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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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Marini L, Marini S, Cutlan J, Hreljac I. Q-S laser micro-drilling and multipass full-beam Q-S laser for tattoo removal - a case series. Lasers Med Sci 2021; 37:1763-1771. [PMID: 34606037 PMCID: PMC8971194 DOI: 10.1007/s10103-021-03431-w] [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: 06/17/2021] [Accepted: 09/26/2021] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to evaluate the safety and efficacy of a new combined method of Q-S laser-assisted tattoo removal. Ten patients with 13 professional, mostly mono-chromatic black tattoos were recruited. All tattoos received the same Q-S laser treatment sequence. An objective evaluation of tattoo clearing was assessed by careful analysis of a standardized collection of digital images taken from each tattoo, 2 months after each laser session, with the help of a custom-made pigment-fading percentage photographic ruler. The percentages of pigment clearance and side effects were evaluated by 4 independent dermatologists. Patient satisfaction and perceived discomfort during and post-procedure were evaluated according to specific scales. Clinical evaluators confirmed an average photographic pigment clearance of 97% after a median 4.85 treatment sessions. The Frac-Tat® method required 40% fewer sessions compared to those calculated by Kirby-Desai estimates. Photographic assessment of laser-exposed skin quality performed 2 months after tattoo clearing was considered almost comparable with untreated peripheral skin, confirming a very low side effect score. The Frac-Tat QS laser-assisted tattoo removal sequence used in our study showed a high degree of safety and efficiency, clearing exogenous pigments in a relatively few number of sessions. Preliminary ablative photo-acoustic fractional 1064-nm Q-S laser micro-drilling was considered an essential step in optimizing tattoo removal, increasing wavelength-independent micro-columnar clearing of deeper dermal exogenous pigments. Our preliminary observations also confirmed a significant improvement of tattoo procedure-induced micro-textural changes thanks to a tissue remodeling effect induced by the 1064-nm Q-S fractional laser photo-acoustic ablation.
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Affiliation(s)
- Leonardo Marini
- SDC The Skin Doctors Center, via dei Bonomo 5/a, 34126, Trieste, Italy.
| | | | - James Cutlan
- Royal Glamorgan Hospital, Llantrisant, Wales, UK
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Lajevardi V, Mahmoudi H, Karimi F, Kalantari Y, Etesami I. Comparing QS Nd:YAG laser alone with its combination with fractional ablative Er:YAG in tattoo removal. J Cosmet Dermatol 2021; 20:4078-4080. [PMID: 33728764 DOI: 10.1111/jocd.14076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/19/2021] [Accepted: 03/10/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Vahideh Lajevardi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mahmoudi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshte Karimi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasamin Kalantari
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ifa Etesami
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Kurniadi I, Tabri F, Madjid A, Anwar AI, Widita W. Laser tattoo removal: Fundamental principles and practical approach. Dermatol Ther 2020; 34:e14418. [PMID: 33068020 DOI: 10.1111/dth.14418] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 11/28/2022]
Abstract
Tattoos have long become a part of human civilization. However, as the number of people who get tattoos increases, so is the number of people who wish to have their tattoos removed. Compared to other methods, laser-based devices are associated with the best efficacy and least side effects in tattoo removal. Lack of understanding of the fundamental principles of laser and managing its parameters may result in suboptimal result and increased risk of side effects. Recognizing and mastering multiple factors including skin types, nature and color of tattoos, and proper selection of laser parameters such as wavelength, fluence, and pulse, are central in achieving an optimal tattoo removal outcome. This review provides a comprehensive overview on the fundamental principle of laser and practical approaches in tattoo removal.
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Affiliation(s)
- Ivan Kurniadi
- Faculty of Medicine, Department of Dermatology and Venereology, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia
| | - Farida Tabri
- Faculty of Medicine, Department of Dermatology and Venereology, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia
| | - Asnawi Madjid
- Faculty of Medicine, Department of Dermatology and Venereology, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia
| | - Anis Irawan Anwar
- Faculty of Medicine, Department of Dermatology and Venereology, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia
| | - Widya Widita
- Faculty of Medicine, Department of Dermatology and Venereology, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia
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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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del Río-Sancho S, Castro-López V, Alonso MJ. Enhancing cutaneous delivery with laser technology: Almost there, but not yet. J Control Release 2019; 315:150-165. [DOI: 10.1016/j.jconrel.2019.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 12/30/2022]
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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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Zhang M, Gong X, Lin T, Wu Q, Ge Y, Huang Y, Ge L. A retrospective analysis of the influencing factors and complications of Q-switched lasers in tattoo removal in China. J COSMET LASER THER 2017; 20:71-76. [PMID: 29020482 DOI: 10.1080/14764172.2017.1376096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mengli Zhang
- Department of Cosmetic Laser Surgery, Hospital of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, China
| | - Xiangdong Gong
- Division of Sexually Transmitted Disease Epidemiology, Hospital of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, China
| | - Tong Lin
- Department of Cosmetic Laser Surgery, Hospital of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, China
| | - Qiuju Wu
- Department of Cosmetic Laser Surgery, Hospital of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, China
| | - Yiping Ge
- Department of Cosmetic Laser Surgery, Hospital of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, China
| | - Yuqing Huang
- Department of Cosmetic Laser Surgery, Hospital of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, China
| | - LiYu Ge
- Department of Pharmacal Research, Hospital of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, China
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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
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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