Trans Epidermal Pigment Release (TEPR), delivered via a device called the Eclipse MicroPen TR (Eclipse Aesthetics), may provide a viable alternative to laser tattoo removal, according to one expert speaker at this year’s annual American Academy of Cosmetic Surgery (AACS) meeting in New Orleans, LA.
TEPR is a non-surgical and low-cost technique that removes all types and colors of pigment in a small number of sessions, says Gustavo H. Leibaschoff, M.D., president of the International Consultants in Aesthetic Medicine.
Dr. Leibaschoff explains that the prevalence of tattoos and the demand for their removal have both increased significantly over the past 20 years. New high-density and color-fast pigments, improved delivery devices for tattoo artists and more multi-colored designs have also become increasingly pervasive, which complicate the removal process.
Further confounding the process is the general lack of knowledge regarding the composition of tattoo inks and pigments, Dr. Leibaschoff says. In addition to the standard ingredients contained in inks such as additives, bonding agents and ethanol, tattoo artists can add their own ingredients to “personalize” the ink. Tattoo pigments have not been approved or regulated by the FDA, and can contain any one or mixture of a myriad of ingredients depending on their color, he explains.
“Currently there is no guaranteed method of removing all tattoo pigment without leaving some sort of mark or evidence that something has been there before,” says Dr. Leibaschoff.
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Tattoos & TEPR
Tattoo pigments are deposited into the skin using needles that introduce them at an array of intracellular depths, he says. Once the pigment becomes intracellular, it is protected by the immune system and remains within the dermal layer. To remove tattoo pigment, it either has to be expelled from the cells within which it exists, or those cells themselves must be eliminated, Dr. Leibaschoff explains.
Dr. Leibaschoff pointed out that lasers work by destroying the tattoo pigment along with the cells within which they are contained. The body recognizes these broken up and released pigment molecules in the extracellular environment as foreign, causing them to be taken up by the immune system. Studies have linked tattoos to cancer and poisoning, he says, and laser tattoo removal actually releases these potentially carcinogenic or toxic tattoo fragments into the body a second time, eventually depositing them on the lymph nodes or liver. Conversely, the MicroPen TR dissolves the tattoo ink and removes it without releasing it back into the patient’s liver and lymphatic system, he notes.
TEPR utilizes a treatment technique described as System for Trans Epidermal Pigment Removal (SFTEPR). “It works by treating a small surface area with closely spaced partial thickness injuries with intervening skin bridges of intact epidermis and dermis,” he explains. TEPR removes all types of tattoo ink, color and dye, and the pigment is expelled directly from the skin rather than being released back into the body. There is no risk of the body re-absorbing the pigment molecules, he says.
TEPR Mechanism of Action
According to Dr. Leibaschoff, TEPR uses medical-grade micro-needles set to precise penetration depths to remove the epithelium of the tattooed area. First, circular patches of de-epithelialized skin, measuring about 5 mm in diameter and spaced 3 mm apart in every direction, are created on the skin in a pattern, which covers the tattoo. “The practice is like reverse tattooing,” notes Dr. Leibaschoff.
Once the de-epithelialized patches are exposed, what he refers to as “a proprietary and natural product” is introduced into the dermis, which acts to isolate the tattoo pigment in the deeper layers. Variable thickness skin injury and eschar formation will then occur. Once the TEPR wounds have healed, this method is used on adjacent tattooed skin until the tattoo is completely removed.
It is important to carefully evaluate how the patient’s tattoo was created, the type and color of pigment used, and whether previous removal has been attempted, as these factors can influence the outcome and success of the TEPR method, and will also determine the length of time needed to remove the tattoo, he adds. Complete removal is typically achieved in three treatments, allowing eight weeks between sessions.
Dr. Leibaschoff is a consultant and on the advisory board for ICAM USA.