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Single-session repeat laser-assisted treatments improve tattoo removal

Key iconKey Points

  • Results of small study suggest treatment with multiple laser exposures in same session can reduce number of sessions required for tattoo clearance
  • 'R20' method was designed based on understanding of tissue response to laser exposure

ATHENS, GREECE — A series of four Q-switched laser treatments performed in a single session shows promise for overcoming many of the limitations associated with current laser procedures for tattoo removal, according to Theodora Kossida, M.D., Ph.D.

Recently, Dr. Kossida performed a prospective, split-lesion study that compared the efficacy and safety of tattoo removal after a single laser exposure versus using four consecutive exposures administered in a repeated fashion at 20-minute intervals (the "R20" method). She performed all of the treatments using a Q-switched 755 nm alexandrite laser (Cynosure) under routine topical anesthesia and with injection of a local anesthetic upon patient request.

Outcomes included assessment of tattoo lightening using standardized digital photographs taken at baseline and three months post-treatment; histological review comparing pre- and immediate post-treatment biopsy samples; and patient impressions at three months post-treatment. The photographic and histological evaluations were performed by independent dermatologists and dermatopathologists blinded to treatment.

The study included 18 tattoos of 12 patients. Three were re-tattoos and most were black amateur tattoos, but there were a few professional tattoos that also contained green or some blue pigment.

STUDY RESULTS The post-treatment evaluations showed that the R20 protocol resulted in significantly greater lightening as well as greater and deeper dispersion of the tattoo ink within the dermis compared with the single treatment. Results were better for amateur versus professional tattoos with either technique, but overall, about 60 percent of R20-treated tattoos were cleared completely, while only 0 to 25 percent lightening was achieved in
60 percent of the control group, and none of the latter tattoos lightened by more than 50 percent after a single exposure.

There were no permanent adverse events, and at least 90 percent or more of patients agreed the R20 treatment was tolerable, produced a cosmetically appealing outcome and was cost-effective, and they would recommend it to a friend.

"Q-switched lasers are the current gold standard for tattoo removal, but the treatment usually requires multiple sessions, which adds to cost and increases patient exposure to treatment-related discomfort along with needs for post-treatment woundcare. Even then, the magnitude of improvement achieved is variable and there is a significant risk of hypopigmentation. Therefore, it is not surprising that patient dissatisfaction leading to premature abandonment of treatment is common," says Dr. Kossida, Sygros Hospital of Skin and Venereological Diseases, Athens, Greece.

"The results of this small study suggest that treatment with multiple laser exposures in the same session can reduce the number of sessions required for achieving tattoo clearance while also increasing the overall efficacy of the procedure. These benefits can be achieved without the need to purchase new technology; however, our encouraging findings need to be validated in larger prospective studies," Dr. Kossida says.

The patients were treated in Greece and the study was performed in collaboration with R. Rox Anderson, M.D., professor of dermatology, Harvard Medical School, and director of Wellman Center for Photomedicine, Massachusetts General Hospital, Boston. The parameters used for tattoo removal included a 100 nanosecond pulse duration; repetition rate of 1 Hz; 3 mm spot size with 10 to 15 percent overlap; and energy of 5.5 J/cm2 .


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