Effective Tattoo Removal Treatments

Effective Tattoo Removal Treatments

Human beings have been experimenting with tattoos since ancient times. And, it’slikely, that as long as tattoos have been around so has the need for tattoo removal. Through the years, many methods of removal havebeen attempted. Some of the first attempts at removal were done through techniques such as dermabrasion, salabrasion, liquid nitrogen, and surgical excision among others. The advent of the laser brought new options for removal – beginning with the argon laser and CO2 laser.

But these options have been replaced by newer options. Here, we’ll discuss the three lasers most commonly used in tattoo removal :

• Q-switched ruby (QSRL)
• Q-switched neodymi-um:yttrium-aluminum-garnet (QSNd:YAG)
• Q-switched alexandrite (QSAlex)

and offer tips on choosing the best treatment for the patient.

THE Q-SWITCHED LASERS

Q-switching of a laser is a mechanism often used to control the light output by concentrating all the energy into intense bursts or series of pulses. To put it simply : The Q-switched lasers deliver a fast, powerful pulse. Due to their high energy and short pulse duration these lasers induce selective photothermolysis. The Q-switched lasers have uniformly replaced both the carbon dioxide and argon laser for the treatment of tattoo pigment.

Q-switched ruby laser (QSRL):

The QSRL is a laser containing a ruby crystal of aluminum trioxide doped with chromium ions. Doping is a process in which the crystal is grown in the presence of an impurity so that the crystal lattice purposely forms with an impurity within it. A ruby rod is placed within the laser cavity where flashlamps excite the chromium ions to produce photons at a wavelength of 694 nm with 20 ns to 40 ns pulse durations.

QSRL light penetrates about 1 mm into the skin and is well absorbed by black tattoo ink.This level of penetration is clinically advantageous for reaching tattoo pigment located within the dermis. At a wavelength of 694 nm, the QSRL light is minimally absorbed by hemoglobin but is well absorbed by melanin.

In 1965, Goldman documented the earliest report of tattoo pigment interaction with Q-switched
lasers. Less than satisfactory results including necrosis and retention of tattoo ink were noted, however, Goldman continued to follow these patients and noted continued fading of the treated area with time.

In 1983 Reid et al published a report on the removal of black pigment in both professional and
amateur tattoos with the QSRL. They reported good results, particularly with amateur tattoos but noted several disadvantages, including the need for multiple treatments. They found that amateur tattoos cleared after an average of four to six treatments where as professional tattoos required one to three additional treatment sessions for complete pigment removal.

In a later study by Taylor et al., 35 amateur and 22 professional blue-black tattoos showed fading or total clearing in 78% of amateur and 23% of professional tattoos. Although these statistics were less than ideal, the authors were optimistic that the QSRL would become the favored treatment for tattoos.

Lowe et al demonstrated that after five treatment sessions, 22 of 28 professional tattoos showed excellent results (>75% improvement). Green pigmented tattoos responded variably but did fade with continued treatment. Kilmer and Anderson reported black and green ink to be the most responsive with other colors requiring significantly more treat-
ments. They also noted that professional, distally located, recently acquired, or deeply placed tattoos may be more difficult to remove.

Overall, the QSRL was found highly effective for amateur tattoos, moderately effective for black professional tattoos, and less effective for brightly colored professional tattoos.

BY WILLIAM KIRBY, D.O., TEJAS DESAI, D.O., AND FRANCISCA KARTONO, B.S.

We will discuss the Q-switched neodymi-um:yttrium-aluminum-garnet (QSNd:YAG) in the next post.

Effective Tattoo Removal Treatments