Tattoo removal has been done with various tools since the beginning of the tattoo. While tattoos are considered permanent, it is now possible to remove them with care, fully or partially.
"The standard modality for tattoo removal" is the removal of non-invasive tattoo pigments using a Q-switched laser. Different types of Q-switched lasers are used to target different colors of tattoo ink depending on the specific light absorption spectra of the tattoo pigment. Usually, black ink and other dark colors can be removed completely using a Q-switched laser while lighter colors such as yellow and green are still very difficult to remove. Success can depend on a variety of factors including skin color, ink colors, and the depth at which the ink is applied.
The Q-switched laser was first commercially available in the early 1990s. For decades before that, continuous wave lasers were used as medical lasers to remove tattoos. Continuous wave lasers use high-energy rays that obscure the target area and destroy the surrounding tissue structures and tattoo inks. Treatment tends to be painful and causes scarring.
Prior to the development of laser tattoo removal methods, common techniques include dermabrasion, TCA (Trichloroacetic acid, acid removing the top layer of skin, reaching as deep as the layers where tattoo ink is), salabrasion (rubbing the skin with salt), cryosurgery and occasional excision used in conjunction with skin grafts for larger tattoos. Many other methods for tattoo removal have historically been suggested including injection or application of tannic acid, lemon juice, garlic and pigeon droppings.
Recent research is investigating the potential for multi-pass treatment and the use of picosecond laser technology, which seems promising.
Video Tattoo removal
Motives
A poll conducted in January 2012 by Harris Interactive reported that 1 in 7 (14%) of 21% of American adults who have a tattoo of regret get one. The poll did not report the reason for this regret, but a poll conducted four years earlier reported that the most common reasons were "too young when I get a tattoo" (20%), "permanent" and "I" m flagged for life "(19% ), and "I just do not like it" (18%). Previous polls show that 19% of British people with tattoos have regrets, as do 11% of Italians who have tattoos.
Surveys of tattoo removal patients were conducted in 1996 and 2006 and provide more insight. Of those surveyed, patients who regretted their tattoos usually obtained their tattoos in their late teens or early twenties, and were distributed equally by gender. Among those who sought relocation, more than half reported that they "suffered shame". New jobs, problems with clothing, and significant life events are also often referred to as motivation. Tattoos that were once symbols of inclusion in groups, such as gangs, can make it difficult to become employable. Tattoos that show significant relationships like a spouse, girlfriend or girlfriend, can be a problem if the relationship ends. Angelina Jolie, Eva Longoria, Marc Anthony, and Denise Richards are some celebrities who have removed this type of tattoo.
The choice to get a tattoo that later regrets is related to the illusion of late-history, where teenagers and adults of all ages know that their tastes have changed regularly for many years before the present moment, but believe that their tastes will change. somehow not growing and maturing in the future. As a result, they wrongly believe that any tattoos that appeal to them today will always appeal to them in the future.
Maps Tattoo removal
Removal with replacement
Some users decide to cover up unwanted tattoos with new tattoos. This is commonly known as cover-up. Artfully done closures can make the old tattoo completely invisible, although this will depend heavily on the size, style, color and techniques used on old tattoos and tattoo artist skills. Covering the previous tattoo requires a darker tone on the new tattoo to effectively hide older and unwanted pieces. Many tattoos are too dark to be covered up and in those cases patients may receive laser tattoo removal to brighten up the existing ink to make themselves better as candidates for a covered tattoo.
Laser deletion
The tattoo removal is most often done by using a laser that breaks the ink particles in the tattoo into smaller particles. Dermal macrophages are part of the immune system, responsible for collecting and digesting cell debris. In the case of tattoo pigments, macrophages collect ink pigments, but difficulty deciphering them. Instead, they store ink pigments. If the macrophage is damaged, it releases its captive ink, which is removed by other macrophages. It can be very difficult to remove tattoos. When the treatment breaks the ink particles into smaller pieces, macrophages can more easily remove them.
Tattoo pigments have a specific light absorption spectrum. Laser tattoos should be able to radiate enough energy in the absorption spectrum of the given pigment to provide effective treatment. Typical tattoo pigments, such as yellow and fluorescent inks, are more challenging to treat than dark and dark blue, because they have absorption spectra that fall outside or on the edge of the emission spectrum available on the tattoo laser. The latest pastel-colored ink contains highly reflective titanium dioxide concentrations. As a result, the ink is difficult to remove because they reflect a large amount of light energy coming out of the skin.
The gold standard of tattoo lifting modalities is considered as laser tattoo removal using several separate Q-switched lasers (depending on the specific wavelength required for the dye involved) during a number of repeat visits. There are several types of Q-switched lasers, and each is effective for removing different color spectrum ranges. Lasers developed during or after 2006 provide some wavelengths and can successfully treat tattoo pigments that are much wider than previous individual Q-switched lasers. Unfortunately the dye system used to alter the wavelengths results in significant power reduction so that the use of several separate specific wavelength lasers remains the gold standard.
The energy density (fluence), expressed as joule/cm 2 , is determined before each treatment as well as the spot size and repetition rate (hertz). To reduce pain, the preferred method is to cool the area before and during treatment with medical grade coolant/coolant and use topical anesthesia. During the treatment process, the laser beam passes through the skin, targeting the ink to rest in a liquid state inside. While it is possible to see immediate results, in many cases fading occurs gradually over a 7-8 week healing period between treatments.
The Q-switched laser is reported by the National Institutes of Health to produce rare scar tissue. Areas with thin skin will be more likely to scar than thick-skinned areas.
Mechanism of laser action
The experimental observations of the short pulsation laser effects on tattoos were first reported in the late 1960s by Leon Goldman and others. In 1979, argon lasers were used to remove tattoos in 28 patients, with limited success. In 1978 carbon dioxide lasers were also used, but due to water targeted, chromophores present in all cells, this type of laser generally causes scarring after treatment.
In the early 1980s, a new clinical study began at Burns and Plastic Surgery Unit at Canniesburn Hospital, in Glasgow, Scotland, into the energy effects of a ruby ​​laser Q-switched on a blue/black tattoo. Further research into other tattoo colors is then done with varying degrees of success. Research at the University of Strathclyde, Glasgow also shows that there is no detectable mutagenicity in tissue after radiation with a ruby ​​laser Q-switched. This basically shows that care is safe, from a biological point of view, without the detectable risks of cancer cell development.
It was not until the late 1980s that the Q-switched laser became commercially practical with the first marketed lasers coming from Derma-lase Limited, Glasgow. One of the first published American articles describing laser tattoo removal was written by a group at Massachusetts General Hospital in 1990.
Tattoos are made up of thousands of tattoo pigment particles that stick to the skin. While normal human growth and healing process will remove small foreign particles from the skin, the tattoo pigment particles are too large to be removed automatically. Laser treatment causes the tattoo pigment particles to heat up and break down into smaller parts. These smaller pieces are then removed by normal body processes. The Q-switched laser produces bursts of infrared light at certain frequencies that target a particular color spectrum in tattoo ink. The laser passes the top layer of skin to target specific pigments in the bottom layer.
Laser tattoo removal is a successful application of selective photothermolysis (SPTL) theory. However, unlike treatment for blood vessels or hair, the mechanisms required to destroy tattoo particles use photomechanical effects. In this situation the energy is absorbed by the ink particles in a very short time, usually nanoseconds. The surface temperature of the ink particles can rise up to thousands of degrees but this energy profile quickly collapses into a shock wave. These shock waves then spread throughout the local tissues (dermis) causing the fragile structure to fragment. Therefore the network is largely unaffected as they only vibrate when the shock wave passes. For the removal of laser tattoos the destruction of tattoo pigments selectively depends on four factors:
- The color of light must penetrate far enough into the skin to reach the pigment tattoo. Deeper pigments in the skin are more difficult to remove than near ones.
- The color of the laser beam should be absorbed more by the tattoo pigment than the surrounding skin. Different tattoo pigments therefore require different laser colors. For example, red lights are absorbed by green tattoo pigments, while yellows tend not to absorb light.
- The duration of time (pulse duration) of the laser energy must be very short, so that the tattoo pigment is heated to a fragmentation temperature before the heat can disappear into the surrounding skin. Otherwise, heating the surrounding tissues can cause burns or scars. For laser tattoo removal, this duration should be on a nanosecond sequence.
- Sufficient energy must be delivered during each laser pulse to heat the pigment to fragmentation. If the energy is too low, the pigment will not break and no removal will occur.
The Q-switched laser is the only commercially available device that can meet this requirement.
Although they are rare, mucosal tattoos can be successfully treated with Q-switched lasers as well.
A new method for removing laser tattoos using fractionated CO2 or Erbium: YAG lasers, alone or in combination with Q-switched lasers, was reported by Ibrahimi and colleagues from the Wellman Center of Photomedicine at Massachusetts General Hospital in 2011. This new approach to eliminating laser tattoos may be able to remove colors such as yellow and white, which have proven resistant to traditional Q-switched laser therapy.
Laser parameters affecting result
Some color laser light (measured by laser wavelength) is used to remove tattoos, from visible light to near-infrared radiation. Different lasers are better for different tattoo colors. As a result, the removal of multi-color tattoos almost always requires the use of two or more laser wavelengths. Tattoo laser removal is usually identified by the amplifier medium used to create wavelength (measured in nanometers (nm)):
- Q-switched Frequency-doubled Nd: YAG: 532Ã, nm. This laser produces a green light that is absorbed by red, yellow, and orange targets. Useful primarily for red and orange tattoo pigments, these wavelengths are also highly absorbed by melanin (a chemical that gives skin tones or browns) that make the laser wavelength effective for fading spots or sunspots. Nd: YAG laser can cause absorption of hemoglobin, which leads to purpura (blood collection under tissue in large area), indicates bleeding, or whiten skin.
- Q-switched Ruby: 694Ã, nm. This laser creates a red light that is so absorbed by green and dark tattoo pigments. Because more is absorbed by melanin, this laser can produce unwanted side effects such as pigment changes for all but the white patient. This is the best wavelength for blue ink.
- Q-switched Alexandrite: 755Ã, nm. The weakest of all devices is q-switched and somewhat similar to Ruby lasers in which Alexandrite creates red lights that are so absorbed by green and dark tattoo pigments. However, the color of the alexandrite laser is slightly less absorbed by melanin, so this laser has a slightly lower incidence of unwanted pigment changes than the ruby ​​laser. This laser works well on a green tattoo but due to its weaker peak strength it works only quite well in black and blue ink. It does not work at all (or very minimal) on red, orange, yellow, brown, etc. The laser wavelength is also available in picosecond speeds with anecdotal claims that it removes ink more quickly.
- Q-switched Nd: YAG: 1064Ã, nm. This laser creates a near-infrared (invisible to humans) light that is absorbed poorly by melanin, making it the only laser suitable for darker skin. The laser wavelength is also absorbed by all dark tattoo pigments and is the safest wavelength to use on tissue due to low melanin absorption and low hemoglobin absorption. This is the preferred wavelength for tattoo removal on darker skin types and for black ink.
- The Dye module is available for multiple lasers to convert 532m to 650nm or 585nm light which enables one laser system to safely and effectively treat multi-color tattoo ink. When the dye module takes the 532 wavelength laser and changes it, there is a loss of energy. Treatment with dye packs, while effective for some of the first treatments, many of which can not completely clear the ink color. The role of laser dye in tattoo removal is discussed in detail in the literature.
Pulsewidth or pulse duration is a critical laser parameter. All Q-switched lasers have the correct pulse duration to remove tattoos.
The spot size, or width of the laser beam, affects the treatment. Light is optically scattered on the skin, like a car's headlights in the fog. The larger spot size slightly increases the effective penetration depth of laser light, thus enabling more effective targeting of deeper tattoo pigments. Larger spot sizes also help with faster maintenance.
Fluence or energy density is another important consideration. Fluence is measured in joules per square centimeter (J/cmÃ,²). It is important to be treated in a setting high enough to cut tattoo particles.
Repetition rates help speed up treatment but are not associated with any treatment effects. A faster treatment is usually preferred because the pain ends more quickly.
Number of laser tattoo lifting care sessions needed
Complete laser tattoo removal requires many treatment sessions, usually spaced at least seven weeks. Treating more often than seven weeks increases the risk of side effects and does not always increase the rate of ink absorption. Anecdotal reports of four-week treatment sessions cause more scarring and dischromia and can be a source of responsibility for doctors. At each session, some but not all tattoo pigment particles are effectively fragmented, and the body removes the smallest fragments for several weeks or months. The result is that the tattoo becomes lighter over time. The remaining large particles of tattoo pigment are then targeted at the next treatment session, leading to further enlightenment. The number of sessions and the distance between treatments depends on various parameters, including the area of ​​the treated body, skin color and the effectiveness of the immune system. Tattoos located in the extremities, such as the ankles, generally take the longest time. As a faded tattoo doctor can recommend that patients wait months between treatments to facilitate ink resolution and minimize unwanted side effects.
The amount of time it takes to eliminate tattoos and removal success varies with each individual and their immune system function. Factors that affect this include: skin type, location, color, amount of ink, scar tissue or tissue changes, ink layer, immune system function and circulation. Factors under individual control are more time between care, nutrition, stress, sleep, exercise, and fluid levels. In the past health care providers will only guess the amount of patient care that is somewhat frustrating to the patient. Predictive scale, "Kirby-Desai Scale", developed by Dr. Will Kirby and Dr. Alpesh Desai, a dermatologist specializing in tattoo removal techniques, assesses the potential success and number of treatments required for laser tattoo removal, provided that medical practitioners use Q-switched Nd: YAG (neodymium-doped yttrium aluminum garnet) lasers that combine selective photothermolysis with six weeks between treatments.
The Kirby-Desai scale gives numerical values ​​to six parameters: skin type, location, color, amount of ink, scarring or tissue changes, and layering. The parameter scores are then added to produce a composite score that will show the approximate number of treatments needed to eliminate successful tattoos. Experts recommend that the Kirby-Desai scale be used by all laser practitioners before starting the tattoo removal treatment to help determine the amount of care needed to remove the tattoo and as a predictor of successful laser tattoo removal treatment. Prior to 2009, doctors had no scientific basis to estimate the amount of care needed to remove tattoos and the use of this scale is now a standard practice in laser tattoo removal.
Certain colors proved more difficult to remove than others. In particular, this occurs when treated with the wavelength of incorrectly used laser light. Some people postulate that the reason for the slow resolution of green ink in particular is because the size of the molecule is relatively smaller relative to other colors. As a result, green ink tattoos may require treatment with 755 nm light but can also respond to 694 nm, 650 nm and 1064 nm. Some wavelengths of light may be needed to remove colored ink.
One small Greek study showed that the R20 method - four passes by laser, twenty minutes apart - caused more ink solving than conventional methods without more scars or adverse effects. However, this study was conducted on a very small patient population (a total of 12 patients), using the weakest QS laser, Alexandrite 755nm laser. One other major problem with this research is the fact that more than half of the 18 tattoos removed are unprofessional and amateur tattoos are always easier to remove. Evidence of concept studies is being done, but many laser experts suggest the R20 method uses more modern and powerful tattoo removal lasers that are available in most offices as increased adverse side effects include scarring and possible dischromia. Patients should inquire about the laser used if the R20 treatment method is offered by the facility as it is usually only offered by clinics that use the weak Alexandrite 755, compared to the more powerful and versatile devices that are more commonly used. In addition, dermatologists offering R20 methods should inform patients that it is only one alternative to a proven protocol and not a standard gold treatment method for tattoo removal.
Factors contributing to laser tattoo removal success
There are a number of factors that determine how much care is needed and the level of success that may be experienced. Age tattoos, ink density, colors and even where tattoos are on the body, all play an important role in how much care will be required for complete removal. However, the rare tattoo removal factor is the role of the client's immune response. The normal process of tattoo removal is fragmentation followed by phagocytosis which is then passed through the lymphatics. Consequently, it is an inflammation resulting from actual laser treatment and a natural stimulus of the host immune response that ultimately results in the removal of tattoo ink; so the result variation is huge.
Pain management during treatment
The laser tattoo removal is uncomfortable - many patients say it's worse than getting a tattoo. The pain is often described as being similar to hot oils on the skin, or "snap" of a rubber band. Depending on the patient's pain threshold, and while some patients may forget anesthesia, most patients will need some form of local anesthesia. Pre-treatments may include application of anesthetic cream under occlusion for 45 to 90 minutes or cooled by ice or cold air prior to laser treatment sessions. A better method is complete anesthesia that can be given locally with 1% to 2% injection of lidocaine with epinephrine.
A simple new technique (published in March 2014) that helps reduce the sensation of pain felt by the patient has been described by MJ Murphy She uses standard glass microscope slides pressed on the skin of the tattoo and fires the laser through the glass. Results in 31 volunteers showed a significant decrease of up to 50% in pain in addition to decreased blisters and mottled bleeding. This technique is the simplest and most effective method for reducing the pain sensation using noninvasive procedures.
Post-treatment considerations
Immediately after laser treatment, slight alteration, white discoloration with or without intubation bleeding is often observed. This white discoloration is regarded as the result of a rapidly formed vapor or gas, causing skin vacuolization and epidermal. Appropriate bleeding shows a vascular injury from photoacoustic waves created by laser interactions with tattoo pigments. Minimal edema and erythema in adjacent normal skin usually resolve within 24 hours. Next, the crust appears throughout the tattoo, which is peeling off about two weeks after treatment. As mentioned above, some tattoo pigments can be found in this crust. Post-operative wound care consists of simple wound care and non-occlusive dressings. Because the application of sterile laser light is not required topical antibiotics. In addition, topical antibiotic ointment may cause an allergic reaction and should be avoided. Faded tattoos will be recorded over the next eight weeks and re-maintenance energy levels can be adjusted depending on the observed clinical response.
Side effects and complications
About half of patients treated with Q-switched lasers to remove tattoos will show some temporary changes to normal skin pigmentation. These changes usually disappear within 6 to 12 months but may be rarely permanent.
Hyperpigmentation is related to the patient's skin color, with skin types IV, V and VI more susceptible regardless of the wavelength used. Twice a day treatment with hydroquinones and broad-spectrum sunscreens usually resolve hyperpigmentation within a few months, although, in some patients, resolution may be prolonged.
Hypergigmentation is more frequently observed in darker skin tones. More likely to occur with higher fluence and more frequent treatments. Sometimes lighter skin exhibits hypopigmentation after a series of treatments. Allowing more time between treatments reduces the likelihood of hypopigmentation. Because it is more likely to see hypopigmentation after several treatments, some practitioners suggest to wait for several additional weeks, after several sessions. Usually the treatment stops until hypopigmentation heals in a matter of months.
Transient textual changes are sometimes recorded but often disappear within a few months; However, changes in the permanent texture and scarring are very rare. If the patient is susceptible to pigment or texture changes, longer intervals of treatment are recommended. In addition, if a blister or crust forms after treatment, it is essential that the patient does not manipulate these secondary skin changes. The early removal of scaly blisters increases the chances of developing a scar. In addition, patients with a history of hypertrophic or keloidal scarring should be warned about the increased risk of scarring.
Local allergic responses to many tattoo pigments have been reported, and an allergic reaction to tattoo pigment after Q-switched laser treatment is also possible. Rarely, when yellow cadmium sulfide is used to "brighten" the red or yellow part of a tattoo, an allergic photo reaction can occur. The reaction is also common with red ink, which may contain cinnabar (mercury sulphide). Erythema, pruritus, and even inflamed nodules, verrucose papules, or granulomas may be present. The reaction will be limited to the red/yellow ink spots. Treatment consists of rigorous sun avoidance, sunscreen, interlesional steroid injection, or in some cases, surgical removal. Unlike the destructive modalities described, Q-switched lasers mobilize ink and can produce systemic allergic responses. Oral antihistamines and anti-inflammatory steroids have been used to treat allergic reactions to tattoo ink.
Studies of various tattoo pigments have shown that a number of pigments (mostly containing iron oxide or titanium dioxide) change color when irradiated with Q-switched laser energy. Some of the tattoo colors including flesh tones, bright red, white, peach and light brown containing pigments as well as some green and blue tattoo pigments, turn black when irradiated with Q-switched laser pulses. The resulting black gray color may require more care to be removed. If a dark tattoo does not occur, after 8 weeks the newly darkened tattoo can be treated like a black pigment.
Very rarely, laser treatment without Q-switched, such as CO2 or Argon lasers, rarely offered today, can damage blood vessels and aerosol tissues that require plastic shields or cones to protect the laser operator from tissue and blood contact. The protective goggles can be worn if the laser operator chooses to do so.
With mechanical tattoo removal methods or salabrasion, scarring incidence, pigment changes (hyper and hypopigmentation), and ink retention is very high.
The use of Q-switched lasers very rarely produces large bullish developments. However, if the patient follows the post treatment guidelines for lifting, resting, and applying intermittent icing, it should minimize the likelihood of bulls and other side effects. In addition, health care practitioners should reflect on the use of refrigeration devices during tattoo removal procedures. While the rare development of bulls is a possible side-effect of eliminating Q-switched laser tattoos, if handled appropriately and quickly by health care practitioners, it is unlikely that long-term consequences will occur.
Risk
Although laser treatments are well known and often used to remove tattoos, unwanted side effects from laser tattoo removal include possible skin discoloration such as hypopigmentation (white spots, more common in darker skin) and hyperpigmentation (black spots) as well as texture changes - this change is usually not permanent when Nd: YAG is used but is much more likely with the use of Alexandrite 755 nm, Ruby 694 nm and R20 method. Very rarely, burns can cause scarring but this usually only happens when the patient does not care for the treated area properly. Sometimes, the "paradoxical darkening" of tattoos can occur, when the treated tattoo becomes darker, not brighter. This is most common with white ink, skin color, pink, and cosmetic make-up tattoos.
Some tattoo pigments contain metals that can theoretically break down into toxic chemicals in the body when exposed to light. It has not been reported in vivo but has been demonstrated in laboratory tests. The removal of a traumatic tattoo laser can also be tricky depending on the substance of the pigment material. In one reported instance, the use of a laser resulted in ignition of particles attached to the fireworks debris.
References
Note
Source of the article : Wikipedia
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