To evaluate the effects of combining neodymium-doped yttrium aluminium garnet laser and highintensity focussed ultrasound techniques to remove a professionally-done tattoo. The interventional study was conducted from November 2021 to April 2022 at the at the Postgraduate Medical Physics Laboratory of Mustansiriyah University, Baghdad, Iraq, and comprised healthy adults aged 18-60 years who wished to have their tattoo areas from their hands, arms and forearms removed. Each tattoo was divided into 3 areas. The first area was treated with multiple passes of neodymium-doped yttrium aluminium garnet laser with 450mJ. The second area was treated with multiple passes of neodymium-doped yttrium aluminium garnet laser with 450mJ and 850mJ. The third area was treated with multiple passes of neodymium-doped yttrium aluminium garnet laser with 450mJ, followed by 5-10 consecutive strokes of HIFU waves with energy 0.25-0.6mJ, 1.4mm depth, 10MHz and 7MHz frequency, and a second blow of the neodymium-doped yttrium aluminium garnet laser with 450mJ. The intervention lasted 8 sessions, and the time required between the sessions ranged 15-20 days. The percentage of pigmentation was evaluated using the image segmentation method based on fuzzy c-means. Data was analysed using SPSS 24. Of the 20 subjects, 12(60%) were males and 8(40%) were females. There were 10(50%) subjects aged 17-24 years, 6(30%) aged 25-35 years and 4(20%) aged 36-45 years. The tattoo pigments showed a significant reduction in all the 3 groups (p<0.05), but intergroup comparison showed that the reduction was most significant in the group treated with neodymium-doped yttrium aluminium garnet laser plus high-intensity focussed ultrasound (p<0.05). The combination of high-intensity focussed ultrasound and neodymium-doped yttrium aluminium garnet laser led to more positive outcome compared to the use of low- or high-intensity laser alone.
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