What’s new in tattoo removal with lasers ?
Although tattoos are fairly easy to do they can be a challenge to remove.
Why are lasers used for tattoo removal ?
- In the past tattoo removal involves tissue-destructive techniques including excision/grafting, dermabrasion, cryosurgery and electrosurgery. Although effective at removing the tissue pigments, these techniques often cause scaring, textural changes, keloids and permanent dyschromia.
- Lasers in Dermatology began when Anderson and Parrish’s introduced the theory of selective photothermolysis that is to target specific tattoo pigment with specific wavelengths and pulse durations of laser light. This allows selective destruction of tattoo pigments while leaving the surrounding skin undamaged.
What are the established treatments ?
- At the time of publishing, the nanosecond pulse duration lasers e.g. Q-switched ruby (694nm), Nd:YAG (1064nm and 532nm), alexandrite (755nm) lasers are lasers of choice for the removal of most tattoos.
What’s New in laser tattoo removal ?
- Recently a R20 treatment regimen was introduced to enhance tattoo removal. “R” stands for Repeating or Rapid while the “20 “stands for 20 minutes. The R20 Method will do a single pass of the laser every 20 minutes, up to 4 passes. This is essentially 4 removal treatments done in one single session. A 20 minute wait period is required because each pass of the laser produces very small nitrogen bubbles that looks like frost on top of the tattoo (immediate whitening reaction). The laser cannot penetrate through this frost until approximately 20 minutes later, another session can be conducted.
- *Topical perfluorodecalin was recently reported to resolve immediate whitening reactions and allows rapid effective multiple pass treatment of tattoos.
- Another significant recent development in laser tattoo removal is the introduction of the 755nm picosecond alexandrite laser.
What are the side effects of laser tattoo removal ?
- The common complications include scarring, skin textural changes, incomplete removal of pigment and ink colour changes (Pigment darkening)
- There may be some ink colours that change colour prior to removal and others that simply will not respond to this laser (eg. green tattoo).
- Pigment darkening is often seen upon treatment of skin-coloured, red-brown, or off-white tattoo colors with the Q-switched lasers.
- Chemical reduction of iron and titanium is thought to be responsible for this potentially permanent pigment darkening and this occurence is thought to be dependant on the settings used).
- Repeated Q-switched laser treatments of up to 10-30 sessions can lighten these laser-darkened tattoos
- Other non-selective modalities are often required to shorten the treatment course. These include ablative and nonablative fractionated lasers. Fractionated photothermolysis uses microbeams to damage an array of microscopic columns of skin. This technique has recently been reported to be effective in removing cosmetic tattoos. Fractionated photothermolysis damage the dermal-epidermal junction and epidermis and allows regression of dermal tattoo pigments. The surrounding tissue is not involved which allows for fast epidermal repair.
Take home message: Combination of lasers may be necessary to effectively treat the broad spectrum of colors within cosmetic tattoos. Green pigment tattoos more than other colors usually requires multiple treatment sessions with the QS Alexandrite laser. Overall The treatment can be time-consuming, costly and the results are by no means guaranteed
*Topical perfluorodecalin resolves immediate whitening reactions and allows rapid effective multiple pass treatment of tattoos: Reddy KK, Brauer JA, Anolik R, Bernstein L, Brightman L, Hale E, Karen J, Weiss E, Geronemus RG. Lasers Surg Med. 2013 Feb;45(2):76-80. doi: 10.1002/lsm.22106. Epub 2012 Dec 19.
Dr Christophe Hsu – dermatologist. Geneva, Switzerland
Source of information+ 2014 (09) – Recent Advances on Laser Tattoo Removal. C. L. Goh. International Pigment Cell Conference (IPCC). Singapore