Tattoos are implantations of exogenous pigment into the skin or mucous membranes. There are five major subtypes of tattoos. Amateur tattoos are decorative tattoos performed by nonprofessionals (in most cases) and are often placed by using handheld needles that deliver Indian ink, Chinese ink, or carbon injected to variable depths of the skin. As these are placed more superficially than professional tattoos, they can be easily removed with a laser. Professional tattoos, which are permanent decorative tattoos, are made using a handheld tattoo gun that delivers uniformly deep dense dermal injections of ink, usually below the dermo-epidermal junction, which is retained by macrophages and fibroblasts in the dermis. Cosmetic tattoos are done using organic pigments in areas where the application of eyeliner, lip liner, or eyebrow makeup is common. Additionally, cosmetic tattoos can be used to treat surgical scars, draw nipples after a mastectomy, or even cover the scalp where a patient has alopecia. Medicinal tattoos are small gray or blue-black markings placed by medical personnel to designate radiotherapy fields or port placement sites. Similar to amateur tattoos, they are usually in the superficial layer of the skin. Traumatic or accidental tattoos result from deposits of foreign particles such as metal, glass, dirt, asphalt, amalgam, graphite, ink, or gun powder into the skin following mechanical penetration, often after blast injuries or trauma.
Laser tattoo removal is based on the concept of selective photothermolysis. It was described by Anderson and Parrish in 1980 as revolutionizing the landscape for laser therapy by allowing precise tissue targeting, thus ameliorating the risk of dyspigmentation and scarring associated with other methods of tattoo removal. It also mentions the concept of the thermal relaxation time (TRT), defined as the time taken for the target to dissipate about 50% of the incident’s thermal energy.
Picosecond lasers are a relatively novel laser technology with the ability to create a pulse of less than one nanosecond. They deliver optical pulse lengths that most closely match the TRT of tattoo pigment molecules. They are highly effective, due to their capacity to create greater mechanical stress on the target with fewer thermal effects, in comparison to nanosecond lasers. The high specificity of the picosecond laser to the target, with less diffusion of heat, creates fewer potential side-effects after each session.
This case represents an actual 39 year old patient, who tattooed himself 25 years ago using Chinese ink and a needle. He affirms he has lost important work opportunities due to the fact that he has that specific tattoo on his hand. Years ago, a small part of the tattoo had been surgically removed, leaving an atrophic scar shown on the pictures below.
I applied an anesthetic cream thirty minutes before each session, then began the treatment. During each session, the patient described his pain as 3/10.
Currently, he has been treated with two sessions of PicoCare 1064 nm Zoom handpiece for his amateur tattoo with the following parameters: spot 4 mm, fluence 1.5 J/cm2, frequency 3 Hz, 1 pass, obtaining brisk frosting and erythema.
His scar was also treated with Picocare 1064 nm MLA handpiece 1064 nm, fluence 2.5 J/cm2, spot 4 mm, frequency 3 Hz, only 1 pass, obtaining moderate petechiae.
Fitoestimuline (triticum vulgare) was used immediately after each session. The tattoo was covered with gause for 24 hours. The patient applied Fitostimuline two times a day and sunscreen until the end of the healing phase (fifteen days approximately). The time difference between the two sessions was 3 months.
Currently this patient is experiencing steady improvement through his laser tattoo removal treatments and favorable improvement of his atrophic scar. Although he’s having progressive improvement throughout his treatment series, more time will be needed to see the final result, and decide if a third session would be necessary for total tattoo removal.
The main mechanism of picosecond laser tattoo removal involves the fragmentation of the chromophore through both photothermal and photoacoustic effects. Picosecond lasers transmit light pulse lengths that are closer to the TRT of tattoo pigment molecules; therefore, they can deliver heat radiation more efficiently, while focused on the target area. The fact that amateur tattoos are more superficial than professional tattoos guarantees better results with fewer sessions, and a high degree of comfort when using topical anesthesia before the treatment.
ABOUT THE AUTHOR:
Valentina Dicker, MD is a certified doctor, trained in Aesthetic Medicine that specializes in lasers and injectable treatments for beautification and rejuvenation, non-surgical body contouring, and healthy habits to encourage integral treatments for her patients. She attended Medical School at Universidad del Rosario in Bogota, Colombia, where she also spent her three year residence in Aesthetic Medicine. She won the Arturo Aparicio´s award for her work in photoaging and factors related to it. She exclusively practices Aesthetic Medicine in Bogota, Colombia and is an active member of the Colombian Aesthetic Medicine Society.
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