Tattoo Removal

Tattoo removal has been performed with different tools in the history of tattooing. While tattoos were once considered permanent, it is now possible to remove

them with treatments, fully or partially. The cost and pain of removing tattoos will typically be greater than the expense and pain of applying them. Some parts of the US have introduced payment for the voluntary removal of gang tattoos. 

Laser ablation method include dermabrasion, salabrasion (scrubbing the skin with salt), cryokirurgi and excision which is sometimes still used along with skin grafts for larger tattoos. Among some early forms of tattoo removal include injection or application of wine, lime juice, garlic or DUV feces. Tattoo removal by laser was performed by continuous-wave lasers initially, and later with the Q-switched lasers, which became commercially available in the early 1990s. Today, “laser tattoo removal” usually refers to a non-invasive removal of tattoo pigment with the Q-switched lasers.Normally, black and dark colored inks are removed more completely.

 

Motivation for tattoo removal
in the United States, affecting some 17% of the total population with tattoos of grave regret. According to a survey made ​​in 2008, were the most common causes of remorse
“for young when I got the tattoo (20%),”  it is “permanent”  and I are “marked for life(19%),” and I just “like not (18%) “.  An earlier survey showed that 19% of British people with tattoos regret their tattoo as well as 11% of the Italian population with tattoos. Investigations of tattoo removal patients in 1996 and 2006, and yielded far more insight. These patients were, usually, their tattoos in their late teens or early twenties, and just over half were women. About 10 years later, the patient’s life changed, and more than half of the patients stated that they“sufferedembarrassment.” A new job, problems with clothes, and a significant life event (wedding, divorce, child) emphasized also that motive.

Some carriers choose to cover an unwanted tattoo with a new tattoo. This is universally known as a “cover-up”. An art completing the cover-up can make the old tattoo completely invisible, but this depends largely on the size, style, colors and techniques used on the old tattoo. To cover up an older tattoo requires darker tones in the new tattoo to effectively hide the older, unwanted piece.

 

Methods
Tattoo removal is usually performed using lasers that react with the ink in the tattoo, and break it down. The ink particles are then taken up by the body, it  imitates the natural bleaching by sun exposure would create. All tattoo pigments have particular light absorption. A tattoo laser must be able to emit enough energy within the absorption spectrum of the pigment to provide an effective treatment. Some tattoo pigments, for example, yellow, green and fluorescent inks are harder to treat than black, dark shades and shades of blue. These pigments are harder to treat because they have absorption spectra which are outside or on the edge of the emission spectrum available in each tattoo laser.

Removal of tattoos require repeated treatments to remove a tattoo.  Infinitink, US, developed to allow easier removal of tattoos with a single laser treatment. The new Q-switching  lasers are said by the  National Institutes of Health  to lead to less scarring and can be used after only a topical anesthetic is applied. Areas with thin skin will be more prone to thick scarring. There are several types of Q-switching lasrar-, and all are effective at removing a particular range of color spectra. Q-switch Model 2006 provide multiple wavelengths, and can successfully treat a much wider range of tattoo pigment than before Q-switching lasers.

Another type of tattoo removal is manual removal, machine or method. This practice is very unpredictable and used together with a special type of gel, is often mixed with brine, This balm tattooed in the skin over the tattoo ink into the dermis and is combined with the gel and migrate to the surface of the epidermis. This treatment can cause scarring, changes in tissue structure, prolonged painful healing, discolouration (hyper-and hypopigmentation) and ink retention. The risk of complications after a manual removal is extremely high and the person performing the treatment has significant responsibility. Methods that this is carried out very rarely and in modern countries, the method has been replaced by Q-switch laser treatment. Other methods including thermal injury, dermabrasion and cryotherapy are also used but with the same unpredictable results and negative side effects.

Mechanism of laser action
Experimental observations of the effects of short-pulse lasers on tattoos were first reported in late 1960. In 1979, used an argon laser for tattoo removal on 28 patients, with limited success. In 1978, carbon dioxide is used as well, but it caused serious scarring after treatment. It was not until the end of 1980 Q-switching lasers became commercially useful. One of the first published articles describing the laser removal was authored by a group at the Massachusetts General Hospital in 1990.

Tattoos made up of thousands of pigment particles trapped in the dermis. Although the normal human growth and healing process will remove small foreign particles from skin, pigment particles are permanent because they are too large to be removed naturally by the body. Laser treatment heats up the pigment particles, breaking them down into smaller pieces. These smaller pieces may then removed by the body’s normal cleansing processes.

Laser tattoo removal is a successful application of the theory of selective photothermolysis (SPTL) For laser tattoo removal, SPTL for selective  destruction of the tattoo pigment depends on four factors .:

1.  The color of the light must penetrate deep enough into the skin to reach the pigments.
2.  The color of the laser light must be absorbed more of the pigment than the surrounding skin. Different pigments require different laser colors. For example, red light is absorbed more of the green tattoo pigments.
3.  The length of time (pulse width) of the laser energy must be very short, so that the pigment is heated to fragmentation temperature before the heat can be lost to the surrounding skin. Otherwise, excessive heating of surrounding tissue, causing burns or scars. Laser tattoo removal, this time should be on a few nanoseconds.
4.  Enough energy to be delivered during each laser pulse to heat the pigment to fragmentation. If the energy is too low, the pigment is not fragmented and the body will not be able to repel the pigment.
Q-switched laser is the only commercially available devices that can meet these requirements.

Laser parameters affecting the results
several colors of laser light
(measured as the wavelength of laser energy) is used for tattoo removal, from visible light to near infrared radiation. Different lasers are better for different tattoo colors / pigments. Multi-colored tattoos almost always requires the use of two or more laser wavelengths. Tattoo removal lasers are usually identified by laser “medium” used to create the wavelength(measured in nanometers (nm):

1.  Q-switching frequency-DOUBLED Nd: YAG 532 nm. This creates a green laser light absorbed especially of red and orange pigments. This wavelength is absorbed too strongly by the melanin (the cellular chemical that gives skin sunburn) which means that the laser wavelength is also effective for old age or sun spot removal.

2.  Q-switch ruby: 694 nm. This creates a red laser light that is strongly absorbed by darker green and tattoo pigments. Because this laser is also strongly absorbed by melanin can cause unwanted side effects such as pigmentation changes and permanent whitening of dark skin.

3.  Q-switch Alexandrite: 755 nm.  As with  Ruby  creates  Alexandrite  also a red light that is strongly absorbed by the green and dark pigmentation. However, absorbed  Alexandrites  light slightly less melanin, so that the laser has a somewhat lower risk of unwanted pigment changes than a  Ruby  laser.

4.  Q-switch Nd: YAG: 1064 nm. The laser creates a near infrared light (invisible to humans) that has low absorption of melanin, making this the only laser suitable for darker skin. The wavelength is also taken up by all the dark tattoo pigments and the safest wavelength for use on tissue because due to the low melanin absorption and low hemoglobin absorption. 

Dye modules are available for some lasers to convert 532 nm to 650 nm or 585 nm light. Which enables a laser system to safely and effectively treat multiple colors of ink.

Pulsewidth  and pulse duration is a critical laser parameters. All Q-switching lasers haves have appropriate burning times for tattoo removal. But lasers with shorter pulse length, a safer and more efficient removal method because the peak power of the pulse is higher.

Point size  or width of the laser beam, also affect the treatment. The light is optically scattered in the skin, as well as car headlights in fog. Larger spot size increases the effect any of the penetration of the laser light, so it can more effectively remove deeper tattoo pigments. Larger point size also make the entire treatment more quickly.

Fluence  or energy level is another important factor. Energy is measured in joules per square centimeter (J / cm ²). It is important to perform the treatment at sufficiently high settings for the particles to be fragmented.

Pulse repetition rate  also helps to make reading faster, but should not be associated with any treatment effects.

Number of laser treatments needed
En fullständig tatuerings borttagning kräver flera behandlings tillfällen, vanligtvis placerade med minst 6 veckors mellanrum. Vid varje session fragmenteras partiklar effektivt, och kroppen tar bort dessa under loppet av flera veckor. Resultatet är att tatueringen ljusnar med tiden. Återstående stora partiklar av tatuerings pigmenten fragmenteras då på efterföljande behandlingstillfällen, vilket successivt ger en ljusare nyans. Antalet sessioner och avståndet mellan behandlingarna beror på de olika personliga förutsättningarna, tex hud ton och hud typ. Underarm och vrist tatueringar tar i allmänhet längst tid att ta bort.

The time required to remove a tattoo, and the success of the treatments varies with each individual.Factors affecting this are: skin type, location, color, amount of ink, scarring or tissue changes. In the last caregivers could only guess at how many treatments a patient needed which was quite frustrating for patients. An automatic scale, the “Kirby-Desai Scale”, has been developed to assess the potential success and the number of treatments required for laser tattoo removal, provided that the physician uses a quality-switched Nd: YAG (neodymium-doped yttrium aluminum garnet) laser contains selective photothermolysis of 6 to 8 weeks between treatments.

The Kirby-Desai Scale assigns numeric values ​​to six parameters: skin type, location, color, amount of ink, scarring or tissue changes, and layering. Parameter points are then added to give a combined score which shows the estimated number of treatments needed for a successful tattoo removal. It is recommended that this scale be used by all laser practitioners to determine how many treatments are required for tattoo removal and as a predictor of success laser tattoo treatments [13]. Prior to 2009, the clinics no scientific basis to estimate the number of treatments required to remove a tattoo using a Q-switched laser.

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