Tattoo removal by Q-switched yttrium aluminium garnet laser: client satisfaction

Comparative study of 1064 nm nanosecond, 1064 nm picosecond, 755 nm, and 595 nm lasers for tattoo removal: An essential role by macrophage

OBJECTIVES

Tattoo removal is in high demand, and many types of lasers can be used for tattoo removal. Macrophages play an important role in the persistence of tattoos. However, comparative studies of the efficacy of tattoo removal with different lasers versus the relationship between the destruction of pigment particles or recruitment of macrophages after laser treatment are lacking.

MATERIALS AND METHODS

Tattoo models were established on the rat dorsal surface and randomly treated with 1064 nm nanosecond, 1064 nm picosecond, 755 nm, and 595 nm lasers for one session. Clinical photographic evaluation, melanin index, hematoxylin and eosin staining, identification of macrophages by CD68 staining, and transmission electron microscopy were conducted at different time points.

RESULTS

Regardless of the pulse duration, all lasers included were effective for the removal of black tattoos, with 1064 nm lasers having the best efficacy, followed by 755 and 595 nm lasers. The diameter of the pigment particles and recruitment of dermal macrophages correlated with the efficacy of tattoo removal.

CONCLUSIONS

In this study, the 1064 nm lasers were found to be the most effective for black tattoo removal. However, there was no significant difference between the 1064 nm picosecond and the nanosecond lasers. Macrophage recruitment plays an essential role in pigment metabolism during laser-tattoo removal.

Q-Switched 1064/532 nm Laser with Nanosecond Pulse in Tattoo Treatment: A Double-Center Retrospective Study

Tattoo removal is a well-established procedure in dermatology. Lasers represent the gold standard in the management of this condition nowadays. In this study, we report our experience on the use of a Q-switched nanosecond source. A total of 52 patients were consecutively enrolled in performing tattoo removal at Magna Graecia University of Catanzaro and Tor Vergata University of Rome. Black and blue tattoos were treated with a 1064 nm laser, with a pulse duration of 6 ns and a fluence up to 10 J/cm², while colored tattoos were treated with sessions of 532 nm laser, with a pulse duration of 6 ns and a fluence up to 5 J/cm². Up to nine treatments with a minimum interval of 8 weeks between each session were performed. A six-month follow-up visit assessed patient satisfaction (Visual Analogue Scale). Overall clinical result was assessed with a clinical evaluation by two blinded dermatologists using a 5-point scale, comparing pictures before treatment and at follow up. A total of 52 patients were included and analyzed: 30 females (57.7%) and 22 males (42.3%). Mean age was 43.7 ± 12.7 years. According to Fitzpatrick’s skin classification, 16 individuals (30.8%) were type II, 15 (28.8%) were type III, and 21 (40.4%) were type IV. Most of the treated tattoos were carried out by professionals. The mean number of sessions required to obtain a result was 4.6 ± 2.5, and the final tattoo removal rate was 60% or higher, with 51.9% of the patients reporting highest satisfaction scores Q-Switched 1064/532 nm laser may be considered today as the gold-standard treatment for tattoo removal. Our results confirm literature findings of the safety and effectiveness of these devices.

High-frequency (20 MHz) high-intensity focused ultrasound: New ablative method for color-independent tattoo removal in 1-3 sessions. An open-label exploratory study

BACKGROUND

High-intensity focused ultrasound (HIFU) operating at 20 MHz is new and potentially applicable to ablative tattoo removal. The method was documented safe and rational in preclinical testing.

MATERIALS AND METHODS

High-intensity focused ultrasound was introduced to subjects when lasers and dermatome shaving had failed or caused side effects. Transducers with focal depths between 1.1 mm and 1.7 mm in the skin were used, and settings of 0.4-1.2 J/shot at pulse durations of 150 ms were applied. Tattoos were covered with synergistic "shoulder-by-shoulder" focused ultrasound shots. Effectiveness and side effects were measured.

RESULTS

Twenty-two subjects with 67 tattoos were treated. 62% benefitted (19% cleared, 43% partially cleared), and 28% had minor effect. VAS pain was 5-6 versus 7-9 with previous lasers removal. Wound healing was longer after HIFU ablation (1-3 months). 57% of subjects had no scar or minor visible changes of skin surface markings only, while 19% had moderate or major skin thickening. Hypertrophic scar or keloid scars were not observed.

DISCUSSION/CONCLUSION

High-intensity focused ultrasound was effective in removal of difficult tattoos of any color where Nd:YAG lasers had failed. The method only needs 1-3 sessions. As an ablative method, the wound healing period is longer than with laser removal and needs attention. Focused ultrasound can be used as a first-line treatment of smaller tattoos independent of color, and second line when Nd:YAG lasers have failed or caused problems. The operator shall be qualified, as with lasers.

High-frequency (20 MHz) high-intensity focused ultrasound system for dermal intervention: A 12-week local tolerance study in minipigs

BACKGROUND

High-intensity focused ultrasound (HIFU) operating at 20 MHz is new and applicable to skin. Details of use and instrumentation are not documented.

MATERIALS AND METHODS

A GLP compliant 12-week study of Göttingen minipigs (n = 3) was undertaken. Effects of HIFU treatment at different focal depths, energy levels and field size (single shot vs 5 × 5 multiple shots) were studied. Clinical scoring and histology of treated sites were made.

RESULTS

High-intensity focused ultrasound showed instant and initial effects with wheal and flare responses followed by delayed inflammatory reactions associated with outer skin necrosis, depending on energy dose. HIFU treatment was tunable in the range 0.3-1.5 J, ablative at higher energy level. Transducers with deeper focal points gave more profound effects, while epidermal effects were comparable. Multiple doses of 5 × 5 shots produced stronger reactions than single dose indicating that nearby applied shots were synergistic. Recovery from single doses was faster than in multidose areas. Clinical scarring at the end point was not seen despite occasional fibrous change of dermis. Findings illustrated intended therapeutic use; no special safety issues of concern were raised.

CONCLUSION

The new 20 MHz HIFU was reproducible, tunable and produced targeted effects in the outer skin, for example instant wheal and flare followed by inflammation and possibly necrosis depending on energy setting. Reactions recovered during the study with only minor findings at study end. No special safety concerns were raised. The method can be controlled and modulated, and it is ready for clinical testing of dermatological disease indications including conditions presently treated with lasers.

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Zusammenfassung. Für die Entfernung von Tätowierungen sind Q-Laser derzeit die beste Behandlung. Die richtige Wahl des Lasertyps, basierend auf der Farbe der Tätowierung und des Hauttyps, ist entscheidend, um gute Ergebnisse zu erzielen. In diesem Beitrag stellen wir die verschiedenen Arten von Lasern, die für die Tattooentfernung verwendet werden, sowie ihre Indikationen dar. Wir beschreiben auch die möglichen Komplikationen wie Dyspigmentierung, allergische Reaktionen, Verdunkelung von bestimmten Tinten usw., sowie die Möglichkeiten, um sie zu verhindern.