Role of the Alexandrite laser for removal of tattoos

The First Commercial 730 nm Picosecond-Domain Laser is Safe and Effective for Treating Multicolor Tattoos

Background and Objectives

Laser‐pumped lasers enable driving a secondary wavelength through pumping with a primary device. Here we investigate the first 730 nm laser‐pumped laser for efficacy in tattoo removal.

Study Design/Materials and Methods

Fifteen subjects with 20 tattoos were enrolled to investigate the effect of a new 730 nm, titanium‐sapphire laser‐pumped laser at removing decorative tattoos. A total of four treatments were administered and photographic improvement of pre‐ and post‐treatment cross‐polarized digital images was evaluated by four blinded physician observers using an 11‐point scale.

Results

Blinded assessment of pre‐ and post‐treatment images found 70%, 77%, 83%, 83%, 26%, and 8% clearance from baseline images for black, green, blue, purple, red and yellow pigments, respectively. Side effects were limited to pinpoint bleeding and erythema immediately after treatment and some crusting and scale up to 1–2 weeks following treatment, and a localized allergic reaction in a single subject. There was no scarring or pigmentary alteration visible in any follow‐up images.

Conclusion

The new 730 nm, picosecond‐domain, titanium‐sapphire, laser‐pumped laser is safe and effective for removing multicolored tattoos. Green, blue, and purple pigments cleared the most as expected, but black ink cleared more completely than was predicted. Lasers Surg. Med. © 2020 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC

A novel titanium sapphire picosecond-domain laser safely and effectively removes purple, blue, and green tattoo inks

BACKGROUND

Green, blue, and purple tattoo pigments are often the colors most resistant to laser removal. Recently, the first ever production picosecond-domain laser with a 785 nm wavelength was developed to improve the rate of clearance of green, blue, and purple tattoo inks.

METHODS

Twenty-two tattoos from 15 subjects with skin phototypes II-IV were enrolled in the study. A total of four treatments were administered using a single 785 nm picosecond-domain laser wavelength. Blinded assessment of digital, cross-polarized photographs taken approximately 8 weeks following the last treatment was performed using an 11-point clearance scale.

RESULTS

Fourteen subjects with 21 tattoos completed all study visits. The 21 tattoos contained the following pigments: black (n = 15), green (n = 13), blue (n = 8), yellow (n = 5), purple (n = 4), and red (n = 3). Treatments were performed with a 2-4-mm beam diameter and fluences ranging from 1.1 to 3.1 J/cm2 . Blinded assessment of photographs found 85%, 81%, 74%, 61%, 11%, and 5% clearance from baseline photos for purple, blue, green, black, red, and yellow pigments, respectively. Treatments were well tolerated with typical erythema, edema and one case of pinpoint bleeding. No scarring was noted.

CONCLUSION

This first study of a new 785 nm picosecond-domain laser demonstrates safe and effective removal of multicolor tattoos. Although clearance was shown for a multitude of colors including black, the 785 nm laser wavelength has special affinity to purple, blue and green tattoo pigments. Lasers Surg. Med. 9999:1-7, 2018. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Tattoos and human identification: investigation into the use of X-ray and infrared radiation in the visualization of tattoos

Any person with a tattoo known to their family or friends could potentially be identified from the presence of such personal identifying markers. Problems in identification utilizing tattoos may arise when these markers are removed or defaced in some way. This paper uses infrared wavelengths at 760, 850, and 950 nm to improve the visualization of laser-removed or covered up tattoos and also to establish whether the ink pigments used can be observed on radiographs from any metal that may be present. The results obtained indicate that some older inks have a high enough metallic content to allow them to be viewed on a radiograph, while infrared light can demonstrate latent ink still present in the skin after laser removal and can also be utilized to distinguish an original tattoo through a secondary "cover-up" tattoo. Infrared photography and radiography have been shown to improve tattoo visualization in a forensic context.

Laser treatment of amateur tattoos in Arabs in Kuwait: effectiveness and safety

BACKGROUND

Laser treatment of amateur tattoos on Fitzpatrick type V skin produces a considerable risk of complications because of the increased incidence of adverse pigmentary changes. The principle of selective photothermolysis predicts that the Q-switched alexandrite laser should be effective in removing tattoo ink with minimal side effects in patients with skin phototype V.

OBJECTIVE

To study the effectiveness of the Q-switched alexandrite (755 nm, 50 ns) laser in the treatment of amateur tattoos in Arabs in Kuwait.

METHODS

One hundred patients, each with multiple tattoos, were treated until total clearance. Fluences used ranged from 5 to 7 J/cm(2) with a spot size of 3 mm. Clinical evaluation was performed at baseline and at each follow-up visit until dyspigmentation resolved.

RESULTS

Total clearing was observed in all tattoos after an average of six sessions. Both tattoo clearing and post-laser hypopigmentation (29%) and hyperpigmentation (38%) increased with higher fluences.

CONCLUSION

In this prospective study, our findings suggest that the Q-switched alexandrite laser is an effective laser in removing amateur tattoos in patients with skin phototype V, but with a high incidence of pigmentary changes.

The use of Q-switched alexandrite laser (755 nm, 100 ns) for eyeliner tattoo removal

BACKGROUND

Eyelid tattooing for cosmetic reasons has increased in the past few years, and unsatisfied customers may request pigment removal. Q-switched laser systems have been useful in these cases.

OBJECTIVE

To evaluate the clinical result of a patient with a bluish-black eyelid tattoo treated with Q-switched alexandrite laser.

METHODS

Threshold fluence was determined and a spot test made on the first visit. Treatment was with QSAL, with a fluence range of 6.75-7.50 J/cm2 (mean fluence 7.125 +/- 0.26) and overlapping +/- 10% at 4-week intervals.

RESULTS

The eyeliner tattoo was not completely removed after five treatments with QSAL, but noticeable pigment lightening was obtained. No side effects were seen.

CONCLUSIONS

Q-switched alexandrite laser may be a useful device to remove the bluish-black pigment used in cosmetic eyeliner tattoo.

Lasers and optical technologies in facial plastic surgery

Lasers and optical technologies play a significant role in aesthetic and reconstructive surgery. The unique ability of optical technologies to target specific structures and layers in tissues to effect chemical, mechanical, or thermal changes makes them a powerful tool in cutaneous rejuvenation, hair removal, fat removal, and treatment of vascular lesions such as port-wine stains, among many other procedures. With the development of adjunct techniques such as epidermal cooling, lasers and optical technologies have become more versatile and safe. The constant improvement of existing applications and the emergence of novel applications such as photodynamic therapy, nanoparticles, spectroscopy, and noninvasive imaging continue to revolutionize aesthetic medicine by offering a minimally invasive alternative to traditional surgery. In the future, therapies will be based on individualized, maximum, safe radiant exposure to deliver optimal dosimetry. Lasers and optical technologies are headed toward safer, easier, more quantifiable, and more individualized therapy.

Tattoo removal--state of the art

Tattooing has been around since the early beginnings of modern civilization. The discovery of selective photothermolysis at last has made it possible to remove tattoos without leaving a scar. Q-switched neodymium: yttrium-aluminum-garnet, alexandrite, and ruby lasers with pulse durations in the nanosecond domain fulfill this need. Argon or cw-CO(2) lasers as well as intense pulsed light sources should not be used since they often produce significant scarring. This article provides an overview of current laser systems. Developments leading to new tattoo inks, feedback systems to detect the absorbance characteristics of tattoo inks, dermal clearing agents, and perhaps even lasers with shorter pulse-durations might improve the results in the future.

Efficacy of laser treatment of tattoos using lasers emitting wavelengths of 532 nm, 755 nm and 1064 nm

BACKGROUND

Multifunctional laser devices can be used to treat tattoos successfully.

OBJECTIVES

To report the efficacy of laser treatment in professional, amateur, accidental and permanent make-up tattoos from our own experience and to compare it with the literature.

METHODS

We retrospectively studied 74 consecutive patients with professional, amateur, make-up and accidental tattoos between June 1998 and November 2000. Patients were treated with a Q-switched Nd:YAG laser (wavelengths of 532 nm and 1064 nm), a Q-switched alexandrite laser (755 nm) and a variable pulse Nd:YAG laser (532 nm).

RESULTS

Fourteen patients (19%) achieved a complete response (>95% lightening of treated tattoos), 23 (31%) an excellent response (76-95% lightening) and 21 (28%) a good response (51-75% lightening). Sixteen patients (22%) showed only a slight improvement (< or =50% lightening). Make-up tattoos and blue-black professional tattoos were most successfully treated. Multicoloured professional tattoos needed more treatments (mean +/- SD 5.7 +/- 5.4) in comparison with single-colour tattoos (3.5 +/- 2.0). The amateur tattoos needed fewer treatments (2.8 +/- 1.1) in comparison with professional tattoos. With accidental tattoos the results depended on the particles which had penetrated the skin. In contrast to literature reports, newer tattoos showed a trend to better treatment results than older tattoos.

CONCLUSIONS

Using modern Q-switched lasers, tattoos are removed successfully with minimal risk of scarring and permanent pigmentary alterations. Even multicoloured tattoos can be treated successfully and with a low rate of side-effects.

Laser-tattoo removal--a study of the mechanism and the optimal treatment strategy via computer simulations

BACKGROUND AND OBJECTIVE

The physical mechanisms for laser-tattoo interactions and the tattoo particle breakup process are not well understood. This study investigates whether the mechanism of the breakup process can be identified via computer simulations and proposes a treatment strategy that can potentially minimize the collateral damage to the surrounding tissues. Note that the "removal" of tattoo particles is defined here as breakup of particles into smaller ones with sizes approaching or smaller than the visible wavelength of light so that they become less visible.

STUDY DESIGN/MATERIALS AND METHODS

The radiation-hydrodynamics code LATIS is used for the modeling. We first identify the magnitude of the tensile stress generated inside graphite tattoo particles as functions of laser pulse length and particle size. We then calculate the relationship between the surface laser fluence (defined as the time integrated energy flux) and the tensile strength of the tattoo particle at a given depth.

RESULTS

If the laser pulse length is sufficiently short, strong acoustic waves with tensile strengths exceeding the fracture thresholds for graphite are generated. The strength of the wave decreases with particle size and increases as the laser pulse length decreases. Simulation results are in general agreement with clinical studies. Although temperatures of the tattoo particles never reach the melting point, a cavitation bubble around the particle can be formed. The steam generated can get into the cracked particles and induce steam-carbon reactions. Laser energy density decreases rapidly with the skin depth. Therefore, the minimum surface laser fluence, for a given pulse length, required for breaking up tattoo particles at a given skin depth, increases with particle depth.

CONCLUSIONS

Computer simulations confirm that the breakup of tattoo particles is photoacoustic. For the same amount of laser energy, a shorter pulse is more efficient. The optimal pulse length is approximately 10-100 picosecond to minimize the laser fluence and the collateral damage. It is more difficult to break up the smallest tattoo particles that have diameters smaller than 10 nm; however, smaller particles are less important because they are less visible. Tissue surrounding the tattoo particles can be damaged by cavitation bubbles. These bubbles could be the cause of the empty vacuoles in the ash-white lesions throughout the dermis seen after treatment. Steam-carbon reactions can be induced. Particles then become grossly transparent because of this reaction. Different laser intensity should be used for pigments at different depths in order to minimize the collateral damage to the dermis.

Laser eradication of pigmented lesions and tattoos

Laser treatment of pigmented lesions can be a rewarding experience when appropriate lesions are treated. Accurate diagnosis of pigmented lesions is needed before treatment. In some lesions, adjuvant topical therapy is greatly beneficial, and for others it may be the only option. The treatment of melanocytic nevi is controversial but worth pursuing. All tattoos respond well to Q-switched lasers; the appropriate wavelength depends on the color of ink. Amateur and traumatic tattoos clear readily with laser treatment. Cosmetic tattoos should be approached with caution. In addition, the use of laser-responsive ink and higher-powered or shorter-pulsed (picosecond) lasers may further enhance the ability to treat tattoos.

Successful treatment of treatment-resistant laser-induced pigment darkening of a cosmetic tattoo

BACKGROUND AND OBJECTIVE

Cosmetic tattoo removal has a reported risk of immediate pigment darkening when treated with a high energy, nanosecond pulsed-laser system. Surgical treatment options for this reaction are limited and carry significant risk of scarring and permanent pigment alterations. This report describes the response of a resistant Q-switched ruby laser-induced cosmetic tattoo ink darkening to multiple treatments with the Q-switched alexandrite laser and Q-switch Nd:YAG laser and textural improvement with the UltraPulse CO(2) laser.

STUDY DESIGN/MATERIALS AND METHODS

A woman with Q-switched ruby laser-induced pigment darkening of a cosmetic tattoo of the upper lip resistant to four further treatments with the ruby laser and two chemical peels received a total of 26 treatments with the Q-switched alexandrite and Nd:YAG lasers and a single treatment with the UltraPulse CO(2) laser, most treatments being done at monthly intervals.

RESULTS

Treatment of the affected areas with the Q-switched alexandrite and Nd:YAG lasers resulted in complete clearing of the pigment without scarring, but revealed some preexisting textural changes. Use of the UltraPulse CO(2) laser smoothed the surface irregularities.

CONCLUSION

The Q-switched pigment lasers are a useful modality for treating this pigment darkening reaction. As in this case, multiple treatment sessions with the laser may be necessary but the pigment can be expected to clear eventually without scarring. Any textural changes may be blended with the UltraPulse CO(2) laser with further improvement.

Use of Q-switched alexandrite laser (755 nm, 100 nsec) for removal of traumatic tattoo of different origins

BACKGROUND AND OBJECTIVES

Q-switched laser systems have been used for removal of tattoo-related carbon, graphite, and other particles. We assessed elimination of traumatic tattoos of different origin with Q-switched alexandrite laser in nine patients.

STUDY DESIGN/MATERIALS AND METHODS

Fluence threshold was determined and a spot test was made. Q-switched alexandrite laser, with a fluence range 4.5-8.0 J/cm(2) (mean, 7.16 +/- 1.18), was used at 4-5-week intervals. Total treatment ranged from 3-12 sessions (mean, 6.1 +/- 3.6 sessions). Double-pulse technique was used in black/black-bluish areas, but single-shot was applied to slate-gray pigment.

RESULTS

More than 95% lightening was achieved in five patients after 5.2 +/- 2.3 sessions, and >75% lightening in six subjects after 6.1 +/- 3.1 sessions of treatment. Blacktop, surgical pen, and gravel tattoos presented a better response than gunpowder/fireworks tattoos (>95% vs. 68.7 +/- 23.9% clearance), or tattoos of unknown origin (>95% vs. 62.5 +/- 53% clearance). Epidermal splattering and pinpoint bleeding were observed in one case. No pigmentary alteration or scarring was seen.

CONCLUSION

The Q-switched alexandrite laser is a useful system for removal of traumatic tattoos of diverse origin. The best response (>95% clearance) was achieved in blacktop, surgical pen, and gravel tattoos, although an acceptable degree of lightening may be obtained in tattoos due to gunpowder or fireworks.

A clinical and histologic prospective controlled comparative study of the picosecond titanium:sapphire (795 nm) laser versus the Q-switched alexandrite (752 nm) laser for removing tattoo pigment

BACKGROUND

Theory predicts that picosecond lasers should be more effective than the currently available nanosecond lasers in removing tattoo ink. In addition to thermal confinement, such pulse widths cause optimal photomechanical disruption of the target.

OBJECTIVE

This study compared the efficacy of the picosecond titanium:sapphire (795 nm, 500 psec) laser and the Q-switched alexandrite (752 nm, 50 nsec) laser in the treatment of tattooed guinea pigs.

METHODS

Six albino guinea pigs, each with 6 uniformly 1 cm circular black tattoos, were treated. Three of the tattoos were divided into 2; one half was treated with the titanium:sapphire laser and the other half with the alexandrite laser. Fluences used for both lasers were 6.11, 4.24, and 2.39 J/cm2 with spot sizes of 1.25, 1.5, and 2 mm, respectively. The remaining spots served as control. Clinical evaluation and biopsies were performed at baseline and at 11 and 16 weeks after a single laser treatment.

RESULTS

Greater clearance of tattoo was observed in titanium:sapphire laser-treated areas in 2 of the 4 surviving guinea pigs. In some areas total clearing was observed after the single titanium:sapphire laser treatment. Clearing improved with higher fluences. No scarring was present. Histologic results showed similar findings.

CONCLUSION

Our findings suggest that the picosecond titanium:sapphire laser is more effective than the Q-switched alexandrite laser in removing tattoo pigment and may be of significant clinical utility.

Successful removal of traumatic tattoos in Asian skin with a Q-switched alexandrite laser

BACKGROUND

Traumatic tattoos result from mechanical penetration of the skin by foreign-body particles associated with puncture, abrasive, or explosive trauma. Until the recent development of the Q-switched lasers, it was not possible to remove tattoo pigments without scar and pigmentary changes.

OBJECTIVE

The objective of this study was to determine the effectiveness of the Q-switched alexandrite laser (wavelength, 755 nm; pulsewidth, 100 ns), in treating the 27 cases of Asian skin with 36 traumatic tattoos and to observe any side effects such as scarring or pigmentary change.

METHODS

The results of treatments on 16 patients with 19 penetrant tattoos, 10 patients with 16 abrasive tattoos and 1 patient with bomb explosion were clinically analyzed.

RESULTS

Greater than 76% removal of tattooed pigments required an average of 1.7 treatment sessions in penetrant tattoos in contrast with 2.4 sessions in abrasive tattoos. The excellent removal of traumatic tattoos required 7.5 J/cm2 except the scarred region of one explosive tattoo and one abrasive tattoo on soil. There were no permanent side effects such as scar or permanent pigmentary changes.

CONCLUSION

In conclusion, the Q-switched alexandrite laser is a safe and highly effective modality for removal of various traumatic tattoos without scar or permanent pigmentary change in Asian skin.

Complications of cutaneous laser surgery. A review

Continuous wave (CW) lasers, the first medical lasers to be used, continue to be effective, but are extremely operator dependent and can potentially result in significant risks, including scarring. In 1983, the theory of selective photothermolysis was introduced, which enabled physician-scientists to design lasers that were highly selective and safer to operate. These newer lasers are capable of affecting a specific target tissue without a high risk of scarring and pigmentary changes. They accomplish this task by producing a wavelength and pulse duration that is best absorbed by a specific target. However, not all modern lasers employ this theory and, therefore, may operate in either a CW, quasi-CW, pulsed, or Q-switched mode. CW lasers are least selective and tend to produce unwanted tissue damage and scarring through heat dissipation. Quasi-CW lasers attempt to limit unwanted thermal damage by producing a series of brief laser pulses or by the chopping of a CW beam; however, they still have a relatively high risk of causing nonspecific tissue damage and thermal injury. The pulsed and Q-switched systems adhere most closely to the principles of selective photothermolysis and result in the most selective destruction with the lowest risk of scarring and unwanted thermal diffusion. Of course, any laser system can potentially result in scarring and tissue damage; therefore, adequate operator education and skill are essential when utilizing medical lasers.

Laser treatment of tattoos

All three Q-switched laser systems can effectively remove most tattoos with minimal scarring or other adverse sequelae. Despite advances in laser technology, all tattoos cannot be completely eliminated, and several wavelengths remain necessary to optimally treat multicolored tattoos. The major advantage of Q-switched laser irradiation to effect tattoo removal is the low risk of scarring associated with treatment. Limitations include the need for multiple treatment sessions, minimal to incomplete responses in some cases, and the possibility of pigmentary and textural changes. Research continues in an effort to perfect laser removal of tattoos.

Complications of laser surgery

Medical lasers have advanced so rapidly over the past 10 years that a thorough review of the complications of laser surgery must be based on fundamental laser physics in order to provide a general working framework of knowledge. New laser systems are being introduced and older systems have been improved, often making modern laser technology appear intimidating. In order to understand and even predict the side-effect profile of a specific laser, one must comprehend the principles on which the laser operates. The first medical lasers to be designed, continuous wave lasers, are effective but are extremely operator-dependent and can potentially result in a great deal of scarring. In 1983, the theory of selective photothermolysis was introduced that enabled physician-scientists to design lasers that were highly selective and safer to operate. Lasers designed on the theory of selective photothermolysis are capable of affecting a specific target tissue without a high risk of scarring and pigmentary changes. They accomplish this task by producing a wavelength and pulse duration that are best absorbed by a specific target. Not all modern lasers use selective photothermolysis and therefore may operate in either a continuous wave, quasi-continuous wave, pulsed, or Q quality-switched mode. Continuous wave lasers are least selective and tend to produce unwanted tissue damage and scarring through heat dissipation. Quasi-continuous wave lasers attempt to limit unwanted thermal damage by producing a series of brief laser pulses or by chopping a continuous wave beam; however, they still have a relatively high risk of causing nonspecific tissue damage and thermal injury. The pulsed and Q-switched systems adhere most closely to the laws of selective photothermolysis and result in the most selective destruction with the lowest risk of scarring and unwanted thermal diffusion. Of course, any laser system can potentially result in scarring and tissue damage; therefore, adequate operator education and skill are essential when using any medical laser.