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Kassirer S, Zachary CB, Marini L, Adatto M, Landau M. Laser tattoo removal strategies: Part II: A review of the methods, techniques, and complications involved in tattoo removal. J Am Acad Dermatol 2024:S0190-9622(24)00970-8. [PMID: 38980249 DOI: 10.1016/j.jaad.2024.05.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 05/11/2024] [Accepted: 05/25/2024] [Indexed: 07/10/2024]
Abstract
The rising global popularity of cosmetic and corrective tattoos has concurrently led to an increased demand for their removal. While in the past, methods like surgical excision, chemical destruction, and dermabrasion were employed, lasers have emerged as a reliable and effective tool for tattoo removal. Increasing technological options and combination treatment strategies have raised the importance of understanding the various approaches to laser tattoo removal along with their respective clinical impact. This CME aims to describe the multifaceted aspects of laser tattoo removal, including the method selection, application principles, and safety considerations. Furthermore, it addresses the factors considered when selecting the most suitable laser to achieve optimal treatment outcomes.
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Affiliation(s)
- Samuel Kassirer
- American Medical Program, Tel Aviv University Faculty of Medicine, Tel Aviv, Israel
| | | | - Leonardo Marini
- Diplomate General Surgery and Dermatology, Medical and Scientific Director, SDC The Skin Doctors Center, Trieste, Italy
| | - Maurice Adatto
- Skinpulse Dermatology & Laser Centre, Geneva, Switzerland
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Hernandez L, Mohsin N, Frech FS, Dreyfuss I, Vander Does A, Nouri K. Laser tattoo removal: laser principles and an updated guide for clinicians. Lasers Med Sci 2022; 37:2581-2587. [DOI: 10.1007/s10103-022-03576-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022]
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Gurnani P, Williams N, Al-Hetheli G, Chukwuma O, Roth R, Fajardo F, Nouri K. Comparing the efficacy and safety of laser treatments in tattoo removal: A systematic review. J Am Acad Dermatol 2020; 87:103-109. [PMID: 32763326 DOI: 10.1016/j.jaad.2020.07.117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/09/2020] [Accepted: 07/18/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although lasers have been the criterion standard for tattoo removal, selecting the best modality can be challenging because of the varying efficacies and adverse effects. OBJECTIVE To evaluate all lasers used to remove tattoos and assess their efficacies and adverse effects. METHODS Our systematic review searched PubMed, MEDLINE, Embase, Scopus, CINAHL, Cochrane Central Register of Trials, and ClinicalTrials.gov for all laser treatments. The outcomes measured included laser parameters, treatment methods, patient and tattoo characteristics, clearance rate, and adverse effect rate. The quality of the included articles was appraised by using specific assessment tools and given a high, moderate, or low risk of bias. RESULTS Our search led to 3037 studies, with 36 being included in the systematic review (7 randomized controlled trials, 2 nonrandomized controlled trials, and 27 case series). Although quality-switched neodymium-doped yttrium-aluminum-garnet lasers are safe and effective, picosecond lasers have shown superiority with blue, green, and yellow tattoo pigments. Both are safe and effective for black tattoos. LIMITATIONS Variability among studies. CONCLUSIONS Picosecond lasers show superiority when treating blue, green, and yellow tattoos. The R20 and R0 novel techniques can effectively reduce treatment time. Further randomized controlled trials are required to make a more definitive recommendation.
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Affiliation(s)
- Pooja Gurnani
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida; Florida International University Herbert Wertheim College of Medicine, Miami, Florida.
| | - Natalie Williams
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Ghadah Al-Hetheli
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida; Department of Dermatology and Cutaneous Surgery, College of of Medicine, Qassim University, Saudi Arabia
| | - Olivia Chukwuma
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Rebecca Roth
- Florida International University Herbert Wertheim College of Medicine, Miami, Florida
| | - Francisco Fajardo
- Florida International University Herbert Wertheim College of Medicine, Miami, Florida
| | - Keyvan Nouri
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Cannarozzo G, Negosanti F, Sannino M, Santoli M, Bennardo L, Banzola N, Negosanti L, Nisticò SP. Q‐switched Nd:YAG laser for cosmetic tattoo removal. Dermatol Ther 2019; 32:e13042. [DOI: 10.1111/dth.13042] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/02/2019] [Accepted: 07/22/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Mario Sannino
- Unit of DermatologyTor Vergata University Rome Italy
| | - Matteo Santoli
- Division of Plastic SurgeryBellaria Hospital Bologna Italy
| | - Luigi Bennardo
- Department of Health Sciences, Unit of DermatologyMagna Graecia University Catanzaro Italy
| | | | - Luca Negosanti
- Division of Plastic SurgeryMontecatone Rehabilitation Institute Imola Italy
| | - Steven Paul Nisticò
- Department of Health Sciences, Unit of DermatologyMagna Graecia University Catanzaro Italy
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D'Arienzo F, Bomfim FRCD, Sella VRG, Simões MDJ, Plapler H. Dosimetry of a Carbon Dioxide Laser for Black Tattoo Removal in a Rat Model. Photomed Laser Surg 2018; 36:667-675. [PMID: 30311844 DOI: 10.1089/pho.2018.4506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Objective: To determine the optimal parameters of power, energy, and time for the application of a carbon dioxide laser for Tribal Black ink tattoo removal. Background data: The use of antiquated techniques to remove tattoos demonstrates the difficulty of making advances in this field. Studies by the American Society for Dermatologic Surgery have shown that 5% of the global population has at least one tattoo on the body, with 10% of them wanting a tattoo to be removed. Laser removal has been studied and improved as a less invasive and safer method of surgical removal; however, the ideal dosimetry is not yet established. Materials and methods: Thirty-three male Wistar rats were anesthetized and tattooed in the dorsal region in a quadrangular manner. The rats were distributed under low/null luminosity for 4 months into three equal and random groups for the application of the laser, namely, G1 (P = 0.6 W, Et = 0.9 J), G2 (P = 0.8 W, Et = 1, 2 J), and G3 (P = 1 W, Et = 1.5 J), with the application time standardized to 0.15 sec with 10 passes per application. The procedure was repeated at intervals of 4 weeks until 10 cycles of laser application were completed. The images were studied using the ImageJ program and histological analysis and subjected to the one-way ANOVA test for Tukey's multiple comparison post-test. Results: We observed a significant difference between groups 1 and 3 and between groups 2 and 3. Conclusions: The laser with the parameters of P = 1 W, Et = 1.5 J, and t = 0.15 sec yields better Tribal Black ink removal results.
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Affiliation(s)
- Fabio D'Arienzo
- Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo/SP, Brazil
| | | | | | - Manuel de Jesus Simões
- Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo/SP, Brazil
| | - Hélio Plapler
- Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo/SP, Brazil
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Vanarase M, Gautam RK, Arora P, Bajaj S, Meena N, Khurana A. Comparison of Q-switched Nd:YAG laser alone versus its combination with ultrapulse CO2 laser for the treatment of black tattoo. J COSMET LASER THER 2017; 19:259-265. [DOI: 10.1080/14764172.2017.1314506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mithila Vanarase
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Ram Krishan Gautam
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Pooja Arora
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Sonali Bajaj
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Neha Meena
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Ananta Khurana
- Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital, New Delhi, India
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Lakshmi C, Krishnaswamy G. Efficacy of the Q-switched Neodymium: Yttrium Aluminum Garnet Laser in the Treatment of Blue-black Amateur and Professional Tattoos. Indian J Dermatol 2015; 60:578-83. [PMID: 26677271 PMCID: PMC4681196 DOI: 10.4103/0019-5154.169129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Q-switched neodymium: yttrium aluminum garnet (Nd: YAG) laser at a wavelength of 1064 nm primarily targets dermal melanin and black tattoo ink. Recent studies have shown that this laser is effective in treating black tattoos. There are few studies conducted in India for the same. Aim: The aim was to assess the effectiveness of Q-switched Nd: YAG laser (QSNYL) in the treatment of blue-black tattoos following 3 treatment sessions. Materials and Methods: This study, a prospective interventional study included a total of 12 blue-black tattoos. Following informed consent for the procedure, as well as for photographs, a questionnaire was administered, and improvement perceived by the patient was recorded. In addition, global assessment score (GAS) by a blinded physician was also recorded. Photographs were taken at baseline and at every follow-up. Each patient underwent three treatment sessions with 1064 nm QSNYL at 4–6 weekly intervals. Fluences ranged from 1.8 to 9 J/cm2. The follow-up was done monthly for 4 months from the first treatment session. The response was assessed by patient assessment (PA) and GAS by comparing photographs. Results: After three treatment sessions, although no patient achieved clearance, most patients showed good response with few adverse effects. An average of 64.1% (GAS) and 54.2% (PA) improvement was observed in 12 tattoos. Tattoos more than 10-year-old showed quicker clearing than those less than 10-year-old. Amateur tattoos also showed a better response in comparison to professional tattoos. Conclusion: Totally, 1064 nm QSNYL is safe and effective for lightening blue-black tattoos in pigmented Indian skin. All patients achieved near complete clearance following the continuation of treatment (an average of six sessions) although this was spaced at longer intervals.
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Affiliation(s)
- Chembolli Lakshmi
- Department of Dermatology, PSG Hospitals and PSGIMSR, Coimbatore, Tamil Nadu, India
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Abstract
Q-switched (QS) lasers are widely considered the gold standard for tattoo removal, with excellent clinical results, impressive predictability, and a good safety profile. The generation of giant pulses by the method of Q-switching is responsible for the unique laser-tissue interaction that is seen in tattoo removal by QS lasers. The QS lasers work by impaction and dissolution of the tattoo pigments. Mechanical fragmentation of the tattoo pigments encased in intracellular lamellated organelles followed by their phagocytosis by macrophages is thought to be the major event in the clearance of pigments by QS lasers. A few novel techniques have been tried in recent times to hasten the clearance of tattoo pigments.
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Affiliation(s)
- Shyamanta Barua
- Department of Dermatology, Assam Medical College and Hospital, Dibrugarh, Assam, India
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Abstract
Lasers are the standard modality for tattoo removal. Though there are various factors that determine the results, we have divided them into three logical headings, laser dependant factors such as type of laser and beam modifications, tattoo dependent factors like size and depth, colour of pigment and lastly host dependent factors, which includes primarily the presence of a robust immune response. Modifications in the existing techniques may help in better clinical outcome with minimal risk of complications. This article provides an insight into some of these techniques along with a detailed account of the factors involved in tattoo removal.
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Affiliation(s)
- Kabir Sardana
- Department of Dermatology, Maulana Azad Medical College, Delhi, India
| | - Rashmi Ranjan
- Department of Dermatology, Maulana Azad Medical College, Delhi, India
| | - Sneha Ghunawat
- Department of Dermatology, Maulana Azad Medical College, Delhi, India
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Sardana K, Ranjan R, Kochhar AM, Mahajan KG, Garg VK. A rapid tattoo removal technique using a combination of pulsed Er:YAG and Q-Switched Nd:YAG in a split lesion protocol. J COSMET LASER THER 2015; 17:177-83. [DOI: 10.3109/14764172.2015.1007066] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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