A simple method of tattoo removal

The use of trichloracetic acid in the treatment of decorative tattoos is described. The technique is simple to perform. No anaesthesia or analgesia is required. Complications are uncommon and usually minor. Trichloracetic acid acts by inflicting a chemical burn.     

Lasers for tattoo removal: a review

Tattoos have existed and have been used as an expression of art by man for ages—and so have the techniques to remove them. Lasers based on the principle of selective photothermolysis are now being used to remove black as well as colorful tattoos with varying successes. The commonly used lasers for tattoo removal are the Q-switched 694-nm ruby laser, the Q-switched 755-nm alexandrite laser, the 1,064-nm Nd:YAG laser, and the 532-nm Nd:YAG laser. Newer techniques and methods are evolving in tattoo removal with lasers. Choosing the right laser for the right tattoo color is necessary for a successful outcome. Our review aims to understand the principles of laser tattoo removal and their applications for different types and colors of tattoos. The review also highlights the complications that can occur such as dyspigmentation, allergic reactions, epidermal debris, ink darkening, and so on, in this process and how to prevent them.     

Decorative and traumatic tattoo biophysics and removal

Decorative and traumatic tattoos represent foreign-body implantation into various depths of the dermis. Many methods of removal have been attempted with varying rates of success. Surgical excision with primary closure or grafts or flaps may be successful. Mechanical or chemical removal is useful as well. Thermic treatment including use of the argon and carbon dioxide lasers can remove tattoo pigment satisfactorily.     

Latest innovations for tattoo and permanent makeup removal

The goal of this article is to reveal the latest techniques and advances in laser removal of both amateur and professional tattoos, as well as cosmetic tattoos and permanent makeup. Each pose different challenges to the removing physician, but the goal is always the same: removal without sequelae. The authors' technique is detailed, and discussion of basic principles of light reflection, ink properties, effects of laser energy and heat, and outcomes and complications of tattoo removal are presented.     

In vivo study of intradermal focusing for tattoo removal

. Delivery of intradermally focused nanosecond laser pulses with small energy as an alternate technique applicable to clinical procedures in dermatological and plastic surgery is an area of relatively new interest with multiple potential applications. We assessed this approach on common tattoo pigments in dermis in an in vivo study using a wavelength of 1064 nm. Paired micropigs were tattooed with standard blue, black, green and red pigments. The tattoos were allowed to mature and then treated by 12 ns pulses in a focused beam of 11.4° cone angle. Visual observation and histological analysis of biopsies were performed to evaluate results. Significant reduction in pulse energy and collateral damage was achieved with pulse energy ranging between 38 to 63 mJ. Blue and black tattoos were found to respond well from a clinical standpoint. The depth dependence of tissue response and pigment redistributions at 1 hour, 1 week and 1 month after laser treatment was quantitatively analysed through biopsies and a strong relationship was demonstrated between tattoo response and laser-induced dermal vacuolation. The optical absorption coefficients of the four tattoo pigments were measured to be approximately the same and the laser-induced plasma is suggested to be responsible for the pigment redistribution. As we hypothesised, intradermal focusing of nanosecond pulses significantly reduced required pulse energy for tattoo ablation to about 60 mJ or less. These results stimulate a number of additional questions relevant not only to clinical applications but also to the understanding of the fundamental process of laser–pigment interaction in the dermis as it relates to tattoo removal. Paper received 1 November 2001; accepted after revision 14 December 2001     

Picosecond lasers for tattoo removal: a systematic review

Given that the pigment particles in tattoos have a relaxation time of <10 ns, picosecond lasers would be expected to be more effective than nanosecond lasers in tattoo removal. To systematically review the evidence regarding the effectiveness and safety of picosecond lasers for tattoo removal, Pubmed, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and reference lists were searched for relevant trials. The primary outcome was >70 % clearance of tattoo pigment. Secondary outcomes were 90–100 % clearance of tattoo pigment, number of laser sessions required, and adverse effects. Eight trials were included, six with human participants (160 participants) and 2 with animal models. Seven of the eight trials explored the usage of either 755, 758, 795, 1064, or 1064/532-nm picosecond lasers for black and blue ink tattoos. In the human trials, 69–100 % of tattoos showed over 70 % clearance of pigment after 1–10 laser treatments. Reported side effects included pain, hyperpigmentation and hypopigmentation, blister formation and transient erythema, edema, and pinpoint bleeding. Included articles varied in type of laser investigated, mostly non-comparative studies and with a medium to high risk of bias. There is sparse evidence that picosecond lasers are more effective than their nanosecond counterparts for mainly black and blue ink tattoo removal, with minor side effects.     

Laser chalazion removal

CO2 laser excision of chalazion can be done successfully in the office with minimal to no bleeding and with complete extirpation of the granulomous tissue. The technique involves using only the CO2 laser and the curette. This method does not require patching of the eye, and contact lens wearing can be resumed within an hour.     

Laser hair removal

Laser-assisted hair removal has rapidly emerged as a noninvasive technique for long-term reduction in unwanted hair. This article reviews the pertinent aspects of hair follicle biology, the theoretical aspects of the physics and mechanisms of laser epilation, the different types of lasers available for hair removal, and the practical clinical aspects of laser hair removal.     

Laser hair removal

We are in a state of evolution in long-term hair removal. Safe and effective technology is now available. Lasers will always become smaller, faster, and perhaps more effective. For those interested in offering this procedure, evidence indicates that we are beyond the experimental phase. The treating physician should carefully review current available technology and receive proper training specific to that system.     

Laser hair removal

The evolution of new technologies has helped to improve the clinical efficacy of laser hair removal and increase understanding of hair biology and phototrichoregulatory interactions. Long-term hair removal is now a realistic goal in the majority of individuals.Although the optimal schedule for repeat treatments is not known, most laser surgeons report treatments at 4- to 8-week intervals or at the first signs of regrowing hairs.Newer radiofrequency technologies might address the issue of white and light blond hair phenotypes;however, their exact role in the laser hair removal armamentarium remains to be further elucidated by future studies.     

Laser hair removal

Laser hair removal is a minimally invasive cosmetic procedure that is well suited to the office-based practice. A great deal of improvement has occurred in the past 5 years with the technology and the understanding of how and for whom the procedure works. A review of the physics of laser-skin interactions is included as well as guidelines for safe and effective clinical treatments. Four wavelengths of lasers and intense light sources have proven successful for a variety of skin types. Average rates of long-term hair reduction, for properly treated subjects, are consistently reported between 70 and 90% at a minimum of 6 months. When performed by physician extenders under the supervision of a physician, maximal use of time and resources can be achieved.     

Transient immunoreactivity after laser tattoo removal: report of two cases

BACKGROUND AND OBJECTIVE: Laser tattoo removal is one of most commonly used indications for medical lasers. Professional tattoos contain a multitude of potentially immunogenic chemicals that are released or modified by laser treatment. We studied potential immunologic reactions following laser tattoo removal. STUDY DESIGN/PATIENTS AND METHODS: Case report of two patients with immunologic reactions after laser tattoo removal. RESULTS: Two patients developed transient immunoreactivity that presented as regional lymphadenopathy after laser tattoo removal of professional black and blue-green tattoos. These reactions resolved without any complications. CONCLUSIONS: Tattoo pigments released or modified by laser therapy may trigger transient immunoreactivity in susceptible individuals.     

Topical imiquimod in conjunction with Nd:YAG laser for tattoo removal

The purpose of this study is to evaluate the efficacy of tattoo removal using topical imiquimod 5% cream in conjunction with the 1,064-nm Nd:YAG laser. This procedure for tattoo removal will be compared to laser treatment alone, which is the standard for cosmetic removal of tattoos. Previous studies have linked partial tattoo removal to imiquimod application in a guinea pig model. Methods: This was a small-sized, double-blinded, placebo-controlled trial with patients with Fitzpatrick skin types I-IV (light skin) who were 18–65 years of age. The patients were required to have had two tattoos of similar age and dark blue or black in color in areas that can be covered by clothing. There were four visits in total, with laser treatment and photography being performed on the first visit. Laser settings were with 1,064-nm Nd:YAG with a 10-ns pulse, 3-mm spot size, and 4 J of energy, a standard laser used for tattoo removal. During the second visit, tattoos were randomized and chosen to receive either the laser-imiquimod treatment course or laser-vehicle cream treatment. The patients returned 1 month after the completion of cream application (week #10) and 2 months after the completion of treatment with cream (week #14) for final evaluation and photographing. Results: Three patients were enrolled in this study. All of them are Fitzpatrick skin type IV. All of the patients were compliant with the drug application and have good tolerability with only mild pruritus without changing of vascularity or pigmentation. None of the patients had ulceration or scar development during the cream application. Conclusions: imiquimod plus laser therapy demonstrated a more favorable outcome when evaluated by the investigators or subjects. The mean scores for tattoo clearance from baseline to 2 months after completion of treatment with 5% imiquimod cream versus placebo cream were 4.3 versus 2.7 as rated by investigators and 4.7 versus 2.3 as rated by subjects. No textural changes were observed after therapy and were not shown to be different between the two groups. Further large-scale studies are important in developing a role for the use of imiqumod in laser-assisted tattoo removal.     

An Internet-based survey on characteristics of laser tattoo removal and associated side effects

Tattoo removal by laser therapy is a frequently performed procedure in dermatological practices. Quality-switched ruby, alexandrite, or Nd:YAG lasers are the most suitable treatment devices. Although these techniques are regarded as safe, both temporary and permanent side effects might occur. Little has been published on the frequency of complications associated with laser tattoo removal. We performed an Internet survey in German-speaking countries on characteristics of laser tattoo removal and associated side effects. A total number of 157 questionnaires entered the final analysis. Motivations for laser tattoo removal were mainly considering the tattoo as youthful folly (29 %), esthetic reasons (28 %), and 6 % indicated medical problems. One third of participants were unsatisfied with the result of laser tattoo removal, and a complete removal of the tattoo pigment was obtained in 38 % only. Local transient side effects occurred in nearly all participants, but an important rate of slightly visible scars (24 %) or even important scarring (8 %) was reported. Every fourth participant described mild or intense tan when the laser treatment was performed, and the same number of people indicated UV exposure following laser therapy, which should normally be avoided in these circumstances. As reported in the literature, nearly half of the participants experienced hypopigmentation in the treated area. Our results show that from the patients’ point of view there is an important rate of side effects occurring after laser tattoo removal. Appropriate pretreatment counseling with regard to realistic expectations, possible side effects, and the application of test spots is mandatory to ensure patient satisfaction. Laser treatment should be performed by appropriately trained personnel only.     

Colour shift following tattoo removal with Q-switched Nd-YAG laser (1064/532).

Colour shift in tattoo pigment is a recognised complication of laser tattoo treatment. We report our experience over the past 4 years in treating 275 patients, with a total of 323 professional tattoos. Of these, 184 tattoos contained a pigment other than black with 33 displaying a colour shift as a consequence of laser treatment. This adverse effect was recorded with red, yellow, crimson and brown pigments but most frequently with white/flesh pigments. We found brown and white/flesh coloured pigments to be significantly more likely to change colour compared to red and that the chance of certain colours shifting related to the age of the tattoo. We outline our management of this problem and discuss the results of continued treatment.     

Temporary dermal scatter reduction: quantitative assessment and implications for improved laser tattoo removal

BACKGROUND AND OBJECTIVES: Temporary dermal clearing, i.e., reduction in the attenuation coefficient of the dermis and epidermis, may lead to improved laser tattoo removal by providing increased efficiency of laser delivery to embedded ink particles and enabling the use of shorter wavelength visible lasers more effective on certain inks. STUDY DESIGNS/MATERIALS AND METHODS: In a hairless guinea pig model of human tattoo, we tested both intradermal and transdermal application of glycerol, using visual inspection, spectral analysis, and optical coherence tomography techniques to assess effectiveness. In controlled experiments, we compared the outcomes of single laser treatment sessions for both cleared and uncleared tattoo sites using Q-switched 755 and 532 nm lasers on three different inks. RESULTS: Intradermal injection of clearing agents induced dermal clearing but resulted in necrosis and scar. Transdermal application of clearing agents resulted in moderate reversible clearing, which was localized to the superficial layers of the skin and did not result in complications. Statistically significant differences in laser treatment outcome were observed relative to a number of treatment parameters including the treatment of certain tattoos by short wavelength lasers. CONCLUSIONS: Temporary clearing of superficial skin layers may be performed in an apparently safe and reliable manner. Clearing should lead to increased penetration of laser light to tattoos and should, therefore, increase treatment efficiency. Further study is needed to determine the degree to which this change is of clinical value.