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Industry News ❚ Meeting Review ❚ Practice Management ❚ Events ❚ Product News July/August 2016 July/August ❙ Volume 6 Volume July/August 2016 ❙ Volume 6 Issue 4 Issue 4 ❙ Laser body sculpting and skin tightening INTERNATIONAL JOURNAL OF AESTHETIC AND ANTI-AGEING MEDICINE taking aesthetic procedures to a new dimension. INTERNATIONAL JOURNAL OF AESTHETIC AND ANTI-AGEING MEDICINE AND ANTI-AGEING AESTHETIC OF JOURNAL INTERNATIONAL Dual-wavelength laser procedure combining unique PIANO® and ® TATTOO SMOOTH technologies for deep as well as superficial skin tightening and fat reduction. REMOVAL using a multilayer Q-switched laser Dynamis Multi-Application Laser System www.fotona.com TREATING choose perfection HYPERPIGMENTATION To learn more about TightSculptingTM and what the SP Dynamis WITH COMBINATION INJECTIONS can do for your practice contact Fotona at [email protected] today. COSMECEUTICALS REVERSING DERMAL INJURY prime-journal.com THE INFLUENCE Committed to designing, manufacturing and delivering: OF FOOD 97564/1 The Highest Performance, Best Made Laser Systems in the World ON CANCER AND AGEING PEER-REVIEW | TATTOO REMOVAL | TATTOO REMOVAL USING A MULTILAYER Q-SWITCHED LASER Leonardo Marini explains how using sequential, multilayer fractional and full beam Q-switched laser technology can improve tattoo removal results ABSTRACT multilayer techniques have been proposed to photo-acoustic ablative fractional 1064-nm Laser-assisted tattoo removal has shorten tattoo clearing time. Photo-thermal Q-switched laser technology with a sequence revolutionized the medical approach to ablative fractional laser technologies can of 2-3 full beam Q-switched laser passes eliminate ink particles located within be effectively combined with multiple full has proven effective in reducing multilayer dermal layers. Nano-second and sub- beam Q-switched laser passes during the laser session time as well as the number of nanosecond technologies have proven same session improving the efficiency of sessions required to clear tattoo pigments effective in clearing tattoo pigments with intra-dermal ink particle removal processes. both in ‘virgin’ and resistant tattoos. Skin minimal side-effects and complications Ablative fractional Q-switched laser textural changes related to tattoo procedures when proper treatment parameters are technology has been recently introduced, and previously performed tattoo removal selected. The process of tattoo removal paving the way for a virtually thermal- procedures can be improved by photo- is a lenghty procedure requiring multiple free photo-acoustic tissue ablation and acoustic ablative fractional Q-switched laser sessions spaced 2–4 months apart. Recently remodelling. The idea of combining a tissue remodelling. LEONARDO MARINI MD, Skin Doctors Center, Via dei Bonomo 5/a, Trieste, 34100, ATTOOS AND BODY PIERCINGS HAVE diagnostic and surgical procedures4-5. This side-effect is Italy become popular among young adults in not widely known but public awareness campaigns will email: leonardo.marini@ most developed countries around the presumably contribute to decrease tattoo procedures as skindoctors.it world, and this trend seems to be well as increase tattoo removal in the near future. progressively increasing1. The reasons Short (nanosecond) and ultra-short (picosecond) laser behind the tattoo phenomenon remains systems have revolutionized tattoo removal procedures Ta mystery, even if most tattoo bearers confirm a since they represent the perfect technological translation ‘personal’ need for individuality and identity with of the theory of selective photo-thermolysis applied to specific groups2. However, progressive social interactions microscopic targets6–8. Their high peak power, associated and specific working environments may induce tattoo with an extremely short pulse duration, enables these bearers — women more than men — to seek medical laser systems to limit their destructive action to targets as assistance to remove their tattoos. Reasons and small as average tattoo ink particles (40 nm), without — or contributing factors for tattoo removal have been minimally — affecting non-pigmented peripheral cells recently analysed, and include fear of negative and tissue. Single pass Q-switched (Q-S) laser procedures, comments and improving ‘self identity’3. even if progressively effective, usually require an average Additionally, numerous studies have confirmed that of 8–12, and sometimes more, sessions spaced 2-3 months COVER STORY tattoo pigments do not remain in the dermis. With time, apart to clear tattoos. Tattoo removal with this technology they are progressively transferred to regional lymph requires a lot of patience from both patients and KEYWORDS 9 Q-S laser, tattoo removal, nodes through lymphatic vessels. Ink pigments within physicians . pigment, fractional laser lymph nodes might affect medical interpretations during An interesting multilayer, full beam Q-S laser 14 July/August 2016 | prime-journal.com ❚ | TATTOO REMOVAL | PEER-REVIEW Progressive social interactions and specific working environments may induce tattoo ‘bearers’ — women more than men — to seek medical assistance to remove their tattoos. prime-journal.com | July/August 2016 15 ❚ PEER-REVIEW | TATTOO REMOVAL | | TATTOO REMOVAL | PEER-REVIEW Save 15% on the latest procedure (R-20) has recently been presented with the implemented by different State members. Tattoo inks can aim of reducing the total number of laser sessions10. be easily purchased from international manufacturers Unfortunately, this innovative approach has been and, besides water, contain glycerine, ethanol, and dermatology books considered too complex to be routinely used in sometimes preservatives. Colour particles are clinical practice, since 20 minute intervals composed of organic and synthetic pigments between laser passes was considered and are different in size (Table 1). The smallest excessively long. These intervals were are the black particles and consist of carbon from CRC Press necessary to eliminate sub-epidermal gas Colour particles are particles with a mean diameter ranging from 41 bubbles generated by the Q-S photo-acoustic composed of organic and to 165 nm. Most of the black particles (99.94%) effect, before proceeding with subsequent are less than 100 nm in size. White pigments are synthetic pigments and are laser passes. Topical application of usually the largest and consist of TiO2. Their perfluorodecalin was reported useful in different in size. diameter usually ranges from 317 to 738 nm, but The Art of Skin Health Restoration and Rejuvenation reducing inter-laser-pass intervals and the some inks may contain particles less than Second Edition overall duration of the original R-20 procedure11. The 100 nm in size. Green, blue (phthalocyanines), red and Zein E. Obagi, M.D. author thought to ‘prime’ tattoos with a preliminary yellow (azo-pigments) particles are between black and 19 December 2014 | 424pp | 9781842145968 | £121.00 micro-ablative (2,940 nm Er:YAG or 10,600 nm CO2) white pigments in size . fractional pass or micro-acoustic The biological activity of the • Discusses skin peels, approaches to correcting sun damage, 1064 nm Q-S fractional pass microparticles increases as they control of the pigmentary system, and stimulation of skin collagen before performing two or three Table 1 Tattoo pigments decrease in size. Nanoparticles • Details the scientific thinking behind treatment regimes full beam Q-S laser passes to (NPs) are defined as particles with at • Shows how to integrate skin care into a dermatology practice or spa eliminate gas bubbles through VIOLET Manganese violet, indigoid least one dimension less than • Contains more than 200 color illustrations - both drawings and the many micro-holes created by 100 nm. Traditionally, risk BLUE Cobalt aluminate, phthalocyanine, ferric ferrocyanide, the first pass12. The author was assessment of biological clinical photographs indigoid then able to reduce tattoo interactions related to NPs were pigments by 80% after a single GREEN Chromium oxide, hydrated chromium sesquioxide, performed after inhalation, session and reach an almost malachite green, lead chromate, ferro-ferric cyanide, ingestion, and absorption through curcumin green, phthalocyanine dyes complete pigment clearance in the skin20. Carbon black pigments 4–6 sessions in the majority of YELLOW Cadmium sulphide, ochre, curcumin yellow, azo dyes, are produced by imperfect tattoos treated with this limonite, anthraquinone combustion and are available in a technique. Picosecond laser RED Mercury sulphide, cadmium selenide, sienna (red ochre, wide range of sizes (5–500 nm). systems claim to clear tattoo ferric hydrate and ferric sulphate), azo dyes, hematite Their perceived colour saturation is Mohs and Cutaneous Surgery: Maximizing pigment faster and better than FLESH Iron oxides inversely proportional to aggregate Aesthetic Outcomes Q-S nanosecond lasers but so far, size. Black inks contain high Edited by Alexander Berlin BROWN Ochre fractional multilayer Q-S amounts of polycyclic aromatic December 2014 | 173pp | 9781482221367 | £63.99 procedures seem to produce BLACK India ink, carbon, iron oxide, logwood extract, magnetite, hydrocarbons (PAHs) and even • Covers wound healing, surgical planning, intraoperative quite similar results13–16. graphite, ash phenol. Both can cause complex, immunologically-mediated skin techniques, and complications WHITE Titanium dioxide, zinc reactions21. Black carbon pigments • Details surgical scar revision, dermabrasion, laser
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