NOV-DEC 2018

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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Page 33 of 68

MULTI-WAVELENGTH ADVANTAGES Multi-color tattoos require a range of wavelengths to target the specifi c chromophores in the ink. And, although lasers are the No. 1 treatment option for tattoo removal, some pigments such as fl esh-colored, tan or rust inks that are composed of iron oxide or titanium dioxide, should not be treated with the oft-used Q-switched or picosec- ond lasers due to a chemical reaction that causes the tat- too ink to darken. "Instead, it is recommended that these tattoos either be treated with microneedling or CO 2 lasers that vaporize the skin," says Tina Alster, MD, founding director of the Washington Institute of Dermatologic Laser Surgery in Washington, DC. Red and infrared wavelengths, including 755nm alex- andrite and 1,064nm Nd:YAG lasers, are used for black, blue-black and some green inks, according to Dr. Alster. Green wavelengths, such as 532nm Nd:YAG, are effective in removing red, orange and yellow inks. In addition to wavelength, energy and pulse duration sig- nifi cantly impact the effectiveness of devices. For years, Q- switched lasers were the gold standard for tattoo removal due to their short (nanosecond) pulses and large spot sizes. Today picosecond lasers have signifi cantly improved outcomes. "Instead of breaking down pigment from big to small like the Q-switched lasers, the PicoSure turns them to dust," Jeffrey Dover, MD, of Skincare Physicians in Chestnut Hills, Massachusetts told MedEsthetics back in May 2014 following the introduction of the fi rst picosecond laser, Cynosure's PicoSure. Originally these devices were avail- able with 532nm and 1,064nm wavelengths. Now, new picosecond lasers, such as the PicoWay (Syneron Candela), are offering up to four wavelengths to tackle a variety of colors—including the notoriously diffi cult-to-treat greens, blues and purples. "With the addition of the 755nm and 785nm picosecond wavelengths, we can now successfully treat these colors," says Paul M. Friedman, MD, director of Dermatology & Laser Surgery Center in Houston. A study published in the September 2018 issue of Lasers in Surgery and Medicine revealed that lead author Eric F. Bernstein, MD, owner of Main Line Center for Laser Surgery in Ardmore, Pennsylvania, was able to remove 74 percent or more of blue, green and purple tattoos using the PicoWay's 785nm wavelength. He performed a total of four treatments sessions using only the 785nm picosecond wavelength (2mm to 4mm beam diameter and fl uences ranging from 1.1 to 3.1J/cm 2 ). Outcomes were assessed through blinded review of digi- tal, cross-polarized photographs taken approximately eight weeks following the last treatment. Fourteen subjects (21 tattoos) completed all study visits. The tattoos contained black, green, blue, yellow, purple and red inks. Blinded assessment of photographs found 85, 81, 74, 61, 11 and 5 percent clearance from baseline photos for purple, blue, green, black, red and yellow pigments, respectively. "As expected, red and yellow inks were not well treated with the 785nm laser wavelength and would have presumably been removed better using 532nm. Black ink would also have more likely cleared more completely if treated with the 1,064nm Nd:YAG laser," the authors wrote. "Shorter picosecond pulse duration devices with suf- fi cient energy to enable large spot sizes, which results in greater depth of penetration, are key," says Dr. Friedman. "Picosecond lasers allow for better clearance with fewer treatments and also allow us to treat all colors, including stubborn greens and blues. The lower fl uence compared to Q-switched technology also allows for safer treatment in skin of color." "The intense skin disruption that occurs upon laser impact of the darker inks can interfere with adequate visualization of the lighter inks." | NOVEMBER/DECEMBER 2018 31

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