Laser has become the ultimate technique for removing
tattoo. However, it cannot be denied that it comes with its own pros and cons.
While the rate of success with other techniques is still uncertain, even when
appropriate techniques and devices are used, laser is the most trusted and
recommended method.
In their review
study on appropriate device selection and technique of laser tattoo
removal, Jeremy Green and Andrei Metelitsa, suggested
that practitioners must make the patients aware of the effectiveness of the
treatment used for tattoo removal and give them a clear picture of the existing
situation to ensure genuine expectation and compliance. Prior consultation with doctor can help educate patients
regarding the procedure involved in tattoo removal.
Prior to the treatment, the doctors examine the patient
thoroughly to ensure that the patient does not have history of any scar raised
over the surrounding skin area and to eliminate the possibility of existence of
any infectious disease. Thus, keeping in mind the physical condition of the
patient, the tattoo removal treatment may vary from one patient to another.
Other than these factors, the type of tattoo also governs the method that needs
to be adopted for its removal.
Doctors
often avoid giving Q switched laser treatment to patients who have received the
gold therapy as it may lead to pigmentation of the skin due to deposition of
gold in the tissues.
While it is always easier to remove an old tattoo compared
to a new one, an amateur tattoo can be removed in four to six treatments.
However, the same is not true for professional tattoos which take more time and
require eight sessions or more. The location of tattoo also governs the
effectiveness and time needed for its removal. Usually
tattoos done on acral locations (peripheral parts such as limbs, fingers, ears, etc.) are far more easily
removed compared with those done on truncal sites.
In a recent review of 238 patients who underwent tattoo
removal treatment, it was found that 1.26 percent of subjects achieved total
clearance of the tattoo without reporting any pigmentation. The researchers
believe that for other patients the results were less successful because they
were being
inadequately informed of the process and subsequently, they
underwent fewer treatments.
It is mandatory for any
practitioner to choose appropriate device for tattoo removal. To achieve
selective photo-thermolysis, a QS laser is necessary as the exposure time in
the nanosecond (10-9) domain is less than half the thermal relaxation time of
the target pigment. The method is effective since it causes minimal damage to
surrounding tissue from thermal diffusion.
Despite all the guidelines
provided, there is a need to understand that the effectiveness of the treatment
and selection of tattoo removal methods also depends largely on the composition
of the tattoo and the pigment may not necessarily respond to QS laser treatment.
Another device that can be used is
QS Nd:YAG when treating tattoos on Fitzpatrick type IV to VI patients. Fitzpatrick classification is a
skin type classification depending on skin color and reaction to sun exposure.
Skin color varies from brown to black and from 'rarely burn' to 'never burn'
reaction to sun exposure in case of type IV to type VI.
Irrespective of the method, practitioner must strive to control the
pain in order to ensure that the patient has a pleasant experience. This
can be achieved by either by giving topical anesthesia or intra-lesional
anesthesia.
Once
QS laser heat is directed at the tattoo, one can see immediate whitening of the
tissue which is due to rapid heating of chromophore that often leads to gas
formation. However in case of failure, no
such laser-tissue interaction is observed. Multiple wavelengths
of light in laser armamentarium are useful to treat modern day professional
tattoos.
Another
governing factor in the success of the treatment is the utilization of the largest
spot possible.
Practitioners often
reduce the spot to a small size as it results in greater scattering of beam
with less penetration. However, this method may increase superficial delivery
of energy and damage the epidermis. Application of emollients and occlusive
dressing like cooled hydrogel dressing is used to treat the area until the
epithelium over the burnt site is naturally recovered.
If the
treatment is not done properly, side effects like scarring and dys-pigmentation
may start appearing. As epidermal melanin serves as a competing chromophore, it
may lead to hypopigmentation or hyperpigmentation.Thus,
patients are advised
to avoid exposure to sun prior to laser treatment. Pigmentation may also occur
as a result of removing cosmetic tattoos that utilizes pink, yellow, white or
other colors for permanent makeup. In such cases, it is sensible to perform
a test spot prior to treating the entire tattoo.
The
second method for tattoo removal is to treat the spot with fractional carbon
dioxide erbium.
Although
both the methods are widely used for removing tattoos, research is underway to
improve both the techniques and devices. The recently invented "R20"
method is based on repeating QS laser treatment four times in a single session
spaced 20 minutes apart to allow whitening to fade.
It is also observed that fractional carbon dioxide laser therapy
performed immediately after QS laser treatment can enhance the rate of pigment
as compared to QS laser alone.
The researchers are still working
on lasers in the picosecond (10-12) domain. A sub-nanosecond pulse can be more
effective in confining the energy to the tattoo particle leading to an
increased photoacoustic breakup of the target. This will enable more effective
treatment utilizing less light that transfers less heat to the surrounding
tissue and minimizing the risk of scarring.
Reference:
Optimizing Outcomes of
Laser Tattoo Removal; Jeremy.B.Green et al; Skin Therapy Letter.com
Source: Medindia
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