Persistent eschar-like wound healing after Q-switched 1064 nm hybrid nanosecond-picosecond laser monochromatic tattoo removal: management and evolution.

Q-switched (QS) Nd: YAG lasers are frequently utilised light sources for tattoo removal due to their precise micro-confined photo-acoustic interaction with exogenous and endogenous pigments. In order to achieve optimal results, several treatment sessions are usually required. However, the number of sessions depend on tattoo size, design complexity, pigment quantity within dermal layers, and anatomical location. Higher energy settings have often been used to reduce treatment sessions to a minimum however, this approach may lead to possible post-laser skin complications such as pathological wound healing. This case report highlights the importance of recognizing early stages of pathological wound healing encountered after high fluence 1064 nm QS laser tattoo removal. Early implementation of a proportional wound care strategy with anti-neoangiogenic and anti-inflammatory properties through the unconventional use of potent topical steroids applied in a pulsed fashion resulted in positive control of the tissue repair processes. This approach led to effective wound healing re-modulation achieving near normal skin remodelling and optimal tissue healing which in turn, permitted the completion of necessary QS tattoo removal sessions to accomplish successful and safe tattoo fading whilst maintaining overall patient satisfaction.

Assessing the efficacy of a 100 ps Nd:YAG laser for tattoo removal in a minipig model.

Using a minipig model, we evaluated the efficacy of the 100 ps Nd:YAG laser in the removal of tattoo pigments, specifically blue, green, red, and yellow. We observed distinct pigment responses to 532/1064 nm wavelengths at various energy settings. Through a combination of clinical, spectroscopic, and histological methods, we found the 532 nm wavelength to be most effective in disrupting all colors, with notable results for green and yellow at 0.4 J/cm2 and red at 0.72 J/cm2. The 1064 nm wavelength reduced pigment in yellow (1.51 J/cm2), green (1.35 J/cm2), and blue (1.11 J/cm2) tattoos, but was surpassed by the 532 nm in efficiency. Our data underscores the crucial interplay between pigment traits and laser settings in tattoo removal. We advocate for tailored treatment strategies, integrating pigment hue and laser wavelength, to enhance removal outcomes.

Retrospective clinical evaluation of Q-switched Nd:YAG laser safety and efficacy in tattoo removal: A new perspective on the Kirby-Desai scale.

BACKGROUND: With nearly 50% of the population in the United States, Italy, and Sweden tattooed with at least one tattoo, the demand for its removal has risen by 32% since 2011. Traditional removal methods, such as Q-switched (QS) laser-based tattoo removal, can be lengthy, requiring up to 20 sessions. AIM: This study presents a retrospective clinical evaluation of seven short-pulsed QS, dual-wavelength Nd:YAG laser, as an efficient alternative, that can potentially reduce the number of sessions needed as calculated by a founded scale. METHODS: The QS modality delivers high-intensity pulses in four wavelengths, ideal for removing multicolored tattoos, of which two were used. We studied 11 patients who underwent 3-8 treatments (average 5.09) every 2-3 months. Each tattoo was assessed using the Kirby-Desai scale, considering the following factors: location, Fitzpatrick skin type, ink amount, layering, scarring, tissue changes, and tattoo color. Follow-ups were conducted after 6 months and at 4-5 years following last session. RESULTS: The long-term follow-up presented a significantly higher tattoo removal efficiency than the short-term follow-up (p < 0.001), indicating a sustained process of ink breakdown and elimination. Notably, the actual number of treatments were significantly lower than that predicted by the Kirby-Desai scale (average 5.09 vs. 9.9, p < 0.001). No severe adverse events were reported. CONCLUSIONS: In conclusion, the QS Nd:YAG laser offers a safe and effective alternative for tattoo removal, requiring fewer treatments than initially expected.

Fractionated Ablation With Trans-Epidermal Pigment Release: A Novel Tattoo Removal Method.

Tattoos continue to be an important way of emotional and/or identity expression for individuals and communities, whether obtained at a tattoo parlor or through communal rituals. Tattoos vary in their complexity, artistic skill, and overall satisfaction; however, in later years many regret the design, color choice, or the idea of a tattoo altogether. Given the uptick in patients wishing for tattoo removal, various techniques have been developed using energy-based devices such as lasers and destructive methods utilizing caustic chemicals or excision. These modalities come with limitations including incomplete tattoo removal, scarring, and dispersion of tattoo dyes into the lymphatics. Considering these limitations, other treatment modalities for tattoo removal must be explored. In this article, we discuss a new technique for tattoo removal using fractionated ablation of tattoo pigment with trans-epidermal pigment release.  J Drugs Dermatol. 2023;22(11):1103-1106     doi:10.36849/JDD.7250.

Objective monitoring of laser tattoo removal in human volunteers using an innovative optical technique: A proof of principle.

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.

Comprehensive examination of tattoo removal using a 150 ps Nd:YAG laser in a porcine model.

This study aimed to investigate the efficacy of a Nd:YAG laser with a pulse duration of 150 ps at different laser parameters. The effects on multiple-colored tattoos with such ultrashort pulses has not been previously described in the literature. In vivo experiments were conducted on porcine skin to analyze the fragmentation efficiency of five different tattoo colors using different wavelengths, pulse energies, and spot sizes. The results showed that the optimal tattoo clearance to safety ratio for blue, green, red, and yellow tattoos with a 532 nm wavelength was 0.96-2.39 J/cm2. The laser with a wavelength of 1064 nm demonstrated the highest efficacy in eliminating black tattoos, with positive results observed for green and blue pigments at a fluence of 3.02 J/cm2. The study provides valuable insights into the efficacy of laser treatment with 150 ps for removing tattoos of different colors using different laser parameters. This information can help dermatologists and practitioners perform more efficient and effective tattoo removal with fewer side effects.

Non-laser treatment for tattoo removal.

Tattoos are increasingly gathering attention in the young population, especially in second to fourth decade of life. With such trends, rate of its removal also has been on the rise. Treatment options for tattoo removal besides lasers are surgery, radiofrequency, infrared light, cryotherapy, dermabrasion and salabrasion. Unfortunately, none of these procedures are associated with satisfactory cosmetic results due to adverse effects such as scarring and dyspigmentation. Although laser treatment has become the gold standard for tattoo removal, it is also associated with some limitations. Some tattoo inks are resistant to laser, and multiple sessions and multiple wavelengths may be required for its complete removal. Considering these limitations, other treatment modalities for tattoo removal must be explored. This article highlights the non-laser treatment options for tattoo removal. We reviewed all published literature identified from electronic databases (MEDLINE and PubMed) till August 2021 to highlight the non-laser treatment options for tattoo removal.

Tattoo Removal in People of Color Who Were Formerly Incarcerated or Were Gang Members: Complications and Best Practices.

There are limited data about the tattoo removal process in formerly gang-involved and incarcerated people of color. This single center retrospective study was conducted on patients treated at Homeboy Industries' Ya'Stuvo Tattoo Removal Clinic between January 2016-December 2018. It reviewed data on 2,118 tattoos, and a representative sample of 502 patients was used to conduct our analysis. Treatment on 118 of the tattoos (5.57%) resulted in at least one complication (hypo-or hyper-pigmentation, keloids, or scarring). Patients who experienced tattoo removal complications (7.3%) were less likely to return to complete the removal process. More complications were experienced with higher fluences of energy, on tattoos placed by professional artists, on colored tattoos, and tattoos on clients who had a greater number of treatments. The study highlights complications and best practices in tattoo removal in people of color, a process critical to the reintegration and gang disengagement of this vulnerable population.

A Practical Approach to Cosmetic Tattoo Removal with the Nd:YAG Laser.

The Q-switched neodymium-yttrium aluminium garnet (Nd:YAG) laser remains the gold standard method for tattoo removal including cosmetic tattoos. Modern picosecond lasers are referenced to the Nd:YAG laser and essentially do the same job. Persons with cosmetic tattoos in the face are especially eager to achieve perfect removal or correction and from start are critical to suboptimal results. Customers mostly request complete removal; sometimes the goal is fast treatment and bleaching to prepare for a cover up tattoo. Removal or correction of eyebrows is the largest group, followed by lip tattoos and eyeliners. The article gives a systematic and stepwise introduction to routine cosmetic tattoo removal by laser in an Austrian private medical practice. Rationales and selection of customers who can benefit from treatment, preparation, performance, and aftercare is reviewed. Emphasis is given to qualified power adjustment of the laser equipment and the treatment strategy, e.g. the delicate navigation between efficient removal and the risk of short-term and long-term adverse effects. Treatment relies on a partnership between provider and customer. Over the months of treatment, customers gain more insight into the possibilities of treatment, so that they get an understanding of the realistic results that can be achieved. Therefore, customers are also satisfied even with results that are not always optimal since best treatment was given a fair chance.

High-Frequency (20 MHz) Focused Ultrasound: A Novel Method for Noninvasive Tattoo Removal.

Alternatives or complements to laser tattoo removal are needed. Laser removal requires 8-12 sessions and can easily take longer than a year. Some colors cannot be removed, and scars may appear. Applied to allergic reactions in red tattoos, lasers can boost the allergy. A recently developed 20 MHz high-intensity focused ultrasound (HIFU) is introduced as a complementary method to lasers, but also as a stand-alone treatment for selected groups. 20 MHz HIFU allows for application of high-power ultrasound energy to very small focal targets in the dermis, and thereby precise confinement of thermal lesions in the outer layers of human skin, precisely where tattoo inks are deposited. HIFU treatment is "color blind" and can target any type of colored pigment in the dermis. It produces a controlled thermal lesion (up to 65°C) with superficial necrosis followed by an eschar with embedded tattoo pigment. This eschar, containing the tattoo pigment, is discharged over some weeks, and finally replaced by healed skin. HIFU can efficiently remove tattoos of any color in only 1-3 sessions. It can be applied to tattoos when lasers fail to produce efficient removal. The types of side effects are the same as with lasers. The operator shall be trained and knowledgeable. 20 MHz HIFU can furthermore be used in clinical and esthetic dermatology for various other applications, and a range of applications are open in clinical dermatology.