan. Bangladesh Journal of Medical Science Vol. 21 No. 03 July’22 Page: 730-740
... Para esta tarea llamada fototermólisis se utilizan láseres de diferentes longitudes de onda que fragmentan pigmentos de colores determinados para que así el sistema inmune pueda eliminarlos. Es importante señalar que algunos tatuajes (principalmente los que son recientes y coloridos) jamás llegarán a desaparecer completamente y el tratamiento láser puede acompañarse de complicaciones como cambios en la textura y coloración de la piel, dejando cicatrizaciones poco estéticas (Hsu et al., 2016;Kuperman, Levine y Ashinoff, 2001). ...
Existe evidencia de que el ser humano se ha tatuado desde el 3300 a.C., desde entonces, los tatuajes han cambiado significativamente en sus propósitos y significados. En la actualidad, se ha producido un cambio en la cultura del tatuaje, alejándose de la idea que las personas tatuadas son sólo criminales o marineros. Cada vez es más frecuente observar profesionistas con tatuajes, sin embargo, aún existen prejuicios que afectan la vida de muchos de ellos, especialmente de los profesionales de la salud. Este artículo busca exponer cómo el auge del tatuaje ha traído nuevos retos a los médicos, ya sean infecciones en la piel, cuestiones éticas o personales, así como el de combatir el estereotipo que existe de ellos.
... Ultrasonic imaging has been used to monitor dermatological tattoo complications [9,10]. In addition to laser ablation [11], ultrasound has also been experimentally applied for tattoo removal [12,13]. The high-intensity focussed ultrasound used for this purpose ablates the tissue in or near the transducer focus, irrespective of the presence of ink. ...
Black tattoo ink comprises hydrophobic carbonblack nanoparticles. We hypothesized that black tattoo inkdemonstrates transient dynamic activity in an ultrasound field. Brightness-mode sonography was performed on cylindrical receptacles of different bore diameters, filled with black tattooink, water, saline, or air, using pulsed ultrasound with center frequencies of 13 MHz and 5 MHz. The scattering from black ink itself lasted less than tenminutes. At 13-MHz sonication, a transient drop in sound speed was observed, as well as a transient lessening of scattering from distal phantom tissue. The linear acoustic attenuation coefficient of pure black ink was measured to be 0.15±0.01 dB cm
−1
MHz
−1
, equal to whole blood. Low-intensity ultrasonic tattoo removal would be of interestas an alternative to techniques that damage surrounding tissue.
... Following the treatment, macrophages engulf the particle debris by endocytosis and remove them through the lymphatic system, which causes the gradualy fading of the characteristic discoloration. [3][4][5] Nevertheless, laser removal treatment of tattoos can result in adverse side effects and complications, such as hypopigmentation, hyperpigmentation, bleeding, scarring, or infectionor can be ineffective if patient safety is prioritized. New treatment protocols are therefore introduced and tested. ...
We explore the potential for noninvasive monitoring of laser tattoo removal treatment by adapting a recently introduced methodology for quantitative assessment of structure and composition of human skin in vivo. 1 The approach combines diffuse reflectance spectroscopy in visible part of the spectrum with pulsed photothermal radiometry, involving time-resolved measurements of mid-infrared emission after irradiation with a millisecond laser pulse. The experimental data are fitted simultaneously with the respective predictions of a dedicated numerical model of light and heat transport in tattooed skin. For this purpose we apply a three-layer optical model of skin, consisting of epidermis, upper dermis, and lower dermis which includes the tattoo ink. This proof of principle study involved one healthy volunteer undergoing tattoo removal treatment. One half of the tattoo was treated with 5 ns pulses from a commercial Nd:YAG laser (StarWalker® MaQX, Fotona) at radiant exposure of 3 J/cm 2 , and the other half with much shorter, "picosecond" pulses at the same wavelength and 1.3 J/cm 2. Measurements were performed before and 8 weeks after the first treatment session, as well as 20 weeks after the second treatment. The results show a significant reduction of the ink content and an increase of the subsurface depth of the tattoo layer over the course of treatment with both lasers, in agreement with gradual fading of the tattoo.
... Meanwhile, the overlying epidermis is protected from nonselective thermal injury by active cooling 3 . Following the treatment, macrophages engulf the particle debris by endocytosis and the tattoo is gradually removed [4][5][6] . ...
... Second, traumatic tattoos can be removed with mechanical or chemical methods, including the salt abrasion technique, dermabrasion, cryosurgery, and surgical excision. Although all these methods may be effective, they are rarely used due to the high risk of permanent side effects such as scarring and depigmentation (Kent & Graber, 2012;Kuperman-Beade, Levine, & Ashinoff, 2001). ...
Traumatic tattoos can be treated with several methods, including mechanical and chemical devices. However, they are rarely used due to the high risk of permanent side effects such as scarring and depigmentation. Recently, laser devices, especially the Q‐Switched (QS) laser and the Pulsed Dye Laser (PDL), applied in combination, have achieved complete clearance of the lesions without any risk of side effects. Herein, we reported three cases of traumatic facial tattoos successfully treated with combined PDL and QS Nd:YAG laser. This article is protected by copyright. All rights reserved.
... Kuperman -Beade used 3 types of laser in the treatment of tattoo, Q-switched ruby laser (694nm); Q-switched Nd:YAG laser (532,1064) and Q switched alexanderite laser (755nm). They achieved similar results and side effects compared to this study [17]. The mechanism responsible for clinical improvement of acne scars after dermabrasion is unknown. ...
Dermabrasion is an abrasive process used to remove the epidermis and superficial dermis to treat a variety of skin conditions. OBJECTIVE: To evaluate the household scrub pad as a tool for dermabrasion for the treatment of rhinophyma, congenital naevi and static vitiligo.
... Through the years, many methods of tattoo removal, such as dermabrasion, salabrasion, surgical excision, and freeze-burning the tattooed skin with liquid nitrogen, have been explored [2] ; however, multiple laser treatments to remove a tattoo via selective photothermolysis remain the gold standard. [3] Here, in this case, we used Q-switched 1064-nm Nd:YAG laser for tattoo removal, which because of its longer wavelength, higher fluence, and shorter pulse is a better laser for the black and dark blue/black tattoo pigment. ...
Q-switched Nd:YAG laser remains the gold standard for tattoo removal, but still some tattoos are not completely removed in a specified period as desired by the patient. Herein, we present a case report of 23-year-old patient who came to the outpatient department for tattoo removal. The tattoo measured around 20cm × 18cm and was located on the back. Nine to 12 sessions of 1064-nm Q-switched Nd:YAG laser were planned at 4- to 6-week interval. After the completion of nine sessions, all the shades of the tattoo disappeared, but the lines persisted. A trial of increased laser energy and multiple-pass R20 treatment was performed, which rather increased the scarring and no improvement in tattoo clearance was noticed. We tried mini-punch skin excision for clearing the remnant tattoo lines. The tattoo was cleared successfully without significant scarring. Mini-punch skin excision is a very promising technique, similar to the follicular unit extraction technique of hair transplant, for tattoo removal of the patients who want immediate results as compared to lasers that take almost a year, provided the patient accepts the risk of scarring.
... Lazerle farklı dalga boyları ve frekanslarıyla farklı renklere müdahale edilir. Dövmeyi silmek için doğru lazer yöntemini seçmekle beraber dövmenin rengi, cilt tipi, hastanın yaşı, güneşe maruziyet ve retinoid tedavisi, Herpes gibi başka dermatolojik hastalıklar için tedavi alıp almadığı da önemli rol oynar (2,10). Bununla birlikte dövme sildirme işlemi sonrası alerjik reaksiyonlardan pigmentlerdeki renk değişimine kadar geniş çerçevede pek çok komplikasyon gelişebilir. ...
Dövme (tatuaj) çok eski tarihlerden günümüze süregelen bir uygulamadır. Dövme topluluklar için bir inancı, toplumsal sınıfı veya kimliği temsil eder. Dövme insan vücuduna farklı desen ve renklerde uygulanmaktadır. Bunların bir kısmı geçiciyken bir kısmı da kalıcıdır. Derinin alt tabakasına enjekte edilen mürekkep dövmenin kalıcı olmasını sağlar. Tatuaj son yıllarda gençler arasında yaygınlık kazanmıştır. Yaygınlaşmayla birlikte daha sonra dövmeyi sildirmek isteyenlerin artmasına bağlı olarak bilim adamları dövme silme yöntemleri üzerine değişik tedavi arayışlarına girmiştir. Bu yöntemlerden bazıları; dermabrazyon, kriyocerrahi, elektrocerrahi ve cerrahi eksizyon gibi tahrip edici tekniklerdir. Bunların yan etkisi oldukça fazla olduğundan son yıllarda lazer teknolojisi gelişmiştir. Günümüzde dövme sildirmek için kullanılan en yaygın yöntem Q-anahtarlı lazer yöntemidir. Birkaç seansta farklı dalga boyları ve sıklığıyla farklı renklere müdahale edilerek dövme boyasının parçalanması hedeflenir. Bu olgu sunumunda, hasta 2015 yılında koluna ve el bileğine dövme yaptırmıştır. 2016 yılında dövme silinmesi için bir merkeze başvurmuştur. Doktor hastaya hastanın bahsi geçen dövmelerin lazerle...
... Application of visible and NIR light for therapeutic purposes covers a whole spectrum of cutaneous interventions across both cosmetic and medical domains. Examples include removal of vascular and pigmentary lesions [6], unwanted hair [7], and tattoos [8] to wound healing [9], scar resurfacing [10], skin rejuvenation [11,12], and stimulation of hair growth [13][14][15], treatment of psoriasis and eczema [16,17] and more [18]. Effective therapeutic modalities, which rely on all five types of light-tissue interactions (plasma ablation, photodisruption, photoablation, photothermolysis and photochemical reactions), and where the impact of photons on tissue depends on the wavelength, optical power density and exposure time [19], have already been very successfully embraced by a range of professional and home-use devices [20,21]. ...
Finding a path towards a more accurate prediction of light propagation in human skin remains an aspiration of biomedical scientists working on cutaneous applications both for diagnostic and therapeutic reasons. The objective of this study was to investigate variability of the optical properties of human skin compartments reported in literature, to explore the underlying rational of this variability and to propose a dataset of values, to better represent an in vivo case and recommend a solution towards a more accurate prediction of light propagation through cutaneous compartments. To achieve this, we undertook a novel, logical yet simple approach. We first reviewed scientific articles published between 1981 and 2013 that reported on skin optical properties, to reveal the spread in the reported quantitative values. We found variations of up to 100-fold. Then we extracted the most trust-worthy datasets guided by a rule that the spectral properties should reflect the specific biochemical composition of each of the skin layers. This resulted in the narrowing of the spread in the calculated photon densities to 6-fold. We conclude with a recommendation to use the identified most robust datasets when estimating light propagation in human skin using Monte Carlo simulations. Alternatively, otherwise follow our proposed strategy to screen any new datasets to determine their biological relevance.
... The tattoo ink particles undergo photomechanical fragmentation which reduces both the dark scar colour and prominence as there is a reduction in the inflammatory and granulomatous reaction driven by the presence of the foreign body. 151 In some resistant cases, formal surgical excision of the tattooed scars or combination therapy is performed. ...
Lay Summary
Scars can result as part of the normal healing process after a burn or other trauma such as surgery or injury. However, there is a range of scarring from ‘good’ to ‘bad’ depending on various features of the scars. Some can be can be lumpy and raised (hypertrophic and keloid scars), have changes in pigmentation (increased or decreased colouration) or have specific features related to the cause (for instance acne scars, burns scars). We review the senior author’s experience over twenty years in treating scars with a range of treatments in conjunction with lasers. This is the second and final article in the series looking at 4 main aspects of scarring. In part 1, the focus was burns scars.
In Part 2, we now focus on hypertrophic and keloid scars (thickened raised scars); pigmented scars and acne scars. Lasers play an important role in managing a variety of scars in our practice, which work best in combination with other treatments as described.
... In modern clinical practice, having only one laser for removing tattoos may only suffice for removing black tattoos. However, even when treating black tattoos, the ink may become refractory to a single type of laser, necessitating the use of another type of tattoo laser to achieve complete removal [15][16][17][18][19][20][21][22][23][24]. Nowadays, even though Q-switched lasers are the current gold standard for laser tattoo removal, certain limitations exist when following the standard protocol, including incomplete clearance, long total treatment duration with a large interval between ses-sions, ink retention, despite multiple sessions and treatment-associated side effects, such as blistering and dyschromia. ...
Introduction: Modern tattoo removal began as a science approximately 20 years ago, and relatively few advances have been made since then. The aim of this study is twofold: first, to review the complications of tattoos and tattoo removal methods and second, to investigate both the epidemiology and legal issues of this phenomenon in Italy.
Discussion: Complications of medical tattoos are changes in colour, leading to colour mismatch. The complications of decorative tattoos include infections and allergic and foreign body reactions. Tattoos are popular in Italy, especially among the younger generations. As these people age, the demand for tattoo removal will continue to grow. Q-switched (QS) lasers are widely considered the gold standard for tattoo removal. Although Q-switched lasers are capable of removing tattoos without harming the skin, removal often requires numerous treatments and it can still be incomplete , especially when attempting to remove multicoloured tattoos. Moreover, complications can occur, with an incidence of about 5%. Immediate complications include pain, blisters, crusting and pinpoint haemorrhage. Delayed complications include pigmentary changes, either hypopigmen-tation or hyperpigmentation. Developments leading to removable tattoo inks, feedback systems to detect the absorbance characteristics of tattoo inks, dermal clearing agents and, perhaps, even shorter pulse-duration lasers should result in improvements in tattoo removal in the near future.
Conclusions: In Italy there is no specific prescriptive legislation for tattooing, and there is also a great diversity in terms of regional regulatory approaches. Future educational campaigns by school counsellors and primary care physicians should also be aimed at specific groups that are more likely to get tattoos, such as minors and women.
... Gracias al principio de fototermolisis selectiva, que logra una mínima afectación del tejido adyacente y ejerce su efecto sobre cromóforos específicos, se logran resultados muy favorables y escasos efectos adversos 11,12 . : 158 -163 Los tatuajes traumáticos son indeseados, causados por el depósito accidental de diferentes sustancias exógenas como asfalto, polvo, pólvora, vidrio, metales, etc. que penetran forzosamente en distintos niveles de la dermis 13,14 . Independiente de la etiología, el resultado final es un tatuaje con un patrón irregular que varía desde azul a negro dependiendo de la profundidad del depósito del material 15 . ...
Introduction: Q-switched are the most used lasers in the treatment of traumatic tattoos. We report the results of treat- ment of nine patients with these tattoos. Materials and Methods: We used the Revlite QS Nd:YAG 1064 nm laser (Hoya ConBio®). The device parameters were adjusted for each patient varying between the following values; spot size 4-6 mm, energy 3,5-7 J/cm2 and 5-10 Hz. The minimum time in between each session was eight weeks. Photographs were taken before and after each session to assess the clearance of the lesions. Results: We achieved a complete clearance (>95%) in three patients at 1.6 ± 0.5 sessions and excellent results (75%-95%) in one patient after seven laser sessions. Of the remaining five patients, three of them have had a good response (50%-75%) in 1.6 ± 0.5 sessions, however two of them are still under treatment. Only two patients had a rea- sonable clearance (25%-50%). Conclusion: QS laser Nd: YAG 1064 nm is effective in the treatment of traumatic tattoos.
... Tattoos are usually treated with Q-switched LASER. Th is treatment requires several sessions (about 10-12) organized over a period of 6-8 weeks [14]. Laser treatment can also be selected according to the color pigment of the tattoo [15]: ...
Tatooing has been practiced for thousands of years. It has become a common practice for people of Western countries in the last 10-20 years, where approximately 3-5% of the population has at least one tattoo. Various pigmented substances introduced into the skin may cause the occurrence of adverse irritative, immunological, infectious or other reactions of the skin. We present three clinical cases with adverse reactions after tattooing.
... This was time consuming, painful and very risky and also leads to other serious side effects i. e. being permanent scarring or deadly infection. Laser technology has promoted more efficient in clearing tattoo, reducing the risk of infection or scars and accelerate the healing process [10][11][12] . It is advanced, safe and efficient method to remove the tattoo ink. ...
Invention of the Q-switch advanced laser method is the most effective methods of tattoo removal compared to other methods of i.e. chemical, mechanical and surgical. In this study, we are reporting black pigment tattoo removal by comparing two wavelengths 532 nm and 1064 nm of Q-switched Nd-YAG laser. Using a single-pulse laser at 1064 nm wavelength, the maximum laser fluence for skin damage is 3.04 J/cm2 with pulse energy 0.55 J. While, at 532 nm wavelength, maximum laser fluence is 0.5 J/cm2 with pulse energy 0.42 J at 8-10 ns for tattooed skins. Moreover, after 1064 nm and 532 nm laser irradiations, skin biopsy of black tattooed rat’s skin demonstrates the ink granules local redistribution. Microscopic study indicates that black ink particles become smaller and vanished from the skins after 1064 nm laser treatment. The findings of this study indicate that 1064 nm wavelengths of Q-switched Nd-YAG laser treatment with 0.55 J pulse energy, is one of the significant methods of black tattoo removal with emarkable differences.
... At present, there are 4 different types of Q-switched lasers that are successful in tattoo removal: 532 nm and 1064 nm Nd:YAG, alexandrite, and ruby laser. 1,2,6,9,11 Having a range of single wavelength laser systems to remove each color separately is time-consuming and presents a great expense. No single-wavelength laser can remove all the tattoo color effectively, especially when treating multicolored tattoos.12,13 ...
Background: Decorative tattooing gained popularity in many western countries throughout the 1990s. Some estimates show that approximately 10 % of men in the United States already have tattoos. However, tattoos often become a personal regret. As recent surveys suggest, 17 % of people that have obtained a tattoo and more than 50 % of adults over the age of 40 in the United States of America consider having them removed. The same trend can be observed in our country as well. Laser therapy is the gold standard for tattoo removal. In Slovenia, laser tattoo removal therapy is available and widely accessible. There is a wide range of facilities offering laser tattoo removal, ranging from different private clinics to beauty salons. Different facilities use different lasers, but not all lasers, however, are optimal for successful and complete tattoo removal, as inappropriate use can cause many unwanted side effects. Methods: Eleven (11) patients (2 men and 9 women) requesting tattoo removal were treated in our department. When treating our patients, we used Fotona's QX MAX quality-switched Nd:YAG laser which offers four different wavelengths in a single system; 1064 nm Nd:YAG was used to treat and remove dark pigments, 532 nm KTP for red, tan-colored, purple and orange tattoo inks, 650 nm dye for green tattoo inks and 585 nm dye for sky-blue colored inks. Results: Satisfactory tattoo removal was achieved in all patients treated. Patients were very satisfied with the success and the number of treatments needed for tattoo removal. There were mild unwanted side effects and the pain was moderate. The average number of treatments required for complete tattoo removal was less than 7, ranging from 3 to 21 treatments. Patients' satisfaction with tattoo removal was estimated at 5.2 (on a scale from 1 to 6). Conclusions: Our study showed that Q-switched lasers successfully remove tattoo ink, however several treatments are required for satisfactory tattoo removal.
Tattooing has been in practice since millenniums across the globe for various purposes such as art and beautification. Recently, a new perspective has become popular, particularly among youngsters as a fashion statement, an improvement of body image and as an expression of affection toward their loved ones. Various side effects such as infections, allergic contact dermatitis, scarring and granuloma formation, and inflammatory reactions have also been associated with tattooing. Tattoo regret is also on the rise with the increase in tattooing. The most common motivation for the removal of a tattoo is the enhancement of self-esteem. Other reasons for removal include eradication of a socially discrediting lesion, domestic pressure, and improvement of employment prospects.
Tattoos are commonly seen in the United States. Tattoos can be divided into five classes: professional, amateur, medical, cosmetic, and traumatic. Considering the tattoo market is poorly regulated by the legislation, adverse effects are common, for example, allergic reaction, localized infections, or systemic infections. Traditionally, tattoos were removed by dermabrasion, excision, and other surgical approaches, which caused varying degrees of scarring. The advancement of laser techniques, especially Q-switched laser and picosecond laser, allows clinicians to tackle tattoos with minimal scarring. In this article, we briefly discuss the history of tattoo removal, present the clinical data, and discuss evidence regarding laser tattoo removal. Ultimately, we will elaborate on some factors influencing laser tattoo removal outcomes and our approach to consult patients requesting tattoo removal.
We present the viability of Raman spectroscopic approach for detection and determination of tattoo ink pigments, and the use of polymer optical skin tissue phantoms as possible tools for regulatory agencies.
This thesis is aimed to find efficient oxide based solid-state materials for the development of lasers, particularly in visible spectral regions. We focused on Pr3+ and Nd3+ luminescent ions, doped in oxide-based hosts. Pr3+ ions are suitable for direct visible emissions in various regions, whereas the emission of Nd3+ ions in near infrared around 0.9 μm can be converted into blue laser by Second Harmonic Generation. A large-covered visible region could be expected in the range of 450 nm – 750 nm. First, we selected appropriate oxide hosts by using optical spectroscopy tools. All selected materials with congruent melting behavior were grown as single crystal. On the other hand, cubic materials with very high melting point, Nd:Y2O3 and Nd:Y3Al5O12, were prepared as standard and micro-core composite transparent ceramics, respectively. Next, all samples were thoroughly investigated in terms of physical, optical and spectroscopic properties. In the meantime, Judd-Ofelt analysis were computationally performed by using ground state absorption data to calculate radiative properties of studied solid-state materials, including radiative lifetime and branching ratio. Finally, laser operations were carried out within a plane-concave or V-type resonant cavity under blue and near infrared pumping for Pr3+ and Nd3+ solid-state materials, respectively. We achieved visible lasers in the relevant range with satisfying efficiencies with Pr:Sr1-xLaxAl12-xO19 single crystal and Nd:Y3Al5O12 micro-core transparent ceramic. Both present a real potential for the development of laser emissions in visible spectral regions.
Altered or uneven pigmentation is a common reason to present to a dermatologist or laser surgeon. Modalities available for treating pigmentary alterations include medication, destruction, excision, resurfacing lasers, and lasers specifically targeted to pigment. The last modality will be the focus of this chapter.
Background: Tattoos have played an important role in various human cultures for thousands of years. The creation of high power, short pulse Q-switched lasers (QS) has provided a tool for considerable therapeutic advances in tattoo removal. Objective: The aim of the study is to correlate the clinical efficacy of QS Nd: YAG laser for tattoo removal with histological as well as histometric findings. Patients and Methods: QS Nd: YAG laser was used for blue tattoo removal in 12 Egyptian patients. Sessions were done every 2 months for about 6–10 sessions (average 7). Skin phototypes of patients ranged from phototype III to V. Photographs were taken before and after every treatment session. Skin biopsies were taken from the patients before treatment and after six sessions to perform histological and histometric analysis. Results: Eight patients (66.7%) showed excellent response and four patients (33.3%) good response. No textural change or scarring was observed in any patient. Histological examination confirmed the clinical response. Haematoxylin and Eosin (H&E) stained sections showed a significant decrease or almost complete disappearance of the tattoo pigment. Meanwhile, histometric study objectively confirmed a significant decrease in ink particle surface area after treatment. Conclusion: QS Nd: YAG laser effectively treats tattoos in dark-skinned Egyptian patients with excellent cosmetic outcome and minimal side effects. The histopathologic and histometric findings significantly correlated with the clinical response.
People in today's society get tattoos to decorate their bodies, to identify with particular groups or gangs, or to camouflage areas such as birthmarks or other tattoos. Tattoos may be divided into five categories: professional, amateur, cosmetic, traumatic, and medical. Dermabrasion, thermal destruction and cryotherapy are the mechanisms used to remove tattoo. Lasers remove tattoos by altering the optic properties of their pigments. Early laser tattoo removal methods included the argon laser and the carbon dioxide laser, both of which carried significant deficiencies and side effects. More recent discoveries involving the use of quality‐switched lasers have allowed the production of nanosecond lasers, using high‐powered pulses with very short duration, which decrease the incidence of thermal damage to surrounding skin layers. The most common complications of laser tattoo removal include textural changes in the overlying epidermis, scarring, pruritus, hyperpigmentation, hypopigmentation, and allergic reactions.
Characteristics such as skin tone and pigmentation color vary among patients, but most researches on laser irradiation in laser ablation have revolved around minimizing damage to reduce pain. Chromophores are the most important factors in photon energy absorption, a key principle of laser ablation. We investigated the influences on ablation depth by different chromophores on the target and modulating duration per laser exposure using an Nd:YVO4 nanosecond 532-nm laser. We used a Fourier-domain optical coherence tomography (Fd-OCT) system combined with a 532-nm Nd:YVO4 laser to observe the ablation process. In addition, an external customized shutter and water-based color pens (red, green, blue, black) were used to determine the effects of modulating the duration per laser exposure and coloring chromophores on porcine skin and hairless mouse models. Experiments with modulating duration per laser exposure demonstrated that shorter duration generated shallower craters than longer one. Painted experimental group showed damaged region as craters in the experiments with coloring various chromophores. In this research, we investigated the effects of modulating duration per laser exposure and different chromophores on the target. Coloring chromophores with water-based dyes using pens increased tissue damage without dyeing cells or tissue.
We report a case of successful treatment of a traumatic tattoo in a 2‐year‐old patient. He presented with a green discoloration on the left infraorbital region after his sister accidentally hit him with a face paint brush while playing together. A single treatment with an alexandrite picosecond laser resulted in a complete clearance without any side effects for this disfiguring condition.
All laser operators should be up-to-date on associated laser risks and standard safety measures for each laser that they use. Different wavelengths of light are responsible for different ocular damage; thus, appropriate eyewear should be used with each laser treatment.
Objective: To retrospectively evaluate the efficacy of an Alexandrite picosecond laser versus Nd:YAG nanosecond laser for removing blue–black eyeliner tattoos which have existed more than 10 years.
Methods: A total of 40 patients were treated with an Alexandrite picosecond laser in our department from August 2015 to July 2017, with a fluence of 1.96–6.37J/cm², spot size of 2.0–3.6 mm, and pulse width of 750 ps. Another 32 patients were treated with an Nd:YAG nanosecond laser, with a fluence of 2.80–7.00 J/cm², spot size of 3 mm, and pulse width of 5–20 ns. All analysed patients completed at least one treatment and follow-up.
Results: The median number of treatment for all the patients was 1 (range, 1–4). After a single session, no difference was found between the two lasers for the eyeliner removal (p > 0.05). For the people who achieved an excellent response of tattoo clearance, there was still no difference between the two groups (p > 0.05). Transient side effects were observed in two groups, but neither group had significant adverse reactions.
Conclusions: To treat blue–black Chinese eyeliner tattoos over 10 years, Alexandrite picosecond laser does not provide better clearance than the Nd:YAG nanosecond laser.
Background:
Picosecond-domain laser pulses improve the photomechanical disruption of tattoos.
Objective:
This study evaluates the efficacy and safety of a novel, dual-wavelength, 1,064/532-nm, picosecond-domain laser for tattoo clearance.
Materials and methods:
This was a prospective, self-controlled, clinical study of 34 subjects with 39 tattoos treated at 2 sites with an interval of 4.8 ± 1.6 weeks and up to 10 treatments (mean, 7.5). Blinded evaluation and investigator assessment of serial digital images was performed to evaluate treatment efficacy in the 36 tattoos that received at least 3 treatments. Investigators also assessed efficacy before each treatment visit up to 10 treatments. Safety and tolerability was evaluated for all 39 tattoos that underwent at least 1 treatment.
Results:
Blinded evaluation demonstrated that lightening of tattoos was achieved in all subjects, with 86% (31 of 36 tattoos) showing at least a 50% clearance after 3 treatments. Adverse events were few and transient in nature. Patient satisfaction and treatment tolerability were high.
Conclusion:
Treatment of single-colored and multicolored tattoos with this novel 1,064/532-nm picosecond laser is highly safe and effective.
The objective of this paper is to provide a review on some aspects of the mathematical and computational modelling of skin biophysics, with special focus on constitutive theories based on nonlinear continuum mechanics from elasticity, through anelasticity, including growth, to thermoelasticity. Microstructural and phenomenological approaches combining imaging techniques are also discussed. Finally, recent research applications on skin wrinkles will be presented to highlight the potential of physics-based modelling of skin in tackling global challenges such as ageing of the population and the associated skin degradation, diseases and traumas.
Czochralski growth along with linear optical characterizations and near-infrared laser performances of ytterbium doped lanthanum and gadolinium scandium borate crystals (LaxGdYScZYbw(BO3)4 with x + y + z + w = 4) with acentric huntite-type structure are presented in this paper. Low-temperature spectroscopy analyses reveal two insertion sites for Yb3+ ions: a main one in Sc sites and the other one in lanthanide site. While absorption cross-section spectrum reveals broad bands with a maximum value of 7.8 × 10−21 cm2 at 981.5 nm for the σ state of polarization, the emission cross-section spectrum presents low anisotropy between the two polarization states over 1060 nm. Best laser performance is obtained in continuous-wave operation mode with 0.94W at 1070 nm for a 12.9-at% doped crystal.
Tattooing has become a popular recreational practice among younger adults over the past decade. Although some of the pigments used in tattooing have been described, very little is known concerning the toxicology, phototoxicology or photochemistry of these pigments. Seven yellow tattoo inks were obtained from commercial sources and their pigments extracted, identified and quantitatively analyzed. The monoazo compound Pigment Yellow 74 (PY74; CI 11741) was found to be the major pigment in several of the tattoo inks. Solutions of commercial PY74 in tetrahydrofuran (THF) were deoxygenated using argon gas, and the photochemical reaction products were determined after exposure to simulated solar light generated by a filtered 6.5 kW xenon arc lamp. Spectrophotometric and high-pressure liquid chromatography (HPLC) analyses indicated that PY74 photodecomposed to multiple products that were isolated using a combination of silica chromatography and reversed-phase HPLC. Three of the major photodecomposition products were identified by nuclear magnetic resonance and mass spectrometry as N-(2methoxyphenyl)-3-oxobutanamide (o-acetoacetanisidide), 2-(hydroxyimine)-N-(2-methoxyphenyl)-3-oxobutanamide and N,N"-bis(2-methoxyphenyl)urea. These results demonstrate that PY74 is not photostable in THF and that photochemical lysis occurs at several sites in PY74 including the hydrazone and amide groups. The data also suggest that the use of PY74 in tattoo inks could potentially result in the formation of photolysis products, resulting in toxicity at the tattoo site after irradiation with sunlight or more intense light sources.
A single diagram, encompassing most medical applications for all types of laser in current use, forms the basis of this review of recent medical developments. Emphasis is placed on the physical processes that govern different microscopic mechanisms of laser-tissue interaction. Four distinct photophysical groups are considered in a general classification of these specific modes of interaction: for continuous wave exposure, the photothermal and the photochemical transformations; and, for pulsed irradiations, the electromechanical and the photoablative processes.
Nine years of clinical experience of the application of the Q-switched ruby laser to the removal of tattoos is presented. This laser achieves optimal removal of blue/black amateur tattoos by its selective interaction with the dermal suspensions of pigment which constitute the tattoos. The scar free cosmesis thus achieved is a considerable improvement on non-specific laser techniques whereby the laser is absorbed to a comparable degree in both pigmented and non-pigmented tissue. Long-term results are analysed and it is noted that a variety of professional tattoos may also respond to treatment. The mechanisms and appearance are discussed and correlated with short-term healing processes. It is found that power densities in the range 1200-2800 GW/m2 are most suitable. Appropriate dosimetry can be witnessed by the appearance of opaque intradermal vacuoles corresponding to the vaporization of the tissue water surrounding the pigment suspensions. Treatment by Q-switched ruby laser offers a viable scar-free option for a wide range of dark tattoos, leading to a more acceptable clinical outcome in most cases than other current therapies.
All three Q-switched laser systems can remove most tattoos effectively, with minimal scarring or other adverse sequelae. Despite advances in laser technology, all tattoos cannot be eliminated completely, and several wavelengths remain necessary to treat multicolored tattoos optimally. The major advantage of Q-switched laser irradiation to effect tattoo removal is the low risk of scarring associated with treatment. Limitations include the need for multiple treatment sessions, minimal-to-incomplete responses in some cases, and the possibility of pigmentary and textural changes.
Background:
Until the recent development of the Q-switched lasers, it was not possible to remove tattoos without causing scarring, sometimes very disfiguring. Variations in wavelengths and pulse widths used may result in different clinical effectiveness or risks. The objective of this study was to determine the effectiveness of the alexandrite laser in removing professional and amateur tattoo pigment without adverse tissue response.
Results:
We describe the clinical and histologic effects of the use of a new Q-switched laser for treatment of tattoos, the alexandrite laser (wavelength, 755 nm; pulse width, 100 nanoseconds). The results of treatment of 17 patients with professional tattoos and eight patients with amateur tattoos are analyzed. Greater than 95% removal of tattoo pigment averaged 8.9 treatment sessions. Transient hypopigmentation occurred in approximately 50% of patients, and transient textural surface changes occurred in 12%.
Conclusions:
The alexandrite laser is a safe and effective treatment modality for removal of black and blueblack tattoo pigment.(Arch Dermatol. 1994;130:1508-1514)
Summary Lasers have many applications in dermatology. Recent developments in laser technology have produced significant therapeutic advances in several areas. The introduction of pulsed tunable dye lasers has considerably improved the treatment of vascular lesions, particularly port wine stain malformations in children. A wider range of continuous-wave and quasi-continuous-wave lasers have also become available for treating vascular lesions, and their use in conjunction with automated delivery systems has improved results whilst reducing adverse effects. Increasing interest in treatment of pigmented lesions and tattoos has led to investigation of a range of high-power short-pulse lasers, and early results look very promising. However, further work is needed in all these areas to determine which lesions respond best to each laser system, and which treatment techniques are optimal.
There is no method of removing imbedded pigments of tattoos that restores the skin to its pristine, normal state. The pigments used in modern times are so biologically inert that no natural metabolic mechanism or artificial means solubilizes readily and removes them cleanly and without damage to their site of placement. The most reasonable and practicable of methods may result in more or less scarring. It is required to reach the pigments mechanically and as mechanically remove them by some form of surgery or to inflame the skin so severely by physical methods or chemical caustics that they are thrown off in the healing process. The crudest of methods is simple application of strong chemical caustics like salicylic acid, chloracetic acids, phenol, sulfuric acid, nitric acid, and zinc chloride. More refined methods are: 1) a combination of application of chemical caustics and delicate surgery that makes them operative, 2) salabrasion, 3) cryosurgery, 4) dermabrasion, 5) thermal cautery by fulguration or laser, and 6) various techniques of conventional surgery. These are the methods that will be described briefly and illustrated by various authors.
Short-pulse laser exposures can be used to alter pigmented structures in tissue by selective photothermolysis. Potential mechanisms of human tattoo pigment lightening with Q-switched ruby laser were explored by light and electron microscopy. Significant variation existed between and within tattoos. Electron microscopy of untreated tattoos revealed membrane-bound pigment granules, predominantly within fibroblasts and macrophages, and occasionally in mast cells. These granules contained pigment particles ranging from 2-in diameter. Immediately after exposure, dose-related injury was observed in cells containing pigment. Some pigment particles were smaller and lamellated. At fluences greater than or equal to 3 J/cm2, dermal vacuoles and homogenization of collagen bundles immediately adjacent to extracellular pigment were occasionally observed. A brisk neutrophilic infiltrate was apparent by 24 h. Eleven days later, the pigment was again intracellular. Half of the biopsies at 150 d revealed a mild persistent lymphocytic infiltrate. There was no fibrosis except for one case of clinical scarring. These findings confirm that short-pulse radiation can be used to selectively disrupt cells containing tattoo pigments. The physial alteration of pigment granules, redistribution, and elimination appear to account for clinical lightening of the tattoos.
• Tattoo treatment with Q-switched ruby laser pulses (694 nm, 40 to 80 nanoseconds) was studied by clinical assessment and light and electron microscopy. Fiftyseven blue-black tattoos or portions thereof (35 amateur and 22 professional) were irradiated with 1.5 to 8.0 J/cm2 at a mean interval of 3 weeks. Substantial lightening or total clearing occurred in 18 (78%) of 23 amateur tattoos and 3 (23%) of 13 professional tattoos in which the protocol was completed. Response was related to exposure dose. Scarring occurred in one case, and persistent confettilike hypopigmentation was frequent. Optimal fluence was 4 to 8 J/cm2. Clinicohistologic correlation was poor. Q-switched ruby laser pulses can provide an effective treatment for tattoos.
(Arch Dermatol. 1990;126:893-899)
Seven patients with either homemade or professional decorative tattoos have been treated with both the argon and CO2 lasers and studied clinically as well as histologically. The argon laser is absorbed by dermal pigment and vaporizes this pigment out of the skin. The CO2 laser vaporized tissue layer by layer and must be accompanied by mechanical debridement. Results and complications of treatment with the two lasers were markedly similar, as were histological studies.
A modification of a well-tried, if little-known, chemical technique for removing tattoos is presented as a safe, simple and effective out-patient procedure requiring virtually no after-care.
Suitably brief pulses of selectively absorbed optical radiation can cause selective damage to pigmented structures, cells, and organelles in vivo. Precise aiming is unnecessary in this unique form of radiation injury because inherent optical and thermal properties provide target selectivity. A simple, predictive model is presented. Selective damage to cutaneous microvessels and to melanosomes within melanocytes is shown after 577-nanometer (3 x 10(-7) second) and 351-nanometer (2 x 10(-8) second) pulses, respectively. Hemodynamic, histological, and ultrastructural responses are discussed.
Cryosurgery of tattoo offers a simple alternative to the current methods in use. In four patients, only slight scar formation or pigmentation were associated with the otherwise virtual disappearance of the tattoos.
Several laser techniques have been proposed for the removal of decorative tattoos. The lasers that have been used most successfully are Q-switched red or near-infrared systems because of their ability to target tattoo pigment selectively with minimal risk of scarring or permanent pigmentary changes.
The objectives of this study were to determine the clinical effectiveness of the newest Q-switched system, the alexandrite laser, in removing amateur and professional tattoos and to observe side effects.
Twenty-four multicolored professional tattoos and 18 blue-black amateur tattoos were treated with the Q-switched alexandrite laser (755 nm, 100 nsec) at 2-month intervals until total clearing was achieved. The 510 nm pulsed dye laser was used to treat tattoos that contained red pigment.
Professional tattoos required an average of 8.5 alexandrite laser treatments for total clearance, whereas only 4.6 treatments were necessary to remove amateur tattoos. Red tattoo pigment was successfully treated with an average of two 510 nm pulsed dye laser sessions. No scarring or long-standing pigmentary changes were seen in laser-irradiated skin.
The Q-switched alexandrite laser is highly effective in removing multicolored professional and amateur tattoos without adverse sequelae. The 510 nm pulsed dye laser was useful in eliminating red tattoo pigment.
The Q-switched ruby and the Q-switched neodymium YAG lasers are both widely used in the treatment of amateur and professional tattoos. Comparative evaluation of these two laser systems has not previously been performed; thus, the advantages of each laser have not been delineated. Forty-eight amateur and professional tattoos were treated with both the Q-switched ruby and Q-switched Nd:YAG lasers. The tattoos were divided in half and one side of the tattoo was treated with each laser. After one treatment, the patients returned for evaluation to assess the degree of lightening achieved by each laser. The Q-switched ruby laser was found to be superior in lightening black dye in both professional and amateur tattoos. A significant advantage was noted for the ruby laser in the removal of green tattoo pigment. The differences with the Q-switched ruby laser and the 1064 nm option of the Q-switched YAG laser were not clinically significant in the lightening or removal of other colors. The 532 nm option of the Q-switched YAG laser was superior to the Q-switched ruby and the 1064 nm option of the YAG laser in the removal of red tattoo colors in professional tattoos. Hypopigmentation was found more commonly with the Q-switched ruby laser, while textural change was noted more commonly with the Q-switched Nd:YAG laser. One of the patients treated with the Nd:YAG laser at 1064 nm showed a hypertrophic scar.
Cutaneous allergic reactions to pigments found in tattoos are not infrequent. Cinnabar (mercuric sulfide) is the most common cause of allergic reactions in tattoos and is probably related to a cell-mediated (delayed) hypersensitivity reaction.
The purpose of these case presentations is to describe a previously unreported complication of tattoo removal with two Q-switched lasers.
Two patients without prior histories of skin disease experienced localized as well as widespread allergic reactions after treatment of their tattoos with two Q-switched lasers.
The Q-switched ruby and neodymium:yttrium-aluminum-garnet lasers target intracellular tattoo pigment, causing rapid thermal expansion that fragments pigment-containing cells and causes the pigment to become extracellular. This extracellular pigment is then recognized by the immune system as foreign.
Until the recent development of the Q-switched lasers, it was not possible to remove tattoos without causing scarring, sometimes very disfiguring. Variations in wavelengths and pulse widths used may result in different clinical effectiveness or risks. The objective of this study was to determine the effectiveness of the alexandrite laser in removing professional and amateur tattoo pigment without adverse tissue response.
We describe the clinical and histologic effects of the use of a new Q-switched laser for treatment of tattoos, the alexandrite laser (wavelength, 755 nm; pulse width, 100 nanoseconds). The results of treatment of 17 patients with professional tattoos and eight patients with amateur tattoos are analyzed. Greater than 95% removal of tattoo pigment averaged 8.9 treatment sessions. Transient hypopigmentation occurred in approximately 50% of patients, and transient textural surface changes occurred in 12%.
The alexandrite laser is a safe and effective treatment modality for removal of black and blue-black tattoo pigment.
High-energy, short-pulse lasers, eg, Q-switched lasers, emitting visible and near-infrared light have recently been developed for removing tattoos, with little risk of scarring. The mechanisms of action, and possible adverse effects other than scarring and hypopigmentation, are not fully understood.
We describe five cases of pulsed-laser-induced, immediate, irreversible darkening of cosmetic, white, flesh (skin-color), and pink-red colored tattoos. Irreversible ink darkening can be an insidious complication, because immediate whitening of the skin temporarily obscures the subsequently impressive color change. Among these cases, irreversible ink darkening occurred with Q-switched ruby (694 nm), Q-switched neodymium (Nd):YAG (1064 nm/532 nm), and pulsed green dye (510 nm) lasers. Attempts to remove the darkened ink with further laser treatment failed in two cases, and surgical excision was necessary. In the other three cases, subsequent laser treatments successfully removed the darkened ink. The red cosmetic tattoo ink used in one of the cases was placed in agar in vitro and was converted to a black compound immediately on Q-switched ruby laser exposure. Ferric oxide, a brown-red ingredient commonly used in cosmetic tattoos, was similarly tested and blackened in vitro by Q-switched ruby laser exposures.
Although most tattoos are not darkened by laser treatment, short-pulsed lasers over a wide spectrum can cause immediate darkening of some tattoo inks. Patients should be warned of the potential for irreversible cosmetic tattoo darkening, and test-site exposures should be performed prior to treatment. In some cases, subsequent laser treatments may remove the blackened ink. The mechanism probably involves, at least for some tattoos, reduction of ferric oxide (Fe2O3, "rust") to ferrous oxide (FeO, jet black), but the chemical reaction that is involved remains unknown.
The use of dermatologic laser therapy is rapidly expanding. Thirty years of experience has produced advances in the technology, techniques, and therapeutic efficacy of dermatologic lasers. The original lasers have been improved and modified, and new types of lasers have expanded the dermatologist's therapeutic repertoire. Extensive research has provided a greater understanding of the skin's clinical and histologic response to laser treatment. This has allowed dermatologists to expand their therapeutic options and techniques and to improve clinical outcome.
Many modalities for the treatment of tattoos and pigmented lesions produce a greater risk of complications in Fitzpatrick types V and VI skin because of an increased incidence of adverse pigmentary changes and keloidal scarring. In fair-skinned persons Q-switched lasers have proved effective in removing pigmented lesions and tattoos without scarring.
This study was conducted to determine the efficacy and effects of Q-switched lasers on a small series of darkly pigmented patients with tattoos.
Four patients of Ethiopian origin with facial and neck tribal tattoos were treated with both the Q-switched ruby and Nd:YAG lasers. One black woman with a multicolored tattoo on the mid chest was treated with the Q-switched ruby laser.
Clearing of all lesions was seen. The treatments did not result in scarring or permanent pigment changes other than the ones intended.
Our results indicate that in darkly pigmented patients, Q-switched laser treatment of tattoos can be performed successfully. The longer wavelength Q-switched Nd:YAG laser is recommended when removing tattoos in darker complected persons. A test treatment is advised before treatment of large skin areas.
Flesh-colored tattoos darken with traditional tattoo removal lasers. An alternative method was tried. A pulsed carbon dioxide laser was used to remove a facial iron oxide flesh-colored tattoo. It resulted in significant clearing without scarring or textural changes. This is a significant improvement over other reported laser treatments. If this laser is used to remove tattoos elsewhere on skin other than the face, an increased risk of scarring may occur.
All three Q-switched laser systems can effectively remove most tattoos with minimal scarring or other adverse sequelae. Despite advances in laser technology, all tattoos cannot be completely eliminated, and several wavelengths remain necessary to optimally treat multicolored tattoos. The major advantage of Q-switched laser irradiation to effect tattoo removal is the low risk of scarring associated with treatment. Limitations include the need for multiple treatment sessions, minimal to incomplete responses in some cases, and the possibility of pigmentary and textural changes. Research continues in an effort to perfect laser removal of tattoos.
To test the hypothesis that picosecond laser pulses are more effective than nanosecond domain pulses in clearing of tattoos.
Intratattoo comparison trial of 2 laser treatment modalities.
A large interdisciplinary biomedical laser laboratory on the campus of a tertiary medical center.
Consecutive patients with black tattoos were enrolled; all 16 patients completed the study.
We treated designated parts of the same tattoo with 35-picosecond and 10-nanosecond pulses from 2 neodymium:YAG lasers. Patients received a total of 4 treatments at 4-week intervals. All laser pulse parameters were held constant except pulse duration. Radiation exposure was 0.65 J/cm2 at the skin surface. Biopsies were performed for routine microscopic and electron microscopic analysis at the initial treatment session and 4 weeks after the final treatment in 8 consenting patients. Also, ink samples were irradiated in vitro.
In vivo, on the completion of treatment, a panel of dermatologists not associated with the study (and blinded to the treatment type) evaluated photographs to assess tattoo lightening. Formalin-fixed specimens were examined for qualitative epidermal and dermal changes as well as depth of pigment alteration. Electron micrographs were examined for particle electron density and size changes (in vivo and in vitro). The gross in vitro optical density changes were measured.
In 12 of 16 tattoos, there was significant lightening in the picosecond-treated areas compared with those treated with nanosecond pulses. Mean depth of pigment alteration was greater for picosecond pulses, but the difference was not significant. In vivo biopsy specimens showed similar electron-lucent changes for both pulse durations. In vitro results were similar for both pulse durations, showing increases in particle sizes and decreased electron density as well as gross ink lightening.
Picosecond pulses are more efficient than nanosecond pulses in clearing black tattoos. Black tattoos clear principally by laser-induced changes in the intrinsic optical properties of the ink.
Permanent tattooing for cosmetic reasons has increased in recent years; as a consequence, there has been an increase of requests for pigment removal due to complications or undesired results. The Q-switched alexandrite laser has been found useful in removing black exogenous pigment, which is the most popular color in eyebrow enhancement. We report the case of a patient with black-pigment eyebrow cosmetic tattoo after treatment with the Q-switched alexandrite laser.
Treatment conditions included 755-nm wavelength, 100 +/- 10-nsec pulse width, and 3-mm spot size. Fluence threshold was determined, and a spot test was made at the first visit. Single impact technique with 10% overlapping was applied to the whole tattoo. Five treatments were performed with a mean fluence of 7 J/cm(2).
Complete pigment removal was achieved after five sessions. Superficial bleeding and vesicle formation was observed.
Eyebrow tattooing can be treated efficiently with the use of the Q-switched alexandrite laser when black pigment has been used for cosmetic reasons.
Undesirable effects associated with the treatment of tattoos and pigmented lesions with Q-switched lasers 1064nm and 694nm: The MGH clinical experience
- J M Gravelink
- J M Casparian
- E Gonzalez
- Moreno-Arias
- Dvir