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Tattoo Removal
Greg Mennie, PA-C, MSed
PIH-UCI Family Medicine Residency Program
Adapted from S. Murphy M.D. lecture
History of Tattoos
� Traced back to 3300 BC
� Name tattow from Captain Cook after trip to Polynesia (1700’s)
� Western – King Harold II (1022) Edith/England
� U.S. it has been generally regarded as a marker for rebellious or antisocial behavior.
� First tattoo gun invented in 1891
Adolescents
� AB 99 – no piercings under the age of 18
other than ear
� AB 186 – illegal to tattoo or offer tattoo to
anyone under the age of 18
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Demographics� 15% of Americans are tattooed
� 18 to 29 = 36%
� 30 to 40 = 24%
� 40 to 50= 15%
� Sixteen percent had obtained their first tattoo before age18.
� People of lower educational status were more likely to have a tattoo and also more likely to have more than one tattoo than those of higher educational status.
� Drinking alcohol and using recreational drugs were related to having tattoos.
� Tattoos were seen in all ethnic groups but were more common among those with Hispanic ancestry than among all other ethnic groups combined.
“A permanent reminder of a
temporary feeling”
25% had regrets about their tattoo.
5 % percent had already covered a tattoo with a new tattoo
17 % percent said they were considering tattoo removal.
Individuals who were younger than 18 when they were first tattooed
were more likely than older persons to have regrets.
Five types of tattoos:
� Amateur
� Professional
� Cosmetic
� Medicinal
� Traumatic
Middle Class
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Prison/Gang
Numerology� 13 – This tattoo indicates membership with the Mara
Salvatrucha 13 gang.
� 14 – This tattoo indicates membership with the Nuestra Familia, which is a prison gang. This gang is affiliated with the Nortenos, a street gang.
� 88 – eighth ltr of alphabet = HH
� Area codes – Many gang members use the area code to their neighborhood as a tattoo, though this can become outdated as area codes are changed.
� Dates, prison id number, etc?
Symbolism
Teardrop tattoo – This design is worn by the eye. It indicates the wearer has killed someone or that the person had a friend killed. “a mother has lost her son”
Three dots arranged as a triangle – This design is
most commonly found between the prisoner’s
forefinger and thumb. The design stands for “mi
vida loca,” which means “my crazy life.”
Other - lightning bolts, viking horns, chains, locks,
religious
The Art of Tattooing
Artists use a tattoo gun and mix and blend various inks. The ink is placed into
the dermis and thus permanent.
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PrisonTattoos
Amateur Tattoos
Melted plastic
Burned styrofoam
Baby oil, conditioner, shampoo mixed
with smoke carbon
Pen Ink
Guitar strings, pins, sewing needles
Motors from walkmans, fans
Ink Placement in Skin
The World of Inks?.
� In contrast to drugs and cosmetics, tattoo
pigments have never been controlled or
regulated in any way, and the exact
composition of a given tattoo pigment is
often kept a "trade secret"
� Cadmium, Chromium, Cobalt, Iron, Lead, and
Mercury all figured prominently in these
pigments, with a high incidence of allergic and
phototoxic reactions, as well as scarring.
History of Tattoo Removal
� Dermabrasion
� Carbon Dioxide Laser
� Surgical Excision
� Q-Switched Ruby Laser
� Q-Switched Nd:YAG
� Other- Infrared Coagulator
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Dermabrasion
Salabrasion
Laser wavelengths break up ink
L.A.S.E.R. is an acronym forLight Amplification by Stimulated Emission of Radiation
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Selective Photothermolysis
Selective - Discriminant
Photo - Light
Thermo - Heat
Lysis - Damage
Chromophore Attraction
Tattoo Removal Lasers
� Currently 4 different Q-Switched lasers are available for tattoo removal:
� Q-Switched Ruby Lasers -Red light @ 694nm> usually effective for most black, blue, and green pigments
� Q-Switched Alexandrite- Deep Red @ 755nm>usually effective for most black, blue, and green pigments
� Q-Switched Nd:YAG-Invisible (infrared) @1064nm>usually effective for most black and dark blue pigments
� Q-Switched Frequency-Doubled Nd:YAG-Green light@ 532nm>usually effective for red, satisfactory for black, dark blue, and purple pigments
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LASER SETTINGS
Q:YAG laser settings
� Wavelength (nm)
� Spot size (mm)
� Fluence (j/c2)
Example: Red: Q532nm 4mm 3.5 j/c2 10hz (1st)
Yel-Green: Blend 4mm 3.2 j/c2 10hz
Black: Q1064 4mm 3.5 j/c2 10hz
Larger beam diameters have better
penetration to treat deeper vessels.
Smaller diameter beams have limited penetration due to scattering.
Q-Switched YAG Laser
•Direct Delivery Handpiece
•Shorter Pulsewidth
• Wavelength Mixing Mechanism
Mixed Wavelengths
Unique Wavelength
Mixing Mechanism
� Allows user to mix 532
nm and 1064 nm
wavelengths
� User can treat multiple
colors simultaneously
� User can treat
epidermal and dermal
lesions simultaneously
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Palomar Q-YAG 5
� Q- Switched Nd:YAG laser will treat:
� Multi colored professional tattoos
� Amateur tattoos
� Pigmented lesions� Age spots
� Café au lait birthmarks
� Becker’s nevus
Laser Removal of Tattoos
� Mechanism unclear
� Lymphatic clearing of tattoo particles,
which are released on laser impact
� Carried off by macrophages
� Pregnancy
� Aspirin, Motrin, Aleve
� Photosensitive meds
� Active Sun exposure
� Herpes pre-medicate
Valtrex 1gm BID
Contraindications to Laser
Side effects of tattoo removal
POTENTIAL
� Hypopigmentation
� Hyperpigmentation
� Infection
� Scarring
� Incomplete clearing
� Sub dermal fibrosis
ACTUAL
• Crusting
• Blood Blisters
• Allergic reaction to
antibiotic cream
• Transient
hyperpigmentation in
dark skinned patients
Always warn patient they may experience all of these side effects.
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Anesthesia in Tattoo Removal
� Tattoo to be treated (right) is
covered with Topicaine Gel (center),
and then occluded with plastic wrap
(left). Topical anesthetics should be
applied at least 1 hour, and
preferably 3 hours before treatment.
Occlusion is essential to keep the
anesthetic cream or gel from drying
and losing effectiveness.
� Topical anesthetics:
� EMLA
� LMX 5% (OTC)
� Betacaine
� Betacaine-Lido-Tetracaine compounds
Apply before coming for treatment
Red bar=Infrared 1064 black
brown blue
Thick end of green bar is
Q: 532/1064 for reds,
yellows
Blend for
Greens, yellows, lavender
Patient Treatment
� Clinician is gloved
� Area prepped
� Goggles on
� Place hand piece perpendicular to the skin
� Treat to tissue response
� Always start with reds
Clinical Endpoints of Treatment
� 1064nm erythema
and edema
� 532/1064nm
whitening, erythema,
edema
� Do not treat until
bleeding occurs
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Caution: Metallic Ink May Oxidize
Test Spot
•Metallic
•Glow in the
dark
•Gold
•Pink
•Whites
Complications of Tattoo Removal
� Blistering ankles
Do not debride
Polysporin BID
� Incomplete clearing
� Infection
� Neosporin Allergy
� Crusting
� Hyperpigmentation
� Hypopigmentation
Difficult colors may lighten
Tattoo Art
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Unless someone like you cares a whole awful lot, nothing is going to get better. It's not.
~Dr. Seuss
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