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Dermatologic procedure to remove tattoo pigments

Quanta System Discovery

Example of a tattoo removal laser

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audio icon "Rethinking Ink", Distillations Podcast Episode 220, Scientific discipline History Institute

Tattoo removal has been performed with various tools since the first of tattooing. While tattoos are generally considered permanent, it is now possible to remove them with treatments, fully or partially.

The "standard modality for tattoo removal"[ane] is the non-invasive removal of tattoo pigments using Q-switched lasers. Different types of Q-switched lasers are used to target unlike colors of tattoo ink depending on the specific light absorption spectra of the tattoo pigments. Typically, black and other darker-colored inks can be removed completely using Q-switched lasers while lighter colors such every bit yellows and greens are yet very difficult to remove. Success can depend on a wide variety of factors including peel color, ink colour, and the depth at which the ink was applied.[two] [1]

Q-switched lasers get-go became commercially available in the early 1990s. For a couple of decades before that, continuous-wave lasers were used as medical lasers for tattoo removal. Continuous-wave lasers used a high energy beam that ablated the target area and destroyed surrounding tissue structures as well as tattoo ink. Treatment tended to be painful and crusade scarring.[two] [ane]

Before the development of laser tattoo removal methods, mutual techniques included dermabrasion, TCA (Trichloroacetic acid, an acid that removes the top layers of pare, reaching equally deep as the layer in which the tattoo ink resides), salabrasion (scrubbing the skin with table salt), cryosurgery, and excision, which is sometimes nonetheless used forth with skin grafts for larger tattoos.[3] [ane] [iv] Many other methods for removing tattoos accept been suggested historically including the injection or application of tannic acid, lemon juice, garlic, and dove dung.[5] [six]

Recent inquiry is investigating the potential of multi-pass treatments and the use of picosecond laser engineering science, which seem promising.[7] [eight] [nine]

Motives [edit]

A poll conducted in January 2012 by Harris Interactive reported that 1 in seven (xiv%) of the 21% of American adults who accept a tattoo regret getting 1. The poll did not report the reasons for these regrets, only a poll that was done 4 years prior reported that the most common reasons were "too young when I got the tattoo" (20%), "information technology's permanent" and "I'1000 marked for life" (19%), and "I just don't like it" (18%). An earlier poll showed that 19% of Britons with tattoos suffered regret, as did 11% of Italians with tattoos.[ten]

Surveys of tattoo removal patients were done in 1996 and 2006 and provided more than insight. Of those polled, the patients who regretted their tattoos typically obtained their tattoos in their tardily teens or early on twenties, and were evenly distributed by gender. Amongst those seeking removals, more one-half reported that they "suffered embarrassment." A new task, problems with dress, and a significant life event were likewise ordinarily cited as motivations.[xi] Tattoos that were one time a symbol of inclusion in a group, such as a gang, tin can make it hard to become employed.[2] Tattoos that indicate a significant relationship, such as a spouse, girlfriend, or fellow, can become problematic if the human relationship ends.[12] Angelina Jolie, Eva Longoria, Marc Anthony, and Denise Richards are some of the celebrities who have had this kind of tattoo removed.[13]

The choice to get a tattoo that is subsequently regretted is related to the end-of-history illusion in which teenagers and adults of all ages know that their tastes have changed regularly over the years before the current moment but believe that their tastes will somehow not proceed to abound and mature in the hereafter.[14] Equally a effect, they wrongly believe that whatever tattoo that appeals to them today volition e'er entreatment to them in the future.

Removal by replacement [edit]

Some wearers decide to embrace an unwanted tattoo with a new tattoo. This is commonly known as a camouflage. An artfully done cover-up may render the one-time tattoo completely invisible, though this volition depend largely on the size, style, colors and techniques used on the quondam tattoo and the skill of the tattoo artist.[xv] Roofing up a previous tattoo necessitates darker tones in the new tattoo to finer hide the older, unwanted piece.[16] Many tattoos are likewise dark to encompass upward and in those cases patients may receive light amplification by stimulated emission of radiation tattoo removal to lighten the existing ink to make themselves better candidates for a embrace up tattoo.[ commendation needed ]

Laser removal [edit]

Tattoo removal is most usually performed using lasers that pause down the ink particles in the tattoo into smaller particles. Dermal macrophages are part of the immune organisation, tasked with collecting and digesting cellular debris. In the case of tattoo pigments, macrophages collect ink pigments, just accept difficulty breaking them downwardly. Instead, they shop the ink pigments. If a macrophage is damaged, information technology releases its convict ink, which is taken up by other macrophages. This tin can make information technology particularly difficult to remove tattoos. When treatments intermission downwardly ink particles into smaller pieces, macrophages tin can more than easily remove them.[17]

Tattoo pigments have specific light absorption spectra. A tattoo laser must be capable of emitting adequate energy within the given absorption spectrum of the paint to provide an effective treatment. Certain tattoo pigments, such every bit yellows and fluorescent inks are more challenging to treat than darker blacks and blues, because they have absorption spectra that fall exterior or on the edge of the emission spectra bachelor in the tattoo removal light amplification by stimulated emission of radiation.[three] Recent pastel coloured inks contain high concentrations of titanium dioxide which is highly reflective. Consequently, such inks are difficult to remove since they reverberate a significant amount of the incident light energy out of the skin.[18] [3]

The aureate standard of tattoo removal treatment modality is considered to exist laser tattoo removal using multiple separate Q-switched lasers (depending on the specific wavelengths needed for the dyes involved) over a number of echo visits. There are several types of Q-switched lasers, and each is effective at removing a different range of the color spectrum.[nine] [one] Lasers adult during or after 2006 provide multiple wavelengths and can successfully treat a much broader range of tattoo pigments than previous individual Q-switched lasers. Unfortunately the dye systems used to alter the wavelength effect in significant power reduction such that the use of multiple dissever specific wavelength lasers remains the gilt standard.[ citation needed ]

The energy density (fluence), expressed as joules/cm2, is determined prior to each treatment besides every bit the spot size and repetition rate (hertz). To mitigate pain the preferred method is but to cool the area before and during treatment with a medical-form chiller/cooler and to use a topical anesthetic. During the handling process, the light amplification by stimulated emission of radiation beam passes through the skin, targeting the ink resting in a liquid state within. While it is possible to see immediate results, in most cases the fading occurs gradually over the seven–8 week healing period between treatments.[xix]

Q-switched lasers are reported past the National Institutes of Health to event in scarring only rarely. Areas with thin skin volition exist more probable to scar than thicker-skinned areas.[twenty]

By 2023, the light amplification by stimulated emission of radiation tattoo removal market is expected to grow 12.7% annually.[21]

Mechanism of laser action [edit]

Experimental observations of the effects of short-pulsed lasers on tattoos were first reported in the late 1960s by Leon Goldman and others.[22] [23] [24] In 1979 an argon light amplification by stimulated emission of radiation was used for tattoo removal in 28 patients, with express success. In 1978 a carbon dioxide laser was likewise used, only because it targeted h2o, a chromophore present in all cells, this type of laser generally acquired scarring after treatments.[25] [3] [26] [2]

In the early 1980s, a new clinical study began in Canniesburn Hospital's Burns and Plastic Surgery Unit, in Glasgow, Scotland, into the effects of Q-switched carmine laser energy on blue/black tattoos.[22] [27] Further studies into other tattoo colors were then carried out with various degrees of success.[28] Inquiry at the University of Strathclyde, Glasgow also showed that there was no detectable mutagenicity in tissues following irradiation with the Q-switched ruby-red laser.[29] This essentially shows that the treatment is rubber, from a biological viewpoint, with no detectable chance of the development of cancerous cells.[30]

It was not until the late 1980s that Q-switched lasers became commercially applied with the commencement marketed light amplification by stimulated emission of radiation coming from Derma-lase Limited, Glasgow.[31] [32] Ane of the start American published articles describing laser tattoo removal was authored by a group at Massachusetts General Hospital in 1990.[22] [33]

Tattoos consist of thousands of particles of tattoo pigment suspended in the skin.[34] While normal human growth and healing processes volition remove small foreign particles from the skin, tattoo pigment particles are too big to be removed automatically. Laser treatment causes tattoo pigment particles to heat upwardly and fragment into smaller pieces. These smaller pieces are then removed past normal body processes. Q-switched lasers produce bursts of infrared light at specific frequencies that target a item spectrum of colour in the tattoo ink. The laser passes through the upper layers of the skin to target a specific pigment in the lower layers.[2]

Laser tattoo removal is a successful application of the theory of selective photothermolysis (SPTL).[35] However, dissimilar treatments for blood vessels or hair the mechanism required to shatter tattoo particles uses the photomechanical effect. In this situation the free energy is absorbed by the ink particles in a very short time, typically nanoseconds. The surface temperature of the ink particles can rise to thousands of degrees but this free energy profile rapidly collapses into a shock wave. This shock moving ridge and then propagates throughout the local tissue (the dermis) causing breakable structures to fragment. Hence tissues are largely unaffected since they simply vibrate equally the shock wave passes. For light amplification by stimulated emission of radiation tattoo removal the selective destruction of tattoo pigments depends on four factors:

  • The color of the light must penetrate sufficiently deep into the peel to reach the tattoo pigment. Pigments deeper in the skin are harder to remove than those near the surface.[2]
  • The color of the laser low-cal must be more highly absorbed by the tattoo pigment than the surrounding skin. Different tattoo pigments therefore require different light amplification by stimulated emission of radiation colors. For example, ruby light is highly captivated by light-green tattoo pigments, while yellow tends non to absorb light.[2]
  • The time duration (pulse duration) of the laser energy must be very short, so that the tattoo pigment is heated to fragmentation temperature before its estrus can dissipate to the surrounding skin. Otherwise, heating of the surrounding tissue can cause burns or scars. For light amplification by stimulated emission of radiation tattoo removal, this duration should exist on the society of nanoseconds.
  • Sufficient energy must be delivered during each laser pulse to rut the pigment to fragmentation. If the energy is too depression, pigment will not fragment and no removal will take place.

Q-switched lasers are the only commercially bachelor devices that tin run across these requirements.[36]

Although they occur infrequently, mucosal tattoos can be successfully treated with Q-switched lasers besides.[37]

A novel method for laser tattoo removal using a fractionated CO2 or Erbium:YAG light amplification by stimulated emission of radiation, alone or in combination with Q-switched lasers, was reported past Ibrahimi and coworkers from the Wellman Center of Photomedicine at the Massachusetts General Hospital in 2011.[38] This new approach to laser tattoo removal may beget the ability to remove colors such as yellow and white, which have proven to exist resistant to traditional Q-switched light amplification by stimulated emission of radiation therapy.

Laser parameters that affect results [edit]

Several colors of laser light (quantified by the light amplification by stimulated emission of radiation wavelength) are used for tattoo removal, from visible low-cal to near-infrared radiations. Different lasers are meliorate for different tattoo colors. Consequently, multi-color tattoo removal almost always requires the use of 2 or more light amplification by stimulated emission of radiation wavelengths. Tattoo removal lasers are usually identified by the lasing medium used to create the wavelength (measured in nanometers (nm)):[ citation needed ]

  • Q-switched Frequency-doubled Nd:YAG: 532 nm. This laser creates a green light which is highly absorbed past red, yellowish, and orangish targets. Useful primarily for red and orange tattoo pigments, this wavelength is as well highly absorbed past melanin (the chemical which gives skin color or tan) which makes the laser wavelength constructive for age spot or dominicus spot removal. Nd:YAG lasers may crusade hemoglobin absorption, leading to purpura (collection of claret under tissue in large areas), pinpoint bleeding, or whitening of the skin.[39]
  • Q-switched Cherry: 694 nm. This laser creates a red light which is highly absorbed past dark-green and night tattoo pigments. Because it is more highly absorbed by melanin this laser may produce undesirable side effects such as pigmentary changes for patients of all only white skin.[40] This is the all-time wavelength for blueish ink.
  • Q-switched Alexandrite: 755 nm. The weakest of all the q-switched devices and somewhat similar to the Ruby laser in that the Alexandrite creates a red light which is highly absorbed by green and dark tattoo pigments. Still, the alexandrite laser colour is slightly less absorbed by melanin, and so this laser has a slightly lower incidence of unwanted pigmentary changes than a ruby laser.[41] This light amplification by stimulated emission of radiation works well on green tattoos merely because of its weaker pinnacle power it works only moderately well on black and bluish ink. It does not work at all (or very minimally) on ruby-red, orangish, yellow, brown, etc. This laser wavelength is as well available in a picosecond speed with anecdotal claims that it removes ink faster.
  • Q-switched Nd:YAG: 1064 nm. This laser creates a about-infrared lite (invisible to humans) which is poorly absorbed past melanin, making this the but laser suitable for darker skin. This laser wavelength is likewise absorbed by all dark tattoo pigments and is the safest wavelength to use on the tissue due to the low melanin assimilation and low hemoglobin absorption. This is the wavelength of pick for tattoo removal in darker peel types and for black ink.
  • Dye modules are available for some lasers to convert 532 nm to 650 nm or 585 nm calorie-free which allows one light amplification by stimulated emission of radiation organisation to safely and effectively care for multi-color tattoo inks. When dye modules accept 532 nm laser wavelength and change it, there is a loss of energy. Treatments with dye packs, while effective for the commencement few treatments, many not be able to clear these ink colors fully. The function of dye lasers in tattoo removal is discussed in detail in the literature.[42]

Pulsewidth or pulse duration is a critical laser parameter. All Q-switched lasers take appropriate pulse durations for tattoo removal.[ commendation needed ]

Spot size, or the width of the laser beam, affects treatment. Light is optically scattered in the peel, like automobile headlights in fog. Larger spot sizes slightly increase the constructive penetration depth of the laser light, thus enabling more effective targeting of deeper tattoo pigments. Larger spot sizes likewise help make treatments faster.[ citation needed ]

Fluence or energy density is another important consideration. Fluence is measured in joules per square centimeter (J/cm²). It is important to be treated at high enough settings to fragment tattoo particles.

Repetition rate helps make treatments faster only is not associated with any treatment outcome. Faster treatments are usually preferred because the pain ends sooner.

Number of laser tattoo removal treatment sessions needed [edit]

The number of treatments necessary to remove a tattoo via laser can be predicted by the Kirby-Desai Calibration.[43] The number of sessions depends on various parameters, including the area of the torso treated, skin colour, ink color present, scarring, and amount of ink nowadays. Effectiveness of the immune system may play a part every bit well.

Consummate light amplification by stimulated emission of radiation tattoo removal requires numerous treatment sessions, typically spaced at eight weeks or more than apart. Treating more frequently than viii weeks increases the risk of adverse furnishings and does non necessarily increment the charge per unit of ink absorption. Anecdotal reports of treatments sessions at four weeks leads to more scarring and dischromia and can be a source of liability for clinicians. At each session, some but not all of the tattoo pigment particles are effectively fragmented, and the trunk removes the smallest fragments over the course of several weeks or months. The upshot is that the tattoo is lightened over time. Remaining big particles of tattoo pigment are then targeted at subsequent treatment sessions, causing further lightening. Tattoos located on the extremities, such as the talocrural joint, generally have longest. As tattoos fade clinicians may recommend that patients wait many months between treatments to facilitate ink resolution and minimize unwanted side furnishings.

Sure colors have proved more difficult to remove than others. In particular, this occurs when treated with the wrong wavelength of light amplification by stimulated emission of radiation low-cal is used. Some accept postulated that the reason for slow resolution of green ink in particular is due to its significantly smaller molecular size relative to the other colours.[44] Consequently, green ink tattoos may require treatment with 755 nm lite just may also respond to 694 nm, 650 nm and 1064 nm. Multiple wavelengths of light may be needed to remove colored inks.

One small Greek report showed that the R20 method—4 passes with the laser, twenty minutes apart—caused more breaking up of the ink than the conventional method without more scarring or agin effects. However, this written report was performed on a very small patient population (12 patients total), using the weakest of the QS lasers, the 755 nm Alexandrite light amplification by stimulated emission of radiation. I of the other chief problems with this study was the fact that more than half of the 18 tattoos removed were not professional and amateur tattoos are ever easier to remove. Proof of concept studies are underway, but many light amplification by stimulated emission of radiation experts advise against the R20 method using the more modern and powerful tattoo removal lasers available at nearly offices as an increase in adverse side effects including scarring and dischromia is likely. Patients should enquire nigh the laser existence used if the R20 treatment method is offered by a facility as it is usually but offered by clinics that are using the 755 nm Alexandrite as opposed to the more powerful and versatile devices that are more commonly used. Moreover, dermatologists offering the R20 method should inform patients that it is merely one alternative to proven protocols and is non a gold standard treatment method to remove tattoos.

Multiple pass treatment methods (R20, every bit mentioned above, and R0) have by and large shown to conduct a greater risk of side effects, due to the increased amount of energy used in treatment. One caveat to this, yet, is incorporating a perfluorodecalin (PFD) patch into the protocol.[45] A PFD patch utilizes a clear silicone gel patch, with a pocket-sized amount of PFD liquid practical to the treatment area immediately earlier each pass of laser awarding, and conducting the passes in rapid succession. The combination of the patch and liquid reduce the epidermal besprinkle, which tin limit the predicted side effects typically seen in aggressive laser tattoo removal treatments (hyper and hypopigmentation, blistering, etc).[46] Additionally, the liquid reduces the laser frosting very quickly, assuasive for faster re-handling, limiting the time of handling while still improving efficacy. Early studies have been performed to signal improved clearance with the utilize of this patch in 3-4 passes, in a single session, utilizing more energy than typically allowable with a traditional handling methodology.[47] All these physical properties of the patch work to substantially reduce the full number of laser treatments required for ink clearance. While the PFD patch is currently FDA cleared for use with all pico and nanosecond domain lasers and wavelengths, it is only cleared for Fitzpatrick Pare Types I-III. Early studies have shown anecdotally that at that place isn't necessarily increased risks with Fitzpatrick Skin Types IV-Half dozen, though still not FDA cleared equally an indication.[48]

Factors contributing to the success of laser tattoo removal [edit]

There are a number of factors that make up one's mind how many treatments volition be needed and the level of success one might feel. Age of tattoo, ink density, color and fifty-fifty where the tattoo is located on the body, and whether the tattoo was professional person, or not, all play an of import role in how many treatments will be needed for complete removal.[49] Even so, a rarely recognized factor of tattoo removal is the function of the client'due south immune response.[50] The normal process of tattoo removal is fragmentation followed by phagocytosis which is then drained away via the lymphatics. Consequently, it is the inflammation resulting from the actual laser handling and the natural stimulation of the hosts' immune response that ultimately results in removal of tattoo ink; thus variations in results are enormous.[51]

Pain direction during treatment [edit]

Laser tattoo removal is painful; many patients say information technology is worse than getting the tattoo. The pain is often described to be similar to that of hot oil on the pare, or a "snap" from an elastic band. Depending on the patient'due south pain threshold, and while some patients may forgo anesthesia birthday, most patients will require some form of local anesthesia. Pre-treatment might include the application of an coldhearted cream under occlusion for 45 to xc minutes or cooling by water ice or cold air prior to the laser treatment session. A meliorate method is consummate anesthesia which can be administered locally by injections of 1% to 2% lidocaine with epinephrine.

A technique which helps to reduce the hurting awareness felt past patients has been described by MJ Murphy.[52] He used a standard microscope glass slide pressed against the tattooed skin and fired the laser through the drinking glass. This technique may correspond a simplest and effective method to reduce the pain sensation when treating pocket-size tattoos.

Post-handling considerations [edit]

Immediately after laser treatment, a slightly elevated, white discoloration with or without the presence of punctuate haemorrhage is often observed. This white color change is thought to be the result of rapid, rut-formed steam or gas, causing dermal and epidermal vacuolization. Pinpoint bleeding represents vascular injury from photoacoustic waves created by the light amplification by stimulated emission of radiation'due south interaction with tattoo pigment. Minimal edema and erythema of adjacent normal skin ordinarily resolve within 24 hours. Subsequently, a crust appears over the entire tattoo, which sloughs off at approximately ii weeks mail service-handling. As noted in a higher place, some tattoo pigment may exist plant within this chaff. Post-operative wound care consists of elementary wound intendance and a non-occlusive dressing. Since the awarding of laser light is sterile there is no demand for topical antibiotics. Moreover, topical antibiotic ointments tin cause allergic reactions and should exist avoided. Fading of the tattoo will be noted over the next eight weeks and re-treatment free energy levels can exist tailored depending on the clinical response observed.[53]

Side effects and complications [edit]

Nearly one-half of the patients treated with Q-switched lasers for tattoo removal will show some transient changes in the normal skin pigmentation. These changes usually resolve in vi to 12 months just may rarely be permanent.[54]

Hyperpigmentation is related to the patient'southward skin tone, with skin types IV, 5 and VI more than decumbent regardless of the wavelength used. Twice daily handling with hydroquinones and broad-spectrum sunscreens usually resolves the hyperpigmentation within a few months, although, in some patients, resolution can be prolonged.[54]

Hypopigmentation is more commonly observed in darker skin tones. It is more than probable to occur with higher fluence and more frequent treatments. Sometimes lighter peel exhibits hypopigmentation later on a series of treatments. Assuasive more time between treatments reduces chances of hypopigmentation. Since it is more likely to encounter hypopigmentation after multiple treatments, some practitioners propose waiting a few additional weeks, after a few sessions. Usually treatment stops until hypopigmentation resolves in a thing of months.

Transient textural changes are occasionally noted but often resolve within a few months; all the same, permanent textural changes and scarring very rarely occur. If a patient is prone to pigmentary or textural changes, longer treatment intervals are recommended. Additionally, if a blister or chaff forms following handling, it is imperative that the patient does not manipulate this secondary peel modify. Early removal of a blister or chaff increases the chances of developing a scar. Additionally, patients with a history of hypertrophic or keloidal scarring need to exist warned of their increased risk of scarring.

Local allergic responses to many tattoo pigments take been reported, and allergic reactions to tattoo pigment after Q-switched light amplification by stimulated emission of radiation treatment are too possible. Rarely, when yellow cadmium sulfide is used to "brighten" the red or yellow portion of a tattoo, a photoallergic reaction may occur. The reaction is also mutual with ruby ink, which may contain cinnabar (mercuric sulphide). Erythema, pruritus, and even inflamed nodules, verrucose papules, or granulomas may present. The reaction will exist confined to the site of the ruby/yellow ink. Handling consists of strict sunlight avoidance, sunscreen, interlesional steroid injections, or in some cases, surgical removal. Unlike the destructive modalities described, Q-switched lasers mobilize the ink and may generate a systemic allergic response. Oral antihistamines and anti-inflammatory steroids have been used to treat allergic reactions to tattoo ink.

Studies of diverse tattoo pigments have shown that a number of pigments (nearly containing iron oxide or titanium dioxide) change color when irradiated with Q-switched light amplification by stimulated emission of radiation energy. Some tattoo colors including flesh tones, calorie-free red, white, peach and light brown containing pigments also equally some green and blueish tattoo pigments, inverse to blackness when irradiated with Q-switched laser pulses. The resulting gray-black colour may crave more than treatments to remove. If tattoo concealment does occur, later on 8 weeks the newly darkened tattoo tin be treated every bit if it were black pigment.[55]

Very rarely, non Q-switched laser treatments, like CO2 or Argon lasers, which are very rarely offered these days, can rupture blood vessels and aerosolize tissue requiring a plastic shield or a cone device to protect the laser operator from tissue and blood contact. Protective eyewear may exist worn if the laser operator chooses to practise so.

With the mechanical or salabrasion method of tattoo removal, the incidence of scarring, pigmentary alteration (hyper- and hypopigmentation), and ink retentivity are extremely high.[56]

The employ of Q-switched lasers could very rarely produce the development of large bulla. Nevertheless, if patients follow post care directions to drag, rest, and apply intermittent icing, it should minimize the chances of bulla and other adverse effects. In improver, health care practitioners should contemplate the use of a cooling device during the tattoo removal procedure. While the infrequent bulla development is a possible side effect of Q-switched laser tattoo removal, if treated appropriately and speedily past the health intendance practitioner, it is unlikely that long term consequences would ensue.[57]

Risks [edit]

Although laser treatment is well known and often used to remove tattoos, unwanted side furnishings of laser tattoo removal include the possibility of discoloration of the pare such as hypopigmentation (white spots, more common in darker peel) and hyperpigmentation (dark spots) every bit well equally textural changes - these changes are usually non permanent when the Nd:YAG is used but it is much more probable with the utilise of the 755 nm Alexandrite, the 694 nm Ruby and the R20 method. Very rarely, burns may upshot in scarring but this usually merely occurs when patients do not treat the treated expanse properly. Occasionally, "paradoxical concealment" of a tattoo may occur, when a treated tattoo becomes darker instead of lighter. This occurs most often with white ink, flesh tones, pinkish, and cosmetic make-upward tattoos.[58] [59]

Some tattoo pigments comprise metals that could theoretically break down into toxic chemicals in the body when exposed to low-cal. This has not nevertheless been reported in vivo but has been shown in laboratory tests. Laser removal of traumatic tattoos may similarly exist complicated depending on the substance of the pigmenting material. In 1 reported instance, the use of a light amplification by stimulated emission of radiation resulted in the ignition of embedded particles of firework droppings.[60]

References [edit]

Notes [edit]

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Further reading [edit]

  • Bernstein, E. F. (2006). "Laser handling of tattoos". Clinics in Dermatology. 24 (1): 43–55. doi:x.1016/j.clindermatol.2005.10.025. PMID 16427505.
  • Goldberg, David J. (4 December 2007). "Chapter three: Pigmented Lesions, Tattoos, and Disorders of Hypopigmentation". Laser Dermatology: Pearls and Problems. Malden, Massachusetts: Blackwell. pp. 71–113. doi:ten.1002/9780470691991.ch3. ISBN978-ane-4051-3420-0.
  • Kirby, Due west. (2013) Lasers and Energy Devices for the Skin (Second Edition) Chapter 4: "Tattoo Removal". Ed. Goldman, Fizpatrick, Ross, Kilmer. CRC Press. pp. 74–93. ASIN: 1841849332. ISBN 978-1841849331
  • Kirby, W., Kartono, F., Desai, A., Kaur, R. & Desai, T. (January 2010) "Handling of Large Bulla Germination afterward Tattoo Removal with a Q-Switched Light amplification by stimulated emission of radiation", Journal of Clinical and Aesthetic Dermatology
  • Kirby, W., Kartono, F. & Modest, R.(September 2011). "Chapter 30: Tattoo Removal with Lasers". Dermatologic and Cosmetic Procedures in Part Practice. Elsevier. pp: 367-376. ISBN 978-1-4377-0580-5
  • Kuperman-Beade, M.; Levine, V. J. & Ashinoff, R. (2001). "Light amplification by stimulated emission of radiation removal of tattoos". American Journal of Clinical Dermatology. 2 (ane): 21–v. doi:10.2165/00128071-200102010-00004. PMID 11702617. S2CID 44259544.
  • Pfirrmann, One thousand.; Karsai, S.; Roos, S.; Hammes, S. & Raulin, C. (2007). "Tattoo removal- State of the art". Journal of German Dermatology. five (10): 889–97. doi:10.1111/j.1610-0387.2007.06405.ten. PMID 17910671. S2CID 312548.
  • Vartanian, Varci (July i, 2012) "Your Permanent Record? The Scoop on Tattoo Removal - Give-and-take with Dr. Kirby", The Daily Muse
  • Verhaeghe, Evelien (January 2010). "Chapter seven: Techniques and Devices Used for Tattoo Removal". In De Cuyper, Christa; Pérez-Cotapos Southward, Maria Luisa (eds.). Dermatologic Complications with Body Art . Heidelberg: Springer-Verlag. pp. 91–105. doi:x.1007/978-iii-642-03292-9_7. ISBN978-3-642-03291-2.
  • Wysong, P. (August xvi, 2011) "Tattoo Removal Comes Of Age - An Practiced Interview With Dr. William Kirby and Dr. Rady Rahban", Medscape

External links [edit]

  • How Tattoo Removal Works

wyattboying.blogspot.com

Source: https://en.wikipedia.org/wiki/Tattoo_removal

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