Note: Study did not use latest equipment, used wrong size laser beams for depths, and did not counsel diet/nutrition/ herbal support to speed fading as part of the B.L.A.S.T. Protocol for faster results. Therefore our results should be faster.
NOTE2: Lighter skinned people would be expected to have faster results. We noticed zero people with African American Skin in the study.
NOTE3: Study used 6 weeks or longer with better results for 9 and 10 weeks between treatments. Brooklyn Laser Tattoo Removal Inc. is always counseling people that waiting longer gives better results and recommends a minimum of 8 weeks between treatments. We recommend cash strapped people do at least 2 treatments per year.
Objective To analyze variables affecting the treatment course and prognosis of Q-switched laser tattoo removal.
Design Observational prospective cohort study.
Setting The study was carried out in a referral center for surgery and laser surgery in Milan.
Participants Of 397 consecutive patients initially enrolled from January 1, 1995, to December 31, 2010, 352 patients (201 men and 151 women; median age, 30 years) were included in the analysis.
Intervention All patients were treated by the same investigator with Q-switched 1064/532-nm Nd:YAG laser and Q-switched 755-nm alexandrite laser according to tattoo colors. Laser sessions were scheduled at 6-week or longer intervals.
Main Outcome Measures Successful therapy was defined as removal of the tattoo, with no adverse effects other than transient hypochromia or darkening.
Results The cumulative rates of patients with successful tattoo removal were 47.2% (95% CI, 41.8%-52.5%) after 10 sessions and 74.8% (95% CI, 68.9%-80.7%) after 15 sessions. Smoking, the presence of colors other than black and red, a tattoo larger than 30 cm2, a tattoo located on the feet or legs or older than 36 months, high color density, treatment intervals of 8 weeks or less, and development of a darkening phenomenon were associated with a reduced clinical response to treatment.
Conclusions To our knowledge, this study is the first to formally assess prognostic factors for effective tattoo removal by Q-switched laser. Several variables influence response rates and should be considered when planning tattoo removal treatments.
The prevalence of decorative tattoos is rapidly increasing in Western countries, especially among adolescents and young adults.1 As many as 22% of students in the United States have at least 1 tattoo.2,3 Although popular, tattoos are often regretted later in the individual’s life. Body image and lifestyle may change and a tattoo, once wanted and liked, becomes embarrassing. The demand for removal is becoming an emerging social trend. In the United States, 28% of adolescents regret their tattoos within the first year4 and 50% of those with tattoos choose to undergo removal procedures as adults.
Various methods, such as surgical excision or salabrasion, have been attempted, but are associated with high scarring risk and unsatisfactory outcomes.5 More recently, the advent of Q-switched lasers (QSLs) has made tattoo removal easier, with a higher rate of cosmetic success.6 Targeted destruction of tattoo ink by selective absorption of a specific wavelength emitted by a nanosecond high-intensity pulse laser forms the basis of QSL tattoo removal.7 After light absorption, ink molecules are partially destroyed and broken into smaller fragments by photoacoustic and pressure waves, as well as by the quick conversion of laser high-energy pulse into heat. Subsequently, ink fragments undergo phagocytosis by macrophages and are removed via the lymphatic vessels.8 Additionally, after QSL irradiation, changes in the optic properties of ink particles occur via thermal and photochemical mechanisms, with an overall lightening of the pigment. These mechanisms usually produce progressive tattoo clearing with little damage to the surrounding skin.6
Despite a sound scientific basis for laser treatment, the clinical results of tattoo removal vary greatly among patients, and it is not possible to guarantee complete clearing of a tattoo in any given patient. Predictive variables affecting the course and prognosis of treatment are poorly defined. The quality and type of pigments; multicolored inks; tattoo layering, size, location, and duration; skin phototype; and personal habits could influence the outcome, but their role remains unclear. The aim of this study was to analyze the course of tattoo removal and prognostic factors for clinical response in a cohort of patients who underwent QSL tattoo removal at an Italian referral center.