Objectives: Laser-assisted tattoo removal is an apparently simple procedure providing proper Q-S laser systems are selected and properly used in relation to Fitzpatrick photo-genetic skin type of patients, anatomical location and time persistence of exogenous pigments, as well as their chromatic and chemical characteristics. The number of laser sessions necessary to obtain a complete exogenous pigment clearing has been progressively reduced thanks to the advent of new innovative multi-pass treatment strategies and advances in laser technologies.
Introduction: In spite of these improvements, it is possible to face tattoos not responding to modern treatment approaches. The reasons for tattoos becoming resistant to QS laser treatments are multifactorial. Physical and chemical characteristics of exogenous pigments, their concentration - depth of intradermal distribution – and anatomical location, host immunological reactivity, previously performed unproper treatments, localized traumas may all contribute to decrease laser-specific photo-induced effective interactions.
Materials / method: Exogenous pigments response to these innovative technical innovations has apparently improved due to a more efficient fragmentation of their physical structure making resistant colours more susceptible to be cleared. Resistant tattoos are not predictably responding even when advanced ps-domanin QS laser systems are used. Stubborn obstination in repeating laser-assisted tattoo removal treatments in spite of minimal clinical improvements may transform a “resistant tattoo” into a much more complicated, structurally altered “persistent tattoo”.
Results: Multiple laser treatments of resistant tattoos usually induce superficial fibrotic textural alterations generating variable thickness of light scattering, intensively refracting micro-scars. These textural alteratioins are responsible for a further decrease in the efficacy of laser-pigments interactions and consequently tattoo clearing response. Color-blind ablative 2940-nm fractional (AFR) laser treatmnents of tattoos associated with allergic reactions to exogenous pigments have proven reasonably effective in dealing with these complications.
Conclusion: The combination of 2940-nm Er:YAG AFR and 2-3 passes of Q-S full beam laser have shown promising results in improving virgin and resistant tattoos. Recently high energy 1064-nm Q-S ns-ps domain lasers have been used in a fractional mode to produce photo-acoustic AFR comparable with those induced by photo-thermal mode Er:YAG and CO2 lasers. The sequential combination of 1064-nm Q-S photo-acoustic AFR and full beam ns-ps domain Q-S lasers have shown promising results in clearing virgin, uncomplicated tattoos as well as improving tissue response in resistant tattoos.
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