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Tattoo Laser Removal. What's Up after 25 Years?

Tattoo Laser Removal. What's Up after 25 Years? Tattoo Laser Removal. What’s up after 25 years? WATCH THESE VIDOES AND READ THE ARTICLE IF YOU CONSIDERING TATTOO LASER REMOVAL LASER TATTOO REMOVAL TREATMENT TATTOO LASER REMOVAL PLAY VIDEO HOW DO LASERS REMOVE A TATTOO? TATTOO LASER REMOVAL PLAY VIDEO LASER TATTOO REMOVAL. WHAT'S UP? TATTOO LASER REMOVAL PLAY VIDEO LASER TATTOO REMOVAL RESULTS (befroe and after) TATTOO LASER REMOVAL PLAY VIDEO LASER COSMETIC TATTOO REMOVAL RESULTS (befroe and after) TATTOO LASER REMOVAL PLAY VIDEO History of tattoo Tattoos have fascinated humankind from all cultures and strata of society for centuries. From the ancient Egyptian, Greek, and Roman civilizations to the modern society we have today, skin markings have been used to enhance beauty, demonstrate uniqueness, signify belonging, and sometimes to identify, shame, or punish. The term tattooing is derived from “tattau,” a Tahitian word which translates essentially as “to mark” and is a process of implantation of permanent pigment granules in the skin. - Tattoos date back to 5200 years. The early tattoo was made by cutting the skin and rubbing powdered charcoal in the wound - Scientists believe tattoos may have been the first form of medical treatment - The tattoo has been found on female Egyptian mummies. Ancient Egyptians believed tattoos prevented complicated pregnancies and births - In the 10th and 11th centuries, crusaders had cross-shaped tattoos. If killed, that person would receive a Christian Burial. - The tattoo has been to mark slaves and criminals. - In many tribal communities, facial tattoos indicated a person’s status and accomplishment - In the 5th century, the Japanese developed tattoos in fine art with intricate designs and colors - In 19th and 20th century America, tattoos were mostly associated with sailors, fringe cultures, prisoners, and gangs How is a Tattoo Done? Tattoos are created by the introduction of exogenous pigment into the dermal skin layer and can be placed with intent or be the result of accidents and injury. Tattoo inks are composed of pigments or dyes combined with a tattoo pigment vehicle which entraps, encases, incorporates, complexes, encapsulates, or is otherwise associated with the pigment to form pigment/vehicle complexes that retain the pigment in the tissue. Most professional tattoo artists purchase inks pre-made (known as pre-dispersed inks), while some tattoo artists mix their own using a dry pigment and a carrier. Manufacturers are not required to reveal their ingredients or conduct trials, and recipes may be proprietary. Professional inks may be made from iron oxides (rust), metal salts, or plastics. Homemade or traditional tattoo inks may be made from pen ink, soot, dirt, blood, or other ingredients. Heavy metals used for colors include mercury (red); lead (yellow, green, white); cadmium (red, orange, yellow); nickel (black); zinc (yellow, white); chromium (green); cobalt (blue); aluminium (green, violet); titanium (white); copper (blue, green); iron (brown, red, black); and barium (white). Metal oxides used include ferrocyanide and ferricyanide (yellow, red, green, blue). Organic chemicals used include azo-chemicals (orange, brown, yellow, green, violet) and naptha-derived chemicals (red). Carbon (soot or ash) is also used for black. Other elements used as pigments include antimony, arsenic, beryllium, calcium, lithium, selenium, and Sulphur. Both blacklight and glow in the dark inks have been used for tattooing. Glow in the dark tattoo ink absorbs and retains a light and then glows in darkened conditions by process of phosphorescence. The ingredients in some "glow" inks are listed as: (PMMA) Polymethylmethacrylate 97.5% and microspheres of fluorescent dye 2.5% suspended in UV sterilized, distilled water. Blacklight ink does not glow in the dark, but reacts to non-visible UV light, producing a visible glow by fluorescence. The resulting brightness of both these inks is highly variable. Unsubstantiated claims have been made that some inks fade over time, yielding a "semi-permanent tattoo. The safety of such inks for use on humans is widely debated in the tattoo community. After Tattooing What Happen? After initial injection, the pigment is dispersed throughout a homogenized damaged layer down through the epidermis and upper dermis, in both of which the presence of foreign material activates the immune system's phagocytes to engulf the pigment particles. As healing proceeds, the damaged epidermis flakes away (eliminating surface pigment) while more rooted in the skin granulation tissue forms, which is later converted to connective tissue by collagen growth. This repairs the upper dermis, where pigment remains trapped within fibroblasts, concentrating in a layer just below the dermis/epidermis boundary. Its presence there is stable, but in the long term (decades), the pigment tends to migrate deeper into the dermis, accounting for the degraded detail of old tattoos. Tattoo pigment has been reported both intracellularly and extracellularly, with mild fibrosis and occasional foreign-body giant cell reactions, with allergic granulomas, and with sarcoid reactions. Tattoo ink is remarkably non-reactive histologically, despite the frequent use of different pigments of unknown purity and identity by tattoo artists. Although it rarely occurs, red (mercury), yellow (cadmium), green (chromium), and blue (cobalt) tattoo pigments have elicited a persistent, localized allergic or photoallergic dermatitis and, more infrequently, systemic reactions. Interestingly, the colors most involved in allergic reactions (red and yellow) often spontaneously disappear from a tattoo without clinical signs of a response. Complex and light absorbing molecules are implanted in the skin. When tattooed skin receives UV radiation or natural sunlight, photochemical cleavage of the pigments may occur. The decomposition products are hazardously showing a potential risk of being toxic or even carcinogenic. At present, a risk assessment is not feasible since the concentration of pigments and their decomposition products in skin are unknown. Sun protection is necessary for successful laser tattoo removal. First, it decreases the number of melanin pigments that competed with laser absorption with tattoo pigments. This means reduced intake with tattoo pigments (reduce efficacy and increase absorption by melanin pigments (epidermal injury and more side effects). How to Do Safe Tattooing? What are the Complications? The tattooing should be carried out by trained personnel so that the pigment is placed at the appropriate depth. Thorough cleaning of the surface to be tattooed is mandatory to prevent resident organisms of the skin from being introduced in the dermis. The inks should be sterile and of good quality without external contaminants to reduce the incidence of allergic and granulomatous reactions. Strict aseptic precautions are essential to prevent bacterial, viral, and fungal infections. The instruments should be sterile, and preferably all disposables should be used to avoid transmissible diseases such as Hepatitis B, C, and HIV infection and leprosy. There are regulations that restrict blood donation following a tattoo. The period varies from 4 months to 1 year in different counties. Who Get a Tattoo? In the United States, rates of tattooing have increased over the past several decades. It is currently estimated that 21%to 24%of the population in the United States has at least 1 tattoo. Tattoos also seem increasingly common in younger generations. It has been estimated that up to a quarter of young to middle-aged adults in the United States have at least one tattoo. 2 As tattoos become Who Get Laser Tattoo Removal? Why? 28% of people who get tattoos regret the decision within the first month. The motivation for tattoo removal includes new jobs or careers, the need to portray an image at work or in new social circles, and further, negative feelings towards old tattoos. Various psychosocial reasons, especially when names are tattooed, and patients reconsider or a change of faith in case of religious symbols. Many occupations, such as the armed forces, prohibit the presence of tattoos and seek tattoo removal. It has been rightly sung by Jimmy Buffett, an American singer, that a tattoo is a permanent reminder of a temporary feeling. How Does Laser Remove My Tattoo? The mechanism of action of the QSL is through photon absorption by tattoo pigment within fibroblasts. During the 40-nanosecond pulse, temperatures exceeding 1000°C can occur. Gaseous products of pyrolysis or pores created by superheated steam may account for the lamellated appearance of the granules after laser exposure. The reduction in pigment particle size and fragmentation of pigment-containing cells results from rapid thermal expansion, shock waves, and potentially localized cavitation. Fluence-dependent thermal damage to collagen immediately surrounding the irradiated tattoo pigment also occurs. Q-switched Nd:YAG lasers are capable of emitting two wavelengths of light, 1064- and 532-nm wavelengths. This enables effective treatment of dark tattoo pigments such as black and dark blue using the 1064-nm wavelength, as well as the removal of red and orange pigments using the 532-nm wavelength. This laser sends precise pulses of high energy light into the skin, vaporizing some tattoo inks and fragmenting other tattoo inks into thousands of tiny particles which are then safely eliminated from your skin by macrophages immune cells. How Long Should I Wait Between Tattoo Laser Removal? The appropriate treatment interval is critical and yet poorly understood. Early on, patients were treated every 4 weeks. Higher fluences and shorter pulse widths remove tattoo pigment more rapidly but may induce excessive shock wave tissue reaction; therefore, they must be balanced with the desire to remove dye without scarring or hypopigmentation. The current recommendation is to treat at 6- to 8-week intervals unless a more extended period of 2-3 months is needed for tissue recovery. For highly motivated patients, I schedule them every 2 weeks if only QS lasers are used. Fractional CO2 or Ultra-pulse CO2 is used every 4-6 weeks to help skin recover. You should think of the fading and eventual elimination of your tattoo as a project which you might work on from time to time over the next year or two. What are the Types of Tattoo? Tattoos can be divided into Decorative tattoo (amateur& professional), cosmetic, medical, and traumatic categories. Decorative tattoos are tattoos placed on the skin as a decoration. The classic types of tattoos such as amateur tattoos have paved the way to highly intricate multi-colored professional tattoos, with the current trend being 3D tattoos, optical illusion tattoos, head mandala tattoos, foot tattoos, miniature portraits, etc. Amateur tattoo inks consist of simple, carbon particles originating from burnt wood, cotton, plastic, or paper, or from a variety of inks, including India ink, pen ink, and vegetable matter. A needle used to deposit ink at various depth of the skin. The amateur tattoo is easily to remove as it contains low volume of pigments and superficially place. Professional tattoos contain more ink, deeper ink, and multiple colors with the help of a hollow needle or a tattoo gun to inject pigments into the dermal layer of skin. The granule depth remains uniform and is located at the bottom of about 400 ums in the upper to mid-dermis. This explains the difficulty in treating these tattoos as compared to amateur tattoos, which are superficially placed. Cosmetic tattoos are also known as micro- pigmentation or permanent cosmetics. This type of tattoo is used as permanent eyeliner, lip liner, lipstick, and other permanent cosmetic purposes. This type of tattoo is also used to cover skin pigment disorders, scars, and other blemishes. In the hands of professionals, permanent cosmetics can form a beneficial final step in the treatment of many patients. Cosmetic tattoos using skin-colored tones like medical tattoos used as radiation markers. Medical Tattoo is used to treat a condition, communicate information, or mark a body location. Tattoos have also been used to provide notice to emergency personnel that a person has diabetes mellitus. During breast reconstruction after mastectomy or breast reduction surgery, tattooing is sometimes used to replace the areola or to fill in areas of pigment loss, which may occur during breast reduction performed with a free nipple graft technique. Medical therapeutic tattooing has been used as a camouflage technique in vitiligo, as camouflage for permanent hair loss after craniofacial surgery, and scars following plastic and reconstructive surgery. The inks used often contain pigments that are red, brown, white, or flesh-colored; inks containing titanium dioxide and iron oxide are difficult to remove Traumatic tattoos are deposited in the skin following abrasion, laceration, or explosive injuries. Such pressurized penetration of dark particles into the deep dermis gives rise to black or blue tattoos, depending on the depth of the pigment. Traumatic tattoos acquired because of fireworks or explosives must be treated with great caution. Some of the particles embedded in the skin may be flammable and may reignite after laser treatment. This may result in significant scarring. These tattoos must be approached with care and a small test spot performed before embarking on the removal of large areas What are the Options of Tattoo Removal? The methods for tattoo removal can be distinguished into 2 groups, namely ablative and non-ablative tattoo removal procedures. Ablative or “Do Not Care” Tattoo Removal or the History of Tattoo Removal If you are in a hurry, unwilling to pay the expense of modern, long process of laser tattoo removal and above all willing to accept scars as a trade for tattoo removal (I call this attitude I don’t care" the old, ablative treatment is the way to go. In such treatment, the top layer of your skin that contains the tattoo pigments is ablated, and the skin healed with scar tissue. Another option to get a tattoo out is surgical excision. The main disadvantage of destructive mechanical modalities is the high risk of scarring; hypertrophic scars are common when tissue is removed deeply to extract all of the tattoo pigment. In addition, residual tattoo pigment is standard, and postoperative pain can be significant Salabrasion The oldest method of physical tissue destruction involves abrading the superficial dermis (past the point of bleeding) with coarse granules of common table salt and a moist gauze pad. Salt is then applied to the wound surface and left under the surgical dressing for 24 hours. The upper layer of skin is abraded or “sanded,” and the underlying layers of skin replace the damaged slabs, allowing the pigment to leach out of the skin. Though some authors were enthusiastic about this procedure, including me, residual tattoo pigment often remained after the wound healed, requiring subsequent treatments. I personally, tried this method myself in combination with ablative CO2 lasers with resultant scar tissue formation and incomplete removal of pigments Dermabrasion Dermabrasion is the primary method of mechanical tissue destruction. To remove as much tattoo pigment as possible, a rapidly spinning diamond fraise wheel. The procedure tends to be bloody. Tissue and blood particulates, of a size that can access pulmonary and mucosal surfaces, are aerosolized into the operative suite and may carry infectious agents. Subsequent scarring is worse if complete pigment removal is attempted in one session by creating a wound to the full depth of the tattoo pigment. Removing tissue only to the extent of the papillary dermis minimizes scarring but leaves significant tattoo pigment, requiring additional procedures that increase the scarring potential. To enhance efficacy, gentian violet or tannic acid and silver nitrate are applied to the superficially abraded surface Side effects and complications of this procedure are skin discoloration (hyperpigmentation or hypopigmentation) at the treatment site, infection of the tattoo site, incomplete pigment removal, or scarring, even 3–6 months after the tattoo is removed. Chemical Tissue Destruction In 1888, Variot first described the use of caustic chemicals (tannic acid and silver nitrate) after disruption of the skin surface with punctures and incisions. This technique, known as the French method, results in a scar that is less coarse than that from the application of more destructive chemicals but often leaves variable amounts of residual tattoo pigment. A combination of superficial dermabrasion and a form of tannic acid also resulted in hypertrophic scarring in 34% of patients and remaining tattoo in patients with deep tattoo pigment. Intradermal injection of tannic acid by using reciprocating needles results in epidermal and superficial dermal slough and has the same risks as other destructive modalities. Phenol solution, used in the same manner as in facial peels, and trichloroacetic acid in a 95% solution remove tattoos but result in hypopigmented scars. Repeat application is hazardous and may result in a full thickness burn that requires skin grafting. Thermal Tissue Destruction Thermal injury via fire, hot coals, and cigarettes has been used for centuries to try to remove unwanted tattoos, usually with significant scarring. Thermal cautery, with a glowing soldering iron or an electrical spark for electrodesiccation or electrocautery, is equally crude and unpredictable. The infrared coagulator, developed in West Germany in 1979, delivers a noncoherent, multispectral light with preset pulses triggered by an electronic timer. This instrument attempts to produce a more controlled cutaneous thermal injury that treats cutaneous vascular lesions and tattoos. A tungsten halogen light is the energy source, and it emits light with wavelengths of 400-2700 nm and a maximum emission near the infrared range at 900-960 nm. At this range, the primary tissue chromophores are water and oxygenated hemoglobin; however, when exogenous black and blue tattoo pigments predominate as target chromophores, a nonspecific thermal burn from heat absorption occurs. In general, dermatology, liquid nitrogen (-196 °C), is used to destroy superficial cutaneous lesions, but it is not useful in tattoo removal because the nonspecific destruction leads to prolonged healing and unpredictable results. However, successful treatment has been described, two 30-second, freeze-thaw cycles for the treatment of digital tattoos. Surgical Excision Surgical excision of skin containing tattoo pigment is also conventional but often results in incomplete tattoo removal, tissue distortion, and scarring because of limitations in wound closure and healing. Small tattoos located in areas of adequate skin laxity that allow primary closure without excessive tension can be satisfactorily removed with simple excision and the benefit of only a single treatment. However, this situation rarely occurs, and complicated wound closures, skin grafting, multiple-staged extractions, and the use of tissue expanders are often necessary to repair the tissue defect created by excision. The efficacy of this technique is highly dependent upon the individual surgeon, the size of the area to be resected, the tension of the skin in the area, and the individual’s tendencies toward scarring or developing a keloid. Read the full article

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