Though a revolutionary treatment that helps to remove or fade a tattoo, removal by lasers requires thorough understanding of the laser and the relevant laser-tissue interaction.
What is a Tattoo?
It is a form of body art/modification done by inserting ink into the dermal layer of the skin. There has been a dramatic rise in the trend of having a tattoo. In the past, before lasers came into the picture for tattoo removal, other treatments such as dermabrasion, surgical excision, cryotherapy etc were used. However these did not give good cosmetic results and also caused scarring in many cases. The choice of laser used are Q switched lasers.
Types of Tattoos
There is no one factor which leads to acne, hence there are number of contributing factors:– Amateur tattoos- In this type, carbon-based ink is used. These can be applied by anyone and are less dense that professional tattoos.
– Professional Tattoos- They are complex and multicolored. Inks used in these may be of organic or inorganic compounds. These are made by trained professionals or tattoo artists. They are evenly spread in the layers of skin.
– Cosmetic Tattoos- This involves use of pigments (colored) to create permanent make-up on the skin.
– Traumatic tattoos- These occur naturally after a road accident or an injury from a pen or pencil
The choice of laser or wavelength depends on the tattoo type, colour and its location. The Q-Switched lasers (QSL), work on the principle of selective photothermolysis and also produce an additional photoacoustic effect, causing explosion of the target due to creation of shock waves. The energy delivered is so high that the ink particles are ruptured. These ruptured fragments are then cleared by the body’s natural mechanism of defense.
Latest addition to the artillery, also considered the mainstay of treatment, are picosecond devices (532nm, 694nm, 755nm and 1064nm) which enable to target wide array of tattoos (Henley and Ramsey, 2017).
Further, newer techniques like R20 method, wherein 4 exposures to the laser are performed in 20 minute interval is also a successful treatment option.
Amateur tattoos respond quicker, while it takes time for professional tattoos to fade. Coloured tattoos take even longer than only black ones to fade away. It may take 2-15 sessions for successful lightening depending on the tattoo.
Preoperative Preparation:– The person should avoid tanning as this might hinder with treatment
– If person is on oral retinoids then the treatment should not be done for at least 6-12 months.
– A test patch can be done in order to evaluate treatment parameters
– The area to be treated should be cleaned thoroughly
During the Process:– Patient might feel some pain
– Presence of ash –white colour due to steam and gas bubbles which resolves in 30 min
– Pinpoint bleeding may be observed
– Area appears inflamed
Postoperative Instructions:– Use of broad-spectrum sunscreens throughout the period of treatment
– Application of ice-pack if burning persists for some time, following which an antibiotic can be applied by suggestion of your dermatologist
– Excessive physical activity, pools, spa etc should be avoided for at least 72 hours post treatment
– No scratching or rubbing the area, this can cause aggravation of injury
Complications & Their Management:– Textural changes and scarring
– Darkening of tattoo pigments. If they turn black then it is difficult to treat
– Thermal injury and burns
– Localized allergic reactions
– Postinflammatory hyperpigmentation, usually resolves with time
– Postinflammatory hypopigmentation, may persist for weeks to months and requires attention by dermatologist to treat
Contraindications:– Keloid and keloidal tendencies
– Associated photoaggravated skin diseases and medical illness
– Treatment area with active cutaneous infections like herpes labialis etc
– Unstable vitiligo and psoriasis
– Tattoo granuloma