Challenges in laser tattoo removal: the impact of titanium dioxide on photodegradation of yellow inks

Background : Decorative tattooing gained popularity in many western countries throughout the 1990s. Some estimates show that approximately 10 % of men in the United States already have tattoos. However, tattoos often become a personal regret. As recent surveys suggest, 17 % of people that have obtained a tattoo and more than 50 % of adults over the age of 40 in the United States of America consider having them removed. The same trend can be observed in our country as well. Laser therapy is the gold standard for tattoo removal. In Slovenia, laser tattoo removal therapy is available and widely accessible. There is a wide range of facilities offering laser tattoo removal, ranging from different private clinics to beauty salons. Different facilities use different lasers, but not all lasers, however, are optimal for successful and complete tattoo removal, as inappropriate use can cause many unwanted side effects. Methods : Eleven (11) patients (2 men and 9 women) requesting tattoo removal were treated in our department. When treating our patients, we used Fotona’s QX MAX quality-switched Nd:YAG laser which offers four different wavelengths in a single system; 1064 nm Nd:YAG was used to treat and remove dark pigments, 532 nm KTP for red, tan-colored, purple and orange tattoo inks, 650 nm dye for green tattoo inks and 585 nm dye for sky-blue colored inks. Results : Satisfactory tattoo removal was achieved in all patients treated. Patients were very satisfied with the success and the number of treatments needed for tattoo removal. There were mild unwanted side effects and the pain was moderate. The average number of treatments required for complete tattoo removal was less than 7, ranging from 3 to 21 treatments. Patients’ satisfaction with tattoo removal was estimated at 5.2 (on a scale from 1 to 6). Conclusions : Our study showed that Q-switched lasers successfully remove tattoo ink, however several treatments are required for satisfactory tattoo removal

Tattoos have been a part of the culture and a way of expression for a remarkable portion of society throughout history. However, different dissatisfactions related to tattoos lead people to tattoo removal procedures that can be carried out in various ways. Among them, laser tattoo removal is the most common technique. However, laser tattoo removal could have downsides; thus, novel technologies that either support or replace conventional methods are needed. In the present study, the degradation of red, yellow, green, blue, black and white tattoo inks by plasma treatment was evaluated for possible future use of cold plasma in tattoo removal. Tattoo inks were treated with DBD air plasma in the aqueous form and in the agarose gel. Furthermore, also tattoo pigments were exposed to plasma-treated water. The Kl-starch reagent was used to correlate the oxidative strength of plasma-treated water with the degradation of tattoo inks. Degradation of tattoo inks was determined by reflectance measurements and was measured as color change with respect to plasma treatment time. Color changes of tattoo inks were represented using the CIELAB color system and CIE xyY color space. Our results suggest that air DBD plasma treatment and plasma-treated water are capable of degrading tattoo inks. The color change of tattoo inks due to degradation by plasma was clearly distinguishable by the naked eye, and the maximum value corresponding to color change was measured for red tattoo ink.

Inactivation of B. cereus spores on agar, stainless steel or in water with a combination of Nd:YAG laser and UV irradiation

The mechanisms responsible for variable responses of cosmetic tattoos to Q-switched laser removal treatment remain unclear. We sought to investigate the properties of tattoo inks that may affect the efficacy of laser-assisted tattoo removal. The absorption of white, brown, and black inks before and after Q-switched neodymium-doped yttrium aluminum garnet laser irradiation were analyzed by a reflectance measurement system. Rats were tattooed using the three inks and treated with the same laser for two sessions. Skin biopsies were taken from the treated and untreated sites. Black ink showed strong absorption, reduced after laser irradiation, over the entire spectrum. White ink had low absorption over the visible light spectrum, and brown ink had strong absorption at 400-550 nm wavelengths. White and brown inks turned dark after laser exposure, and the absorption of laser-darkened inks were intermediate between their original color and black ink. White, brown, and black tattoos in rat skin achieved poor, fair to good, and excellent responses to laser treatment, respectively. Transmission electron microscopy showed that white tattoo particles were the largest, brown were intermediate, and black were the smallest before laser. After laser treatment, white and brown tattoo particles were mixtures of large and small particles, while black particles showed overall reduction in number and size. Black tattoo ink's excellent response to Q-switched lasers was associated with its strong absorption and small particle size. White tattoo ink's poor response was associated with its poor absorption, even after laser darkening, and large particle size.

It is widely accepted that Q-switched lasers are the gold-standard treatment for the resolution of unwanted tattoo ink. Although much safer than other tattoo removal modalities, the treatment of tattoo ink with Q-switched devices may be associated with long-term adverse effects including undesired pigmentary alterations such as tattoo ink darkening. Darkening of tattoo ink is most often reported in cosmetic, flesh-toned, white, peach, and pink tattoos. In this paper, we briefly review a case of pink tattoo ink that initially darkened paradoxically but eventually resolved with continued Q-switched laser treatments.

While the practice of tattooing has existed for thousands of years, it has recently begun growing in popularity in the US. With the increasing prevalence of tattoos, the methods and inks involved in the tattooing process have also developed. Tattoos now use many brightly colored inks, often made using metal-based pigments. There is concern that chemicals may be present in tattoo inks in concentrations that may lead to human health concerns either during application or removal of tattoos. Since exposure to metals has been linked to tremors, liver damage, memory loss, cognitive loss, and even death, there is concern about the prevalence of metals in tattoo inks in general. To this end, a survey of 226 commercial tattoo inks was performed and each ink was analyzed for the presence of heavy metals using two different x-ray methods: Particle Induced X-Ray Emission and Scanning Electron Microscopy/ Energy Dispersive Spectroscopy. Fifteen metals were identified in various tattoo inks by these rapid x-ray methods, including chromium, manganese, nickel, copper, barium, and lead. Conclusions can be drawn about the prevalence of metals in some pigment colors and from some brands.

Tattoos have been a ubiquitous phenomenon throughout history. Now, the demand for tattoo removal for aesthetic or practical reasons is growing rapidly. This study outlines the results of field investigations into the chemical and biological removal of tattoo inks (Hexadecachlorinate copper phthalocyanine-C32Cl16CuN8-CAS no° 1328-53-6). FTIR, Py-GC/MS, and NMR analyses yielded intriguing profiles pertaining to the primary chemical constituents, along with others of an ambiguous nature. A bioremoval protocol was developed on a pork rind surface to simulate human tattooing. Two previously studied microbial strains were included in this analysis: (i) a bacterial culture of Pseudomonas stutzeri 5190 DSMZ viable cells and (ii) a fungal culture of Alternaria infectoria strain NIS4, the latter already isolated and identified. A combination of physical, chemical, and microbiological analyses, along with microscopic observations, was conducted. In our experimental conditions, inocula from environmental samples (soil and compost) were capable of inducing changes in even trace organic matter (glycerin and additives in pigments) used as a binder in emulsifiers in tattoo inks. Furthermore, the two microbial strains demonstrated promising potential for removing green tattoo ink. Finally, wastewater effluents containing green ink were recovered via electrochemical treatment, and the environmental impact in terms of the CO2 equivalent of our experiments was assessed. The results are promising and warrant further investigation into the innovative biological and chemical removal of tattoo inks from human skin and wastewater, respectively.

Lasers have been widely used for tattoo removal, but the limited light penetration depth caused by high skin scattering property restricts the therapeutic outcome of deep tattoo. Skin optical clearing method, by introducing optical clearing agent (OCA) into skin, has shown some improvement in the effect of laser tattoo removal. In this study, the enhanced laser tattoo removal has been quantitatively assessed. OCA was applied to the skin of tattoo animal model and Q-switched Nd:YAG laser (1064 nm) irradiation was used to remove the tattoo. The skin evaluation instrument (Mexameter probe, MPA580) was applied to measure the content of tattoo pigment before and after laser treatment, and then the clearance rate of pigment was calculated. Further, Monte Carlo (MC) method was utilized to simulate the effect of skin optical clearing on light transmission in tattoo skin model. By comparing the pigment change of tattoo areas respectively treated with OCA plus laser and single laser, it was found that pigment clearance of the former tattoo area was increased by 1.5-fold. Further, the MC simulation verified that the reduced light scattering in skin could increase the effective dose of luminous flux reaching to the deep tattoo regions. It can be concluded from both experiment and theoretical simulations that skin optical clearing technique could improve the outcome of laser tattoo removal, which should be beneficial for clinical laser tattoo removal and other laser pigment elimination.

Laser lights have been used by dermatologists for tattoo removal through photothermal interactions. However, most clinical studies used a visual scoring method to evaluate the tattoo removal process less objectively, leading to unnecessary treatments. This study aimed to develop a simple and quantitative imaging method to monitor the degree of tattoo removal in in vivo skin models. Sprague Dawley rat models were tattooed with four different concentrations of black inks. Laser treatment was performed weekly on the tattoos using a wavelength of 755 nm over six weeks. Images of non-treated and treated samples were captured using the same method after each treatment. The intensities of the tattoos were measured to estimate the contrast for quantitative comparison. The results demonstrated that the proposed monitoring method quantified the variations in tattoo contrast after the laser treatment. Histological analysis validated the significant removal of tattoo inks, no thermal injury to adjacent tissue, and uniform remodeling of epidermal and dermal layers after multiple treatments. This study demonstrated the potential of the quantitative monitoring technique in assessing the degree of clearance level objectively during laser treatments in clinics.

The purpose of this study was to evaluate the effects of Er: YAG laser irradiation on human extracted root surfaces in vitro, and to compare with Nd: YAG and CO2 laser irradiation. Twelve 5mm×5mm human root slices were prepared for this study. Two areas with 2mm×3mm were marked at both sides to the tooth axis in each slice. One area was irradiated with water cooling and the other without cooling. Three slices were randomly assigned to each of the following 4 different treatment groups: 1) Er: YAG laser treatment; 2) CO2 laser treatment; 3) Nd: YAG laser treatment; 4) Nd: YAG laser treatment to the root surface coated with black stain. Non-lased surfaces served as controls. The pulsed Er: YAG and Nd: YAG laser irradiations were performed for 10 seconds with an energy level of 50mJ at 10pps in the contact mode, holding the 0.6mm contact handpiece at 45 degree angulation to the root surface. The CW CO2 laser was irradiated with an energy level of 0.5W in the non-contact focus mode. After laser irradiation, the specimens were examined with stereoscope and scanning electron microscope. Root surfaces irradiated by Er: YAG laser featured scaly like appearances. Surfaces received CO2 laser irradiation without water cooling exhibited distinct carbonization and many cracks. With the Nd: YAG laser irradiation, charing, melting and lava-like appearance were observed when the laser was irradiated to the black stained surface without water cooling. The results of this study showed that three kinds of laser application to root surfaces resulted completely different morphological changes. We should consider the characteristics of laser and their effects to root surface, using any laser for periodontal treatment such as scaling, root conditioning, and killing of periodontopathic bacteria.(J. Jpn. Soc. Laser Dent, 7: 58-66, 1996 Reprint requests to Dr. ANDO)

Tattoo removal by laser therapy is a frequently performed procedure in dermatological practices. Quality-switched ruby, alexandrite, or Nd:YAG lasers are the most suitable treatment devices. Although these techniques are regarded as safe, both temporary and permanent side effects might occur. Little has been published on the frequency of complications associated with laser tattoo removal. We performed an Internet survey in German-speaking countries on characteristics of laser tattoo removal and associated side effects. A total number of 157 questionnaires entered the final analysis. Motivations for laser tattoo removal were mainly considering the tattoo as youthful folly (29%), esthetic reasons (28%), and 6% indicated medical problems. One third of participants were unsatisfied with the result of laser tattoo removal, and a complete removal of the tattoo pigment was obtained in 38% only. Local transient side effects occurred in nearly all participants, but an important rate of slightly visible scars (24%) or even important scarring (8%) was reported. Every fourth participant described mild or intense tan when the laser treatment was performed, and the same number of people indicated UV exposure following laser therapy, which should normally be avoided in these circumstances. As reported in the literature, nearly half of the participants experienced hypopigmentation in the treated area. Our results show that from the patients' point of view there is an important rate of side effects occurring after laser tattoo removal. Appropriate pretreatment counseling with regard to realistic expectations, possible side effects, and the application of test spots is mandatory to ensure patient satisfaction. Laser treatment should be performed by appropriately trained personnel only.

Background and objectivesThe use of picosecond lasers to remove tattoos has greatly improved due to the long-standing outcomes of nanosecond lasers, both clinically and histologically. The first aesthetic picosecond laser available for this use was the PicoSure® laser system (755/532 nm). Now that a vast amount of research on its use has been conducted, we performed a comprehensive review of the literature to validate the continued application of the PicoSure® laser system for tattoo removal.Study design and methodsA PubMed search was conducted using the term “picosecond” combined with “laser”, “dermatology”, and “laser tattoo removal”.ResultsA total of 13 articles were identified, and ten of these met the inclusion criteria for this review. The majority of studies showed that picosecond lasers are an effective and safe treatment mode for the removal of tattoo pigments. Several studies also indicated potential novel applications of picosecond lasers in the removal of various tattoo pigments (eg, black, red, and yellow). Adverse effects were generally mild, such as transient hypopigmentation or blister formation, and were rarely more serious, such as scarring and/or textural change.ConclusionAdvancements in laser technologies and their application in cutaneous medicine have revolutionized the field of laser surgery. Computational modeling provides evidence that the optimal pulse durations for tattoo ink removal are in the picosecond domain. It is recommended that the PicoSure® laser system continue to be used for safe and effective tattoo removal, including for red and yellow pigments.

Laser treatment of lower extremity telangiectases and small reticular veins has remained difficult because of vessel color, diameter, depth, and associated high-pressure flow. Traditionally, larger-caliber blue leg veins do not respond well to laser treatment. Nd:YAG laser (1064 nm) irradiation is absorbed by oxyhemoglobin and reduced hemoglobin and is associated with greater depth of penetration than other previously studied vascular lasers. To evaluate a millisecond contact-cooled 1064 nm Nd:YAG laser for the treatment of telangiectases and small reticular veins. Twenty-one lower extremity sites, with Fitzpatrick skin types I-IV, received two laser treatments separated by a 4 to 6-week period. Blue and red vessels, ranging in size from 0.25 to 4.0 mm were treated. Pulse durations of 10-50 msec were utilized at fluences of 90-187 J/cm2. Three months after the last treatment, patients were evaluated for vessel improvement and complications. Seventy-one percent of lower extremity vessels had improvement graded as significant. All vessel colors and sizes were successfully treated. The only complication at 3 months was postinflammatory hyperpigmentation. 1064 nm Nd:YAG laser irradiation with associated contact cooling is a safe and effective treatment for telangiectases and small reticular veins of the lower extremities.

Treatment of a refractory allergic reaction to a red tattoo on the lips with methotrexate and Q-switched Nd-Yag laser

The purpose of this paper is to describe a sustainable free laser tattoo removal clinic for economically disadvantaged adult probationers. This paper describes the partnerships, methods and challenges/lessons learned from the implementation of a free monthly laser tattoo removal program for adult probationers within a medical school setting in California. Possible patients are identified via a collaboration with the county's Probation Department. Founded in 2016, this monthly program has provided tattoo removal services to >37 adult patient probationers, many of whom receive follow-up treatments. Clients seek to remove about four blue/black ink tattoos. Since its inception, 23 dermatology residents have volunteered in the program. Challenges to patients' ongoing participation primarily pertain to scheduling issues; strategies for overcoming barriers to participation are provided. No safety concerns have emerged. Programs such as this public-private partnership may benefit probationers by eliminating financial barriers associated with tattoo removal. This model supports the training of cohorts of dermatologists seeking community service opportunities related to laser medicine. Others seeking to implement a similar program may also consider expanding treatment days/times to facilitate access for working probationers, providing enrollment options for other health and social services (e.g. public insurance, food stamp programs) and hosting a mobile onsite clinic to address clients' physical and mental health needs. This paper describes a unique collaboration between law enforcement and a medical school and it may assist other jurisdictions in establishing free tattoo removal programs for the benefit of probationers. The methods described overcome challenges regarding the implementation of this specialized clinical service.