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Q-switched Nd-YAG Laser für Tattoos, Literatur

Hautarzt. 1999 Mar;50(3):174-80
Tattoo removal Q-switched ruby laser (694 nm) and the Q-switched Nd:YAG laser (532 and 1064 nm). A retrospective study (Article in german) Werner S, Drosner M, Raulin C. Praxis fur Dermatologie, Phlebologie und Allergologie, Dr.C.Raulin, Karlsruhe.

In a retrospective study 47 patients with 68 amateur and 25 professional tattoos were examined, considering clearance of tattoo pigments and the frequency of side effects after finished treatments with the Q-switched ruby (694 nm) and the Q-switched Nd:YAG laser (532 and 1064 nm). Black amateur tattoos were found to lighten faster than professional tattoos (13.2 and 18.6 treatments respectively). For the clearance of multicolored tattoos (amateur or professional), similar numbers of laser treatments were needed. Green pigments were removed with the Q-switched ruby laser and red pigments with the frequency-doubled Nd:YAG laser (532 nm). Compared to the Q-switched Nd:YAG laser (1064 nm), the Q-switched ruby laser and the frequency-doubled Nd:YAG laser (532 nm) more often caused blistering and transient hypopigmentation (5.4% and 7.5% vs. 1.1% (blisters); 8.6% and 15.1% vs. 4.3% (hypopigmentation).

Dermatol Surg. 2002 Feb;28(2):177-9.
Multiple color changes following laser therapy of cosmetic tattoos.
Jimenez G, Weiss E, Spencer JM. Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida 33136, USA.

OBJECTIVE: To emphasize the wisdom of small test areas when treating cosmetic tattoos and the need for multiple laser systems. METHODS: A 48-year-old woman requested removal of permanent makeup (cosmetic tattoos) of her eyebrows and around her lips. Physical examination revealed a brown tattoo of both eyebrows and dark red lip liner around both lips. A test area was performed on the red tattoo of the lips. A frequency-doubled Nd:YAG laser (532 nm, 2.0 J/cm2, 2 mm spot size) was used for the lip area, while the same laser at 1064 nm, 3.9 J cm2, 2 mm spot size was utilized for the eyebrows. The lip area immediately turned black. The patient returned for follow-up 1 month later; the black ink on the lip was treated with the same laser at 1064 nm, 3 mm spot size, 4.2 J/cm2, with satisfactory resolution in two monthly treatments. Both brown eyebrow turned bright orange and were treated with 532 nm, 3 mm, 3.0 J/cm2. One month later the eyebrows were a mixture of yellow ink and dark green. The yellow area was treated with 532 nm, 3 mm, 2.3 J/cm2, while the dark green was treated with the 1064 nm, 3 mm spot size, 4.2 J/cm2. One month later little improvement was noted, so Q-switched ruby laser at 694 nm, 6 mm spot size, 16 J/cm2 was utilized. An additional four monthly treatments were given utilizing a combination of both ruby and 532 nm ND:YAG lasers for green and yellow pigment, respectively. RESULTS: Significant but incomplete resolution of the tattoo ink was achieved. CONCLUSION: Multiple laser systems are needed to remove cosmetic tattoos. Test areas must be done before treatment.

Am J Clin Dermatol. 2001;2(1):21-5.
Laser removal of tattoos.
Kuperman-Beade M, Levine VJ, Ashinoff R. Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA.

Tattoos are placed for different reasons. A technique for tattoo removal which produces selective removal of each tattoo pigment, with minimal risk of scarring, is needed. Nonspecific methods have a high incidence of scarring, textural, and pigmentary alterations compared with the use of Q-switched lasers. With new advances in Q-switched laser technology, tattoo removal can be achieved with minimal risk of scarring and permanent pigmentary alteration. There are five types of tattoos: amateur, professional, cosmetic, medicinal, and traumatic. Amateur tattoos require less treatment sessions than professional multicolored tattoos. Other factors to consider when evaluating tattoos for removal are: location, age and the skin type of the patient. Treatment should begin by obtaining a pre-operative history. Since treatment with the Q-switched lasers is painful, use of a local injection with lidocaine or topical anaesthesia cream may be used prior to laser treatment. Topical broad-spectrum antibacterial ointment is applied immediately following the procedure. Three types of lasers are currently used for tattoo removal: Q-switched ruby laser (694 nm), Q-switched Nd:YAG laser (532 nm, 1064 nm), and Q-switched alexandrite laser (755 nm). The Q-switched ruby and alexandrite lasers are useful for removing black, blue and green pigments. The Q-switched 532 nm Nd:YAG laser can be used to remove red pigments and the 1064 nm Nd:YAG laser is used for removal of black and blue pigments. The most common adverse effects following laser tattoo treatment with the Q-switched ruby laser include textural change, scarring, and pigmentary alteration. Transient hypopigmentation and textural changes have been reported in up to 50 and 12%, respectively, of patients treated with the Q-switched alexandrite laser. Hyperpigmentation and textural changes are infrequent adverse effects of the Q-switched Nd:YAG laser and the incidence of hypopigmentary changes is much lower than with the ruby laser. The development of localized and generalized allergic reactions is an unusual complication following tattoo removal with the Q-switched ruby and Nd:YAG lasers. Since many wavelengths are needed to treat multicolored tattoos, not one laser system can be used alone to remove all the available inks and combination of inks. While laser tattoo removal is not perfect, we have come a long way since the advent of Q-switched lasers. Current research is focusing on newer picosecond lasers, which may be more successful than the Q-switched lasers in the removal of the new vibrant tattoo links.

Dermatol Surg. 2000 Mar;26(3):255-8.
Using a side effect to therapeutic advantage: the darkening of red eyebrow tattoo pigment following Q-switched laser treatment.
Casparian JM, Krell J.
University of Kansas Medical Center, Kansas City, Kansas 66160-7319, USA. jcaspari@kumc.edu

BACKGROUND: Q-switched lasers are commonly used to achieve tattoo removal, utilizing the principle of selective photothermolysis. However, certain tattoo pigments may darken following laser pulsing. OBJECTIVE: To determine whether this side effect can be used to therapeutic advantage in a woman who previously had her eyebrows enhanced with a dark tattoo that spontaneously changed to a reddish hue over time. METHOD: The woman's eyebrows were pulsed with the Q-switched Nd:YAG laser at both 532 nm and 1064 nm. RESULTS: The test areas pulsed with the 1064 nm laser revealed partial clearing. However, 532 nm Q-switched Nd:YAG pulses produced darkening of tattoo pigment both at the test sites and in the subsequent treatment. CONCLUSION: Q-switched lasers can produce darkening of red tattoo pigment. In some cases this side effect can be used to therapeutic advantage.

Br J Dermatol. 1997 Sep;137(3):405-10.
The Q-switched neodymium:YAG laser and tattoos: a microscopic analysis of laser-tattoo interactions.
Ferguson JE, Andrew SM, Jones CJ, August PJ. Dermatology Centre, Hope Hospital, Salford, U.K.

The Nd:YAG laser effectively removes or lightens amateur and professional tattoos. The biomechanics of the removal of tattoo particles at the cellular level are incompletely understood. We examined biopsies obtained from 35 amateur and professional tattoos (including coloured tattoos), treated on three or more occasions with the Nd:YAG laser. Biopsies taken immediately after laser treatment showed vacuolation with complete clearance of tattoo particles in the most superficial layers of the dermis, as assessed by light and electron microscopy. We propose that the 'disappearance' of the tattoo particle arises from the formation of atomic species and gaseous products, which are rapidly dissolved in the extracellular fluid. Residual fragmented particles that are commonly found in the mid- and lower dermis are rephagocytosed. The interaction between the Nd:YAG laser and black tattoo particles at 1064 nm, and red tattoo particles at 532 nm, appears to be specific, as there was little evidence of thermal damage to adjacent cells or stromal collagen.

Cutis. 1995 May;55(5):291-6
Tattoo removal with the Q-switched ruby laser and the Q-switched Nd:YAGlaser: a comparative study.
Levine VJ, Geronemus RG. New York University Medical Center, New York, USA.

The Q-switched ruby and the Q-switched neodymium YAG lasers are both widely used in the treatment of amateur and professional tattoos. Comparative evaluation of these two laser systems has not previously been performed; thus, the advantages of each laser have not been delineated. Forty-eight amateur and professional tattoos were treated with both the Q-switched ruby and Q-switched Nd:YAG lasers. The tattoos were divided in half and one side of the tattoo was treated with each laser. After one treatment, the patients returned for evaluation to assess the degree of lightening achieved by each laser. The Q-switched ruby laser was found to be superior in lightening black dye in both professional and amateur tattoos. A significant advantage was noted for the ruby laser in the removal of green tattoo pigment. The differences with the Q-switched ruby laser and the 1064 nm option of the Q-switched YAG laser were not clinically significant in the lightening or removal of other colors. The 532 nm option of the Q-switched YAG laser was superior to the Q-switched ruby and the 1064 nm option of the YAG laser in the removal of red tattoo colors in professional tattoos. Hypopigmentation was found more commonly with the Q-switched ruby laser, while textural change was noted more commonly with the Q-switched Nd:YAG laser. One of the patients treated with the Nd:YAG laser at 1064 nm showed a hypertrophic scar.

J Dermatol Surg Oncol. 1993 Apr;19(4):330-8
Clinical use of the Q-switched ruby and the Q-switched Nd:YAG (1064 nm and 532 nm) lasers for treatment of tattoos.
Kilmer SL, Anderson RR.
Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston 02114.

BACKGROUND. The desire to remove tattoos has probably been around as long as their existence. Recent technological advances in lasers have finally made it possible to remove tattoos without leaving an equally undesirable scar. OBJECTIVE. The purpose of this article is to review the use of the Q-switched ruby (694 nm) and the Q-switched Nd:YAG (532 and 1064 nm) lasers for effective removal of tattoo ink, with cosmetically appealing results. RESULTS. The Q-switched ruby laser (694 nm) effectively removes blue-black and green ink, may treat other colors less efficiently, and is frequently associated with transient pigmentary changes, including rare depigmentation. The Q-switched Nd:YAG laser at 1064 nm quickly removes black ink, as well as other colors less efficiently; pigmentary changes are much less frequent, correlating with its lower absorption by melanin. The 532-nm wavelength treats red ink effectively, but also leads to temporary hypopigmentation. Transient textural changes may be noted at all three wavelengths discussed, but scarring is rare. CONCLUSIONS. Q-switched lasers can remove tattoos without residual scarring. Efficacy of ink removal is dependent on the wavelength used for the targeted pigment.

The Q-switched Nd:YAG laser effectively treats tattoos. A controlled, dose-response study
S. L. Kilmer, M. S. Lee, J. M. Grevelink, T. J. Flotte and R. R. Anderson
Department of Dermatology, Harvard Medical School, Boston.

BACKGROUND AND DESIGN: The Q-switched ruby laser was recently shown to remove tattoos without scarring. The Q-switched neodymium: yttrium aluminum garnet (Nd:YAG) laser, which targets black ink with a longer wavelength that has less absorption by melanin, should effectively treat tattoos with fewer pigmentary alterations. A prospective, blinded, controlled study was conducted to assess the ability of the Q-switched Nd:YAG laser (1064 nm, 10 ns, 5 Hz) to remove tattoos. Twenty-five patients with 39 blue-black or multicolored tattoos (14 previously untreated, 25 Q-switched ruby laser-resistant) were exposed in randomly derived quadrants with 6, 8, 10, or 12 J/cm2 at 3 to 4 week intervals for a total of four treatment sessions. RESULTS: An excellent response (> 75% ink removal) was seen in 77% of the black tattoos and more than 95% of the black ink cleared in 11 (28%) of 39 tattoos at 10 to 12 J/cm2 after four treatment sessions. Colored inks were not as effectively removed. Response was related to fluence with greatest improvement noted in the quadrants treated with 10 and 12 J/cm2. No significant side effects, including pigmentary changes or scarring, were noted. Histopathologic examination demonstrated persistence of tattoo ink in clinically clear areas and confirmed the absence of fibrosis and granulomatous changes. CONCLUSION: The Q-switched Nd:YAG laser (1064 nm) effectively treats black tattoos with an excellent cosmetic outcome. Bright colors were minimally responsive to treatment. Higher doses were more effective and equally well tolerated.



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