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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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Al-Jumaily AM, Liaquat H, Paul S. Focused Ultrasound for Dermal Applications. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:8-17. [PMID: 37806924 DOI: 10.1016/j.ultrasmedbio.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023]
Abstract
Focused ultrasound (FUS) is emerging as one of the most promising, non-invasive treatment techniques. The advancement of transducer technology has paved the way for dermatological applications. A comprehensive review is presented for healthcare practitioners and researchers, summarizing the effect of various operational parameters on the injury zone produced by ultrasound beams for various dermatological applications, which include skin tightening, fat reduction, hyperpigmentation and cancer treatment. In this article, we aim to highlight the efficient operational parameters of FUS to enhance pain relief during surgery and its affordability for skin treatment. Finally, a prospective future technique for efficient FUS is discussed.
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Affiliation(s)
- Ahmed M Al-Jumaily
- Institute of Biomedical Technologies, Auckland University of Technology, Auckland, New Zealand.
| | - Hassan Liaquat
- Institute of Biomedical Technologies, Auckland University of Technology, Auckland, New Zealand
| | - Sharad Paul
- University of Auckland, Auckland, New Zealand
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Yang Q, Xue P, Fan X, Yin Y, Dang H, Li W, Song B. Lasers treatment for traumatic facial tattoo. Lasers Med Sci 2022; 38:28. [PMID: 36580127 PMCID: PMC9800346 DOI: 10.1007/s10103-022-03658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/28/2022] [Indexed: 12/30/2022]
Abstract
Effective treatment for traumatic tattoo is lacking. We aimed to compare the effectiveness and safety between Q-1064 nm laser as monotherapy and alternating Q-1064 nm laser with CO2 AFL in treating traumatic facial tattoo (black or blue color) and accompanied scars. Clinical data of 98 patients were grouped and analyzed based on the different treatment lasers. Tattoo clearance was evaluated with a 4-point scale, and scar improvement was analyzed with modified VOSAS scores. Patient satisfaction of the tattoo clearance and scar improvement, and treatment-related complications were analyzed. Significant increased clinical effects with patient satisfaction and decreased worsened scar were confirmed with the two alternated lasers, relative to those with Q-1064 nm laser alone (P < 0.05). Consequently, alternating Q-1064 nm laser and CO2 AFL treatment could be used for traumatic facial tattoo with black or blue color removal safely and effectively.
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Affiliation(s)
- Qing Yang
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China
| | - Ping Xue
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China
| | - Xing Fan
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China
| | - Yue Yin
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China
| | - Hui Dang
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China
| | - Wei Li
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China
| | - Baoqiang Song
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China.
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Tašič Muc B, Vella D, Lukač N, Kos M, Jezeršek M. Amplification of high-intensity pressure waves and cavitation in water using a multi-pulsed laser excitation and black-TiOx optoacoustic lens. BIOMEDICAL OPTICS EXPRESS 2022; 13:3993-4006. [PMID: 35991925 PMCID: PMC9352300 DOI: 10.1364/boe.460713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/28/2022] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
A method for amplification of high-intensity pressure waves generated with a multi-pulsed Nd:YAG laser coupled with a black-TiOx optoacoustic lens in the water is presented and characterized. The investigation was focused on determining how the multi-pulsed laser excitation with delays between 50 µs and 400 µs influences the dynamics of the bubbles formed by a laser-induced breakdown on the upper surface of the lens, the acoustic cavitation in the focal region of the lens, and the high-intensity pressure waves generation. A needle hydrophone and a high-speed camera were used to analyze the spatial distribution and time-dependent development of the above-mentioned phenomena. Our results show how different delays (td ) of the laser pulses influence optoacoustic dynamics. When td is equal to or greater than the bubble oscillation time, acoustic cavitation cloud size increases 10-fold after the fourth laser pulse, while the pressure amplitude increases by more than 75%. A quasi-deterministic creation of cavitation due to consecutive transient pressure waves is also discussed. This is relevant for localized ablative laser therapy.
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Affiliation(s)
- Blaž Tašič Muc
- Faculty of Mechanical Engineering, University of Ljubljana, Aškerčeva 6, Ljubljana, Slovenia
- Fotona d.o.o., Stegne 7, Ljubljana, Slovenia
| | - Daniele Vella
- Faculty of Mechanical Engineering, University of Ljubljana, Aškerčeva 6, Ljubljana, Slovenia
| | - Nejc Lukač
- Faculty of Mechanical Engineering, University of Ljubljana, Aškerčeva 6, Ljubljana, Slovenia
- Fotona d.o.o., Stegne 7, Ljubljana, Slovenia
| | - Matjaž Kos
- Faculty of Mechanical Engineering, University of Ljubljana, Aškerčeva 6, Ljubljana, Slovenia
| | - Matija Jezeršek
- Faculty of Mechanical Engineering, University of Ljubljana, Aškerčeva 6, Ljubljana, Slovenia
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Zawada T, Bove T. Strongly Focused HIFU Transducers With Simultaneous Optical Observation for Treatment of Skin at 20 MHz. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1309-1327. [PMID: 35410743 DOI: 10.1016/j.ultrasmedbio.2022.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 06/14/2023]
Abstract
High-intensity focused ultrasound (HIFU) transducers are proposed as a new treatment modality for dermatology. The shape and size of pressure fields generated by strongly focused transducers with an f-number equal to 0.75 operating at frequencies up to 20 MHz are analyzed analytically using the Lucas-Muir model and numerically with the wide-angle Khokhlov-Zabolotskaya-Kuznetsov method. The modeling results under quasi-linear conditions are compared against measurements performed in an acoustic tank with the aid of a fiberoptic hydrophone. The size of the focal zone expressed by their depth of focus and focal diameter is found to be directly controlled by their operating frequency and f-number. Devices manufactured for an operating frequency of 20 MHz are characterized by their 6 dB depth of focus of 490 μm and focal diameter of 80.6 µm. The devices are further studied at high power levels using a polyacrylic tissue-mimicking phantom. The devices are equipped with an optical observation system allowing simultaneous treatment and observation of the skin surface. In comparison to conventional cosmetic applications of HIFU, the devices analyzed are concluded to be ideal for treatment of precisely selected and confined layers of the human skin.
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Calik J, Migdal M, Zawada T, Bove T. Treatment of Seborrheic Keratosis by High Frequency Focused Ultrasound - An Early Experience with 11 Consecutive Cases. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:145-156. [PMID: 35125879 PMCID: PMC8808045 DOI: 10.2147/ccid.s348106] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/15/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE High intensity focused ultrasound operating at 20 MHz has been demonstrated as a safe and efficient treatment modality for a range of dermatological indications. The method is potentially also applicable to removal of seborrheic keratosis. PATIENTS AND METHODS A total of 54 seborrheic keratoses in 11 volunteer subjects (8 women and 3 men, average age 51.5 ± 13.2 years) were treated in a single session with a medical 20 MHz high intensity focused ultrasound device developed for dermatological conditions. Handpieces with nominal focal depths of 0.8 mm below the skin surface were used to administer acoustic energy of 0.99-1.2 J/dose. An integrated dermoscope in the handpiece was used to monitor the treatment in real-time. Treatment efficacy and side-effects were assessed directly after treatment and at follow-up 4-15 weeks after treatment. RESULTS The treatment showed positive results in 96.3% of the cases. About 68.5% of the cases were classified as complete response and 27.8% of the cases as partial response. Two cases (3.7%) did not respond to treatment and were classified as stable condition. No subjects experienced worsening of their condition, and no treatment received the classification of progressive condition. Side effects were primarily redness in the treatment area due to superficial telangiectasia, mild scarring, and persisting and slow-healing lichen planus-like keratosis. No adverse events were observed. CONCLUSION HIFU is concluded to be a safe and efficient skin treatment for seborrheic keratoses. It has advantages over conventional treatments that can lead to pain during treatment and scarring after healing.
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Calik J, Zawada T, Bove T. Treatment of superficial benign vascular tumors by high intensity focused ultrasound: Observations in two illustrative cases. J Cosmet Dermatol 2021; 21:3371-3379. [PMID: 34921489 PMCID: PMC9544960 DOI: 10.1111/jocd.14682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
Background Existing therapeutic methods for reduction or removal of superficial vascular malformations and tumors have high risks of scarring and other complications that result in aesthetic appearance less favorable than the baseline. Patients are often cautioned against intervention, which can lead to psychosocial problems and low self‐esteem. Improved treatment modalities are therefore relevant from both medical and aesthetic perspectives. Methods Two volunteer subjects were treated with a medical 20 MHz high intensity focused ultrasound device developed for dermatological conditions. One patient was given three treatments to remove a superficial congenital hemangioma on the left middle cheek. The other patient was given a single treatment to remove seven cherry angiomas on the thighs. Handpieces with nominal focal depths of 0.8 – 1.8 mm below the skin surface were used to administer acoustic energy of 1.1 – 1.2 J/dose. An integrated dermoscope in the handpiece was used to monitor the treatment in real‐time. Results During treatment, blood in the capillary network of the lesions was coagulated immediately, and capillary walls were collapsed due to the thermal and mechanical effects of the high intensity focused ultrasound. During the healing phase, the areas regenerated a normal skin structure with very limited scar or dyspigmentation. At follow‐up, a clear aesthetic improvement was observed over the baseline for all treated targets with the exception of two cherry angiomas, where focal depth and/or dose coverage had not been optimal. Conclusion High intensity focused ultrasound is concluded to be a safe and efficient skin treatment for benign superficial vascular malformations and tumors.
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Carlson CS, Postema M. Deep impact of superficial skin inking: acoustic analysis of underlying tissue. BIO INTEGRATION 2021. [DOI: 10.15212/bioi-2021-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract Background: Skin tattoos are a common decoration, but profound scientific study whether the presence of a skin tattoo alters the acoustic response from superficial tissue, and therefore from underlying tissue, was previously lacking. Any image aberrations
caused by tattoo presence may have been thought negligible, yet empirically found artifacts in brightness-mode images of tattooed skin suggest otherwise. This study investigated the nature of these artifacts theoretically and experimentally in extremely simplified cases of perfectly flat and
homogenous layered media and in tattooed pork.Methods: Theory was derived for computing the acoustic response from horizontally and vertically layered media containing a thin inked layer. Experiments were performed in vitro. Artificial and pork skin were tattooed, attached to phantom
material, and sonicated with a 13‐6-MHz probe. The speed of sound of these materials was determined, and the perceived refraction angles was measured.Results: The measured speeds of sound of tattooed materials were higher than those of their uninked counterparts. The presence
of tattoo ink was found to have increased the linear acoustic attenuation by 1 dB/cm. This value is negligible for typical tattoos of only few millimeters. The perceived critical refraction angles of adjacent materials could be detected, and their corresponding speeds of sound were quantified.
These coincided with values derived from theory.Conclusion: The ratio of speeds of sound of adjacent materials was shown to create distinct highlights in brightness-mode images. The artifacts observed in in vitro and in vivo brightness-mode scans were explained from near-vertical
transitions between areas of different sound speed. This is the first study correlating so-called critical refraction highlighting with speed-of-sound information. In addition, it was found that phantom material is a room-temperature acoustic alternative for experiments on live human skin.
In summary, the presence of superficial tattoos has a small but quantifiable effect on the acoustic response from deeper tissues.
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Affiliation(s)
- Craig S. Carlson
- School of Electrical and Information Engineering, University of the Witwatersrand, Johannesburg, 1 Jan Smuts Laan, 2050 Braamfontein, South Africa
| | - Michiel Postema
- School of Electrical and Information Engineering, University of the Witwatersrand, Johannesburg, 1 Jan Smuts Laan, 2050 Braamfontein, South Africa
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Bove T, Zawada T, Jessen A, Poli M, Serup J. Removal of Common Warts by High-Intensity Focused Ultrasound: An Introductory Observation. Case Rep Dermatol 2021; 13:340-346. [PMID: 34326728 PMCID: PMC8299387 DOI: 10.1159/000515075] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/07/2021] [Indexed: 01/19/2023] Open
Abstract
Therapies of common warts are cumbersome and not very effective. Recurrences are common. A new 20 MHz high-intensity focused ultrasound (HIFU) method is introduced as a new potential treatment modality. With HIFU, selected targets in the epidermis and dermis can be treated with full control of the depth and position of the ultrasound lesion and the energy applied to the target. The treatment can be monitored directly in real-time via an integrated dermoscope in the ultrasound probe. Two warts were treated with 8-10 shoulder-by-shoulder treatment doses, focal depth 1.3 mm, and 1.2 J/dose. Pretreatment ultrasound B-mode scanning had shown the thickness and depth of the warts. The treated areas developed a dry wound covered by a crust over the next 1-2 days. After 2 weeks the skin was healed, with no wart and no scar. Observation showed no reoccurrence. HIFU has future potential for treatment of common warts and flat warts, and a broad range of skin lesions being logic further candidates for targeted ablative treatment. One single treatment may suffice. It is, therefore, a new modality in dermatology with a large range of indications.
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Affiliation(s)
| | | | | | | | - Jørgen Serup
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark
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Gouda M, El-Din Bekhit A, Tang Y, Huang Y, Huang L, He Y, Li X. Recent innovations of ultrasound green technology in herbal phytochemistry: A review. ULTRASONICS SONOCHEMISTRY 2021; 73:105538. [PMID: 33819867 PMCID: PMC8048006 DOI: 10.1016/j.ultsonch.2021.105538] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/16/2021] [Accepted: 03/20/2021] [Indexed: 05/10/2023]
Abstract
Ultrasound (US) has become one of the most important techniques in green chemistry and emerging technologies. Many research investigations documented the usefulness of US in a wide range of applications in food science, nanotechnology, and complementary medicine, where effective extraction of natural products is important. However, as with all novel technologies, US has advantages and limitations that require clarification for full adaptation at an industrial scale. The present review discusses recent applications of US in herbal phytochemistry with the emphasis on US effects on chemical structures of bioactive compounds extracted from herbs and their bioactivities. The impact of different US processing conditions such as frequency, intensity, duration, temperature, and pressure on the effectiveness of the extraction process and the properties of the extracted materials are also discussed. Different frequencies and intensities of US have demonstrated its potential applications in modifying, determining, and predicting the physicochemical properties of herbs and their extracts. US has important applications in nanotechnology where it supports the fabrication of inexpensive and eco-friendly herbal nanostructures, as well as acoustic-based biosensors for chemical imaging of the herbal tissues. The application of US enhances the rates of chemical processes such as hydrolysis of herbal fibers, which reduces the time and energy consumed without affecting the quality of the final products. Overall, the use of US in herbal science has great potential to create novel chemical constructions and to be used as an innovative diagnostic system in various biomedical, food, and analytical applications.
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Affiliation(s)
- Mostafa Gouda
- College of Biosystems Engineering and Food Science, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China
- Department of Nutrition & Food Science, National Research Centre, Dokki, Giza, Egypt
| | | | - Yu Tang
- College of Automation, Guangdong Polytechnic Normal University, Guangzhou 510665, China
| | - Yifeng Huang
- College of Civil Engineering and Architecture, East China Jiaotong University, Nanchang 330013, China
| | - Lingxia Huang
- College of Animal Sciences, Zhejiang University, Hangzhou 310058, China
| | - Yong He
- College of Biosystems Engineering and Food Science, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China
| | - Xiaoli Li
- College of Biosystems Engineering and Food Science, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, China
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Serup J, Bove T, Zawada T, Jessen A, Poli M. 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. Skin Res Technol 2020; 26:839-850. [PMID: 32557859 PMCID: PMC7754334 DOI: 10.1111/srt.12885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/23/2020] [Indexed: 12/28/2022]
Abstract
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.
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Affiliation(s)
- Jørgen Serup
- Department of DermatologyBispebjerg University HospitalCopenhagenDenmark
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