Tattoo fading using Nd: YAG ns laser pulses by water cavitation bubbles and jet formation: (case study).

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.

Black tattoo inks are composed of carbon nanoparticles, additives and water and may contain polycyclic aromatic hydrocarbons (PAHs). We aimed to clarify whether reactive oxygen species (ROS) induced by black inks in vitro is related to pigment chemistry, physico-chemical properties of the ink particles and the content of chemical additives and contaminants including PAHs. The study included nine brands of tattoo inks of six colours each (black, red, yellow, blue, green and white) and two additional black inks of different brands (n = 56). The ROS formation potential was determined by the dichlorofluorescein (DCFH) assay. A semiquantitative method was developed for screening extractable organic compounds in tattoo ink based on gas chromatography-mass spectrometry (GC-MS) and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS). Two black inks produced high amounts of ROS. Peroxyl radicals accounted for up to 72% of the free radicals generated, whereas hydroxyl radicals and H₂O₂ accounted for <14% and 16%, respectively. The same two inks aggregated strongly in water in contrast to the other black inks. They did not exhibit any shared pattern in PAHs and other organic substances. Aggregation was exclusively shared by all ink colours belonging to the same two brands. Ten of 11 black inks had PAH concentrations exceeding the European Council's recommended level, and all 11 exceeded the recommended level for benzo(a)pyrene. It is a new finding that aggregation of tattoo pigment particles correlates with ROS production and brand, independently of chemical composition including PAHs. ROS is hypothesized to be implicated in minor clinical symptoms.

Introduction: Sonographic evaluation of the axilla and percutaneous biopsy of abnormal lymph nodes with fine needle aspiration (FNA) or core needle biopsy (CNB) has become more common practice in patients with newly diagnosed breast cancer prior to neoadjuvant chemotherapy (NAC). Sentinel lymph node (SLN) biopsy is considered the gold standard for axillary staging in clinically node negative breast cancer patients. Currently, there is no clear correlation of sonographically detected abnormal lymph nodes and open surgical assessment. We conducted an exploratory pilot study which marked suspicious axillary lymph nodes with black tattoo ink at the time of percutaneous needle biopsy prior to NAC. Black nodes visualized during axillary surgery were evaluated in comparison to SLNs. Methods: Breast cancer patients with clinical and/or sonographically suspicious axillary lymph nodes prior to NAC were included in the study. Following FNA or CNB biopsy of node, 0.1 to 0.5 ml of a sterile, highly purified, biocompatible fine carbon suspension (Spot™) was injected into the cortex of the lymph node and adjacent soft tissue. A total of 12 patients were injected with black ink prior to NAC. Intraoperative presence of black pigment was assessed and correlation between sentinel and tattooed nodes were evaluated. Results: Nine patients had a positive percutaneous lymph node biopsy prior to NAC. The average number of days that elapsed between injection and to surgery was 130 days. A successful SLN procedure was performed in all patients. A black tattooed node was identified in all patients and correlated to a SLN. 7 patients were down-staged in the axilla and 6 patients did not go onto completion axillary dissection. One patient with a negative SLN had a completion axillary dissection, but no additional positive lymph nodes were found. Four patients with positive SLN had a completion axillary dissection (1 of whom was a false negative percutaneous biopsy). In all four patients, the positive sentinel node contained visible black ink. There was one patient who had an additional positive sentinel node, which was not black. Two axillary dissections contained additional positive nodes. Conclusion: Black ink tattooing with sterile black ink (Spot™), successfully marked suspicious lymph nodes prior to NAC. These correlated to a SLN. In node positive patients with a partial response in the axillary lymph nodes following neoadjuvant chemotherapy, previously marked, black-inked node proved to be the persistent positive node. Tattooing of lymph nodes at the time of percutaneous biopsy may improve the accuracy of surgical axillary staging by aiding in the intra-operative identification of previously biopsied nodes. Citation Format: Nicole Choy, Jafi Lipson, Sunita Pal, Debra Ikeda, Long Trinh, Kimberly Allison, Michael Ozawa, Amanda Wheeler, Irene Wapnir. Correlation of percutaneously biopsied axillary lymph nodes marked with black tattoo ink prior to neoadjuvant chemotherapy with sentinel lymph nodes in breast cancer patients [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-01-05.

The incidence of clinical complications such as granuloma formation and sarcoidosis is often seen in black tattoos and may be associated with agglomeration of black pigment. To measure count and dimensions of agglomerates in black tattoo inks vs red inks and to compare old inks and new inks of identical brands. Examination was performed by light microscopy (Olympus BX51™ ) with magnification 40X, immersion oil. Photographs (Jenoptik Gryphax RGB camera) were taken of each ink sample and analysed by ImageJ software; count, area, width, height, circumference and circularity index were measured. Agglomerates were defined as width and height of objects above 800nm. Twenty-one new unopened black inks and 17 new unopened red inks were compared. Furthermore, five old black inks and five old red inks, that had been opened and stocked for over 2years, were compared with new products of the same brands. Black agglomerates were area wise and with respect to width, height and circumference significantly larger compared with red agglomerates and more circularly shaped. Count of agglomerates was lower in black inks than in red inks, in accordance with bigger dimensions of black agglomerates. Comparison of old and new inks indicated old inks have larger agglomerates but variable bottle size and storage conditions may have confounded results. Pigment agglomerates in black tattoo ink stock products were sized larger than agglomerates in red inks. Agglomerates found directly in black inks may predispose to granuloma formation in black tattoos causing sarcoid reaction.

Black is the most common tattoo color, but only a few studies have shed light on the multitude of functional and contaminating chemicals present in black inks. These studies have generally shown that black inks are a diverse group, containing anything from 5 to 50+ organic components. Little is known about the possible effects on humans of internalizing these chemicals. Analysis has shown that the production of the main component, carbon black, can lead to the formation of pigments with polycyclic aromatic hydrocarbon (PAH) contents that range from very high to almost completely absent. Similar variations in PAH concentrations are observed in black inks. PAHs are known carcinogens and thus, low recommended levels have been suggested by the Council of Europe. Reactive oxygen species (ROS) have recently been a topic in scientific literature related to tattoo ink. Again, it has been shown that some inks produce deleterious ROS (e.g. singlet oxygen or peroxyl radicals), presumably via either adhered organic compounds or particle surface defects. It has been shown that black tattoo inks may contain a multitude of chemicals, including carcinogens and allergens, and some have unknown toxicologies. However, it has additionally been demonstrated that some black inks already on the market do not produce ROS and also contain PAHs at levels that are below those recommended by the Council of Europe and very few additional contaminants.

BackgroundDuring the last decade, the number of people with ≥1 tattoo has increased noticeably within the European population. Despite this, limited safety information is available for tattoo inks.ObjectivesTo test the skin sensitization potential of 5 tattoo inks in vitro by using reconstructed human skin (RHS) and the contact sensitization biomarker interleukin (IL)‐18.MethodsTwo red and 3 black tattoo inks, 1 additive (Hamamelis virginiana extract) and 1 irritant control (lactic acid) were tested. The culture medium of RHS (reconstructed epidermis on a fibroblast‐populated collagen hydrogel) was supplemented with test substances in a dose‐dependent manner for 24 hours, after which cytotoxicity (histology; thiazolyl blue tetrazolium bromide assay) and skin sensitization potential (IL‐18 secretion; enzyme‐linked immunosorbent assay) were assessed.ResultsAll but 1 ink showed cytotoxicity. Notably, 1 red ink and 1 black ink were able to cause an inflammatory response, indicated by substantial release of IL‐18, suggesting that these inks may be contact sensitizers.ConclusionsThe in vitro RHS model showed that 4 tattoo inks were cytotoxic and 2 were able to cause an inflammatory IL‐18 response, indicating that an individual may develop allergic contact dermatitis when exposed to these tattoo inks, as they contain contact sensitizers.

Black tattoo ink comprises hydrophobic carbonblack nanoparticles. We hypothesized that black tattoo inkdemonstrates transient dynamic activity in an ultrasound field. Brightness-mode sonography was performed on cylindrical receptacles of different bore diameters, filled with black tattooink, water, saline, or air, using pulsed ultrasound with center frequencies of 13 MHz and 5 MHz. The scattering from black ink itself lasted less than tenminutes. At 13-MHz sonication, a transient drop in sound speed was observed, as well as a transient lessening of scattering from distal phantom tissue. The linear acoustic attenuation coefficient of pure black ink was measured to be 0.15±0.01 dB cm <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">−1</sup> MHz <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">−1</sup> , equal to whole blood. Low-intensity ultrasonic tattoo removal would be of interestas an alternative to techniques that damage surrounding tissue.

The Q-switched ruby laser was recently shown to remove tattoos without scarring. The Q-switched neodymium: yttrium aluminum garnet (Nd:YAG) laser, which targets black ink with a longer wavelength that has less absorption by melanin, should effectively treat tattoos with fewer pigmentary alterations. A prospective, blinded, controlled study was conducted to assess the ability of the Q-switched Nd:YAG laser (1064 nm, 10 ns, 5 Hz) to remove tattoos. Twenty-five patients with 39 blue-black or multicolored tattoos (14 previously untreated, 25 Q-switched ruby laser-resistant) were exposed in randomly derived quadrants with 6, 8, 10, or 12 J/cm2 at 3 to 4 week intervals for a total of four treatment sessions. An excellent response (> 75% ink removal) was seen in 77% of the black tattoos and more than 95% of the black ink cleared in 11 (28%) of 39 tattoos at 10 to 12 J/cm2 after four treatment sessions. Colored inks were not as effectively removed. Response was related to fluence with greatest improvement noted in the quadrants treated with 10 and 12 J/cm2. No significant side effects, including pigmentary changes or scarring, were noted. Histopathologic examination demonstrated persistence of tattoo ink in clinically clear areas and confirmed the absence of fibrosis and granulomatous changes. The Q-switched Nd:YAG laser (1064 nm) effectively treats black tattoos with an excellent cosmetic outcome. Bright colors were minimally responsive to treatment. Higher doses were more effective and equally well tolerated.

Background and objective: Many different lasers, polychromatic high-intensity light sources (PCLs), and RF devices have claimed clinical efficacy in rejuvenating the skin. In this study, the sequential combination of two different laser wavelengths was evaluated to produce reliably significant clinical improvements optimizing treatment parameters. Methods: The left volar aspects of the forearms of four volunteers were treated with nine different parameter settings using a variable pulsewidth fractional Er:YAG 2940-nm laser with and without air cooling. The pain perception level was recorded on a 0–10 point scale (0=No pain; 10=Most severe pain). Three evaluations were made: during treatment, immediately after treatment, and 5 minutes after treatment. The same investigation was made on the right volar aspects of the same four volunteers using a short-pulse, random pattern, 3-mm spot, scanner-assisted Nd-YAG 1064-nm laser at 0.3 ms pulsewidth at seven different parameter settings. Clinical evaluations were made concerning erythema and edema 3 days after treatment, as well as pre-operative and 60 days postoperative skin texture plus color uniformity. Considering that the majority of cosmetic patients are willing to accept a relatively short and uneventful downtime (2–4 days according to a study we are presently conducting) and do prefer to limit their intra- and postoperative pain to a minimum, the best combination of clinical improvement matching these two important parameters were selected for our study. A treatment strategy combining two sequential passes of long-pulse Nd:YAG laser (Nd:YAG-LP) at 0.3 and 35 ms followed by two passes of long-pulse fractional Er:YAG laser (Er:YAG-FT) at 600 μs was designed to treat the facial regions of 10 volunteers affected by a combination of intrinsic (chrono-) and extrinsic (mostly photo-) aging. The pain perception level was recorded on a 0–10 scale (0=No pain; 10=Most severe pain). Three evaluations were made: during, immediately after, and 5 minutes after treatment. Erythema and edema were evaluated on a 0–3 point scale (0=No clinical signs; 3=Severe Clinical signs) at 7, 15 and 30 days. Improvements were determined by blind evaluation of photographs before, at 4 weeks, and at 8 weeks following treatments. Patient satisfaction was also evaluated on a 0–4 point scale (0=No satisfaction; 4=Excellent perceived improvement, 76–100%). Results: At the 30-day follow-up, participants had clinically detectable improvements of facial telangiectasias (1–25%), lentigines (25–50%), diffuse dyspigmentation (25–75%), fine lines (25–75%), and skin texture (25–75%). Clinical improvements were maintained at the 60-day follow-up, demonstrating the prolonged photothermally induced biological effect on skin function and texture. All volunteers confirmed their willingness to undergo the same procedure again to maintain and possibly improve their clinical results. Further clinical evaluations at 4 and 6 months will therefore be needed to identify a suitably convenient interval between two consecutive procedures. Conclusion: The present study demonstrates objective and subjective improvements in fine lines, skin texture and dyspigmentation of facial skin after one sequential non-ablative and ablative laser treatment combining two different laser sources (Nd:YAG laser + Er:YAG laser).

The purposes of this study were to determine the degree of apical leakage using a dye penetration method after argon, pulsed Nd:YAG with or without black ink, or Er:YAG laser treatment and obturation, and to compare the results of three types of laser irradiation in vitro. There have been only a few reports of the laser effect on apical leakage after laser treatment and obturation. Seventy-five human extracted single root teeth were divided into five groups of 15 teeth each and prepared up to a #60 K-file size. One group served as the control and was not irradiated. The other four groups were irradiated with an argon laser at 0.3 W for 3 seconds at continuous mode, pulsed Nd:YAG laser at 2 W and 20 Hz for 4 seconds with or without black ink, and Er:YAG laser at 50 mJ per pulse and 4 Hz for 5 seconds. In each group, ten teeth for the apical leakage study were obturated and immersed in rhodamine B solution for 48 hours at 37 degrees C, and the others were used for the observation by scanning electron microscopy (SEM). All teeth were longitudinally bisected and observed by stereoscopy or SEM. After pulsed Nd:YAG laser treatment with black ink and obturation, the apical leakage degree (mean score: 0) was reduced compared to that in the control (mean score: 1.2) significantly (p < 0.05). SEM findings showed that specimens irradiated by pulsed Nd:YAG laser with black ink presented clean root canal walls with debris and smear layer evaporated, melted, fused, and recrystallized in most cases. These results suggest that pulsed Nd:YAG laser irradiation with black ink at the apical stop is useful for the reduction of apical leakage after obturation.

We compared the effectiveness of Q-switched Nd:YAG and alexandrite lasers in the treatment of 31 patients with monochromatic black amateur tattoos. The effects of different fluences and varying energy deposition patterns were also investigated. Improvement was determined by clinical scoring. In all patient groups superior results were obtained with the Q-switched Nd:YAG laser. Adverse side-effects other than transient textural changes were not noted. Our observation showed that the homogeneity of energy deposition rather than high fluence is crucial for successful treatment of monochromatic amateur tattoos.

Background: For efficient laser tattoo removal, photodisruption of tissue can ensure a very powerful means to shutter ink granules. At very high laser intensity level, photodisruption dominates and selective photothermolysis will have secondary effect in clearing the tattoo ink. Lower laser fluence is all what to trigger non-linear photons absorption and the generation of exploding cavitation bubbles that can tremendously hammer the ink granules.Subjects, materials, and methods: Three domestic white rabbits; each received simultaneous injections of a color pigment tattoo under general anesthesia, followed by a single session of (1064) Q.S Nd: YAG nanosecond laser pulses for tattoo removal.Results and Discussion: Spectroscopic properties of black, dark brown and red tattoo inks were studied. Near threshold laser fluence was selected to select the optimum conditions for obtaining scar-free treatment. Histological images of the biopsies, taken after thirty days of laser treatment of black, dark brown and red tattoos showed a marked reduction in pigment granules size with no appearance of hyperplasia or inflammatory cells. Coexistence of macrophages was suggested to be responsible for actively phagocytizing the laser-dispersed tattoo fragments.Conclusion: skin biopsies have demonstrated ink granules local redistribution. Photodisruption at 1064nm laser effectively targeted black and dark brown tattoo pigments by the generation of cavitation bubbles. The weaker laser light absorption of red pigments at 1064nm only showed tattoo clearance when using 532nm wavelength.

3D volume-ablation rate and thermal side effects with the Er:YAG and Nd:YAG laser

Skin reactions are well described complications of tattooing, usually provoked by red inks. Chemical characterizations of these inks are usually based on limited subjects and techniques. This study aimed to determine the organic and inorganic composition of inks using X-ray fluorescence spectroscopy (XRF), X-ray absorption spectroscopy (XANES) and Raman spectroscopy, in a cohort of patients with cutaneous hypersensitivity reactions to tattoo. A retrospective multicenter study was performed, including 15 patients diagnosed with skin reactions to tattoos. Almost half of these patients developed skin reactions on black inks. XRF identified known allergenic metals - titanium, chromium, manganese, nickel and copper - in almost all cases. XANES spectroscopy distinguished zinc and iron present in ink from these elements in endogenous biomolecules. Raman spectroscopy showed the presence of both reported (azo pigments, quinacridone) and unreported (carbon black, phtalocyanine) putative organic sensitizer compounds, and also defined the phase in which Ti was engaged. To the best of the authors' knowledge, this paper reports the largest cohort of skin hypersensitivity reactions analyzed by multiple complementary techniques. With almost half the patients presenting skin reaction on black tattoo, the study suggests that black modern inks should also be considered to provoke skin reactions, probably because of the common association of carbon black with potential allergenic metals within these inks. Analysis of more skin reactions to tattoos is needed to identify the relevant chemical compounds and help render tattoo ink composition safer.

To evaluate ex vivo the effect of Nd:YAG laser irradiation with and without black ink on instrumented root canal walls, and the degree of both coronal and apical microleakage of filled root canals. Seventy-two single-rooted teeth were instrumented up to a size 40 K-file, and then divided into six groups of 10 teeth: groups 1 and 4 remained unlased and acted as control groups, groups 2 and 5 were treated with a Nd:YAG laser (Fidelis Plus, Herzele, Belgium), groups 3 and 6 were treated with a laser and black ink; the remaining 12 teeth served as positive and negative controls. The laser was operated at 1.5 W, 15 Hz, four times for 5 s with a 20-s interval. Groups 4-6 were filled using cold lateral condensation of gutta-percha and AH26. After storage in water for 48 h at 37 degrees C, through-and-through leakage (L in microL day-1) was measured for 48 h under a pressure of 1.2 atm using a fluid transport model and recorded as L=0 (L1), 0<L<or=10 (L2), L>10 (L3). After the assessment of leakage with the fluid transport model, the teeth were immersed in rhodamine B solution for 48 h at 37 degrees C. Apical and coronal dye leakage was scored after longitudinal splitting of these teeth. All teeth of groups 1-3 were split longitudinally and observed under SEM for evaluation of remaining smear layer. Through-and-through leakage was only observed in the group lased with black ink (two samples-L2). Apical and coronal dye leakage was observed in all groups; there were no statistically significant differences amongst the three experimental groups. The through-and-through leakage, measured with the fluid transport model in two teeth of group 6, was confirmed in the dye leakage test (rhodamine B dye was observed along the total length of the root filling). There was evidence of melted and ablated root canal dentine in the laser-treated groups. These findings were more obvious in root canals lased in association with black ink. All apical foramina in the lased group remained patent. Nd:YAG laser irradiation with black ink increased the amount of melted and ablated dentine areas compared with that without black ink. Nd:YAG lasing in association with black ink did not result in a reduction of either coronal or apical microleakage in root filled teeth.