An article in American Society for Laser Medicine and Surgery (ASLMS) October 2015 was promoting R20 and a chemical patch to remove the frosting so that additional laser passes can be completed faster during one treatment session. Typical is 3 or 4 passes. The goal was to reduce time between passses. The article used different laser setting some which were not spelled out ar all or clearly in the article. IMHO this is not a fair comparison. Whether ASLMS publishes my criticism or not the comparison between regular single pass laser tattoo removal treatment should not be compared unfairly with differences unmentioned!!! Lets have a fair comparison so good scientific inquiry can lead to improvements in treatment.
Here is the letter sent October27 2015.
Oct 2015 Rapid High-fluence Multi Pass Q switched… with Perfluorodecalin-Infused Patch…
Dear ASLMS Editor,
The article does not mention an important factor in tattoo removal that biases results against normal treatment. Table I lists spot size as 4 (mm) for Perfluorodecalin patch treated tattoos v. spot size as 3 (mm) for control. This was not mentioned in the text. The smaller the spot size the less depth of penetration and higher percentage of scatter. If the max fluence was reached and a smaller size spot was needed that would be with the patch not the control. The article is not clear how many total passes were made for patch v. control but seems to indicate the comparison is of treatment sessions not total number of passes. Of course more passes yield better results.
Comparing patch treated tattoos with a 4mm spot size and higher fluence versus normal treated with 3mm spot size and lesser fluence with a different number of total passes is not comparing apples to apples!!! I would like to see a study comparison where the total number of total of passes and spot sizes were equal, albeit a much longer time interval in non patch controls. This would be approximately the similar cost to patient. Example 4 sessions patch with 4 passes each session 16 total versus control 16 individual sessions.
Another study can be done using a very high peak power and large size laser (names withheld) comparing results with a 4mm spot with the patch. A very large spot size of 10, 12 or 15mm allows much deeper penetration and more even energy application thus lower energy scatter and less tissue damage.
Hope you can publish this in response to the article in volume 47, number 8, October 2015 “Rapid, High-Fluence Multi=Pass Q-Switched Laser Treatment of Tattoos With a Transparent Perfluorodecalin-Infused Patch: A Pilot Study by Brian S Biesman, MD FACS, Michael P. O’Neil, Ph.D and Cara Costner RN FNP
Michael Hizme, CLTR. LSO
Brooklyn Laser Tattoo Removal Inc.