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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Dr. Alster uses both the PicoWay and PicoSure in her practice. "With briefer pulse durations, they can blast tat- too inks into smithereens and provide for their more rapid removal by the body than older Q-switched laser systems," she says. "With a picosecond laser, the number of treat- ments sessions needed is reduced by half: from 9 to 12 with a Q-switched to 4 to 6 with a pico laser." BACK TO BLACK So which devices do you need in your practice to offer tattoo removal? The most common tattoo color is black so, fi rst, you need a laser that is optimized for the treatment of black ink. "Since black ink is such an important tattoo target, the primary wavelength of a tattoo-removing laser should be at 1,064nm," says Dr. Bernstein. "There is always loss of energy when converting from one wavelength to another, and I want all the energy I can get for the largest spot sizes at 1,064nm." He notes that both the 1,064nm Nd:YAG laser and Q- switched ruby laser target the black ink, but the 1,064nm Nd:YAG is the gold standard because it has a lower risk of adverse events. "This wavelength can see the black ink, and it does the best job of ignoring melanin pigment in skin," says Dr. Bernstein. "The Q-switched ruby laser also does a good job of removing black ink but can lead to more side effects in darker skin types." When looking at multi-wavelength systems, he prefers laser-pumped-lasers with a primary wavelength of 1,064nm versus a 1,064nm laser that uses dye cartridges to offer ad- ditional wavelengths. "In my experiences, I have found that these cartridges don't emit laser-precise wavelengths but instead emit ranges of wavelengths that can drift from the primary wavelength stated on the cartridge," he says. EVOLVING PROTOCOLS In 2010, Dora Kassida, MD, introduced the R20 technique, which involves performing four laser passes spaced 20 min- utes apart in the same treatment session to achieve faster clearance of black ink tattoos. The technique was further improved with the introduction of the Describe PFD patch (Merz), which allows practitioners to re-treat the tattoo within seconds of each pass. The perfl uorodecalin-infused silicone patch acts as an optical clearing agent, resolving the white steam bubbles that form after laser treatment and also helping absorb some of the heat from the epidermis, which is especially valuable when treating darker skin types. "Research at our center has shown that picosecond laser tattoo removal with the PFD patch decreases the risk of complications in skin of color," says Dr. Friedman. Roy Geronemus, MD, director of the Laser & Skin Sur- gery Center of New York, uses the R20 method with PFD patch for not only black ink tattoos but color as well. First IMAGES COURTESY OF TINA ALSTER, MD (TOP) AND PAUL M. FRIEDMAN, MD (BOTTOM); © GETTY IMAGES COLOR CORRECTION 32 NOVEMBER/DECEMBER 2018 | MedEsthetics BEFORE AFTER Picosecond lasers combined with PFD patches are helping patients achieve better tattoo clearance in fewer treatment sessions. BEFORE AFTER

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