While picosecond lasers and other advances continue to boost tattoo clearance rates, said an expert at The Cosmetic Bootcamp, there's still a place for earlier-generation pigment-pummeling technologies.
Picosecond lasers improve physicians' ability to break up ink particles, including tough-to-treat green and blue inks, more effectively, said Paul M. Friedman, M.D., a dermatologist with offices in Houston and New York.
"The 1,064 nm should be your primary wavelength for a tattoo-removal laser. It allows you to treat all skin types, which is important to me, practicing in Houston, Texas." He showed photos of a patient with type VI skin and a black tattoo who achieved an excellent outcome after three treatment sessions with a 1,064 nm picosecond Nd:YAG laser — without the dyspigmentation that frequently occurs when treating darker skin types with shorter wavelengths.
More impressive, he said, was the laser's performance in removing red ink safely with the 532 nm laser light. "We've all seen hyper-or hypopigmentation when treating patients with skin of color because the melanin is a competing chromophore. The lower fluence required compared to Q-switched technology allows for safer treatment in skin of color."
For accelerated tattoo removal, the R20 method allows one to perform multiple passes on the same day by waiting 20 minutes between passes. This approach was published in the February 2012 Journal of the American Academy of Dermatology. The R20 method achieved excellent results in the original Harvard study, said Dr. Friedman. "But in reality, that's not very efficient to have the patient in our office for that length of time."
To streamline tattoo treatments, he uses the perfluorodecalin (PFD) patch. "I like it for several reasons – it provides a barrier, so that none of the tissue is splattering back." He also likes PFD's ability to serve as an optical clearing agent. Because heat is conducted from the epidermis into the patch instead of the skin, explains Dr. Friedman, the patch provides an extra layer of safety for darker skin types.
"More importantly, it clears out those little microbubbles that occur between passes. So it allows us to do multiple passes on the same session without having to wait 20 minutes in between. Therefore, we achieve more effective clearing per treatment session." In a 30-patient study published in Lasers in Surgery and Medicine in March 2017, using a PFD patch with a nanosecond Q-switched 755 nm alexandrite laser allowed investigators to perform 3.7 passes in five minutes (versus 1.4 passes with the laser alone) with less erythema and edema.