8/7/2019 Removal Tatto

1/54

Q switched Laser

8/7/2019 Removal Tatto

2/54

Selective photothermolysis Target chromophore

Pulse duration

Thermal relaxation time

8/7/2019 Removal Tatto

3/54

Selective photothermolysisLaser

absorption

Target chromophore

e.g. melanin, Hb, water

8/7/2019 Removal Tatto

4/54

Thermal relaxation time Time taken for the target to dissipate about

63% of the incident thermal energy

Pulse duration < TRT selectivephotothermolysis

8/7/2019 Removal Tatto

5/54

8/7/2019 Removal Tatto

6/54

8/7/2019 Removal Tatto

7/54

Q switched laser Q - switched Ruby (694 nm)

Q - switched Alexandrite(755 nm) Q - switched Nd:YAG (1064 nm)

Frequency-doubled Q-switched Nd:YAG (532

nm)

8/7/2019 Removal Tatto

8/54

Q-switched laser Pigmented lesion

Tattoo removal

8/7/2019 Removal Tatto

9/54

End point ofQ-switched laser Immediate whitening

Pinpoint bleeding

8/7/2019 Removal Tatto

10/54

Tattoo removal

8/7/2019 Removal Tatto

11/54

Tattoo removal Target : ink

Fragmented ink gradual uptake by activated

macrophage

Removed through lymphatic system or

transepidermal elimination

8/7/2019 Removal Tatto

12/54

Type of tattoo Professional tattoo : mid dermis

Amateur tattoo : more superficial

Traumatic tattoo

8/7/2019 Removal Tatto

13/54

8/7/2019 Removal Tatto

14/54

Patient selection for tattoo removal Natural, untanned skin

Stop oral retinoid 12 months

Hx. of HSV infection : oral antiviral

prophylaxis

8/7/2019 Removal Tatto

15/54

Ideal Patient for tattoo removal Skin type 1-2

Untanned skin

Tattoo > 1 year

8/7/2019 Removal Tatto

16/54

Treatment session for tattoo removal Professional tattoo : 6-10 session

Amateur tattoo : 3-5 session

6-8 wks apart

Some tattoo still remain (ghost-like), even

after multiple session

8/7/2019 Removal Tatto

17/54

8/7/2019 Removal Tatto

18/54

Precaution in tattoo removal White & cosmetic flesh tone ink

immediate, permanent darkening after laser

and impossible to remove Test spot 4-6 wks before treatment

8/7/2019 Removal Tatto

19/54

Side effect of tattoo removal Pigment alteration

: hyperpigmentation

: hypopigmentation

Tattoo darkening

:white, red, pastel ink

Scarring

8/7/2019 Removal Tatto

20/54

Post operative care Polysporin ointment,bacitracin, petrolatum

dressing

Dressing twice daily

Keep moist

Dry crust not allow to form

8/7/2019 Removal Tatto

21/54

8/7/2019 Removal Tatto

22/54

8/7/2019 Removal Tatto

23/54

8/7/2019 Removal Tatto

24/54

8/7/2019 Removal Tatto

25/54

8/7/2019 Removal Tatto

26/54

8/7/2019 Removal Tatto

27/54

8/7/2019 Removal Tatto

28/54

8/7/2019 Removal Tatto

29/54

8/7/2019 Removal Tatto

30/54

8/7/2019 Removal Tatto

31/54

8/7/2019 Removal Tatto

32/54

8/7/2019 Removal Tatto

33/54

Pigmented lesion

8/7/2019 Removal Tatto

34/54

Epidermal pigment Freckles

Lentigenes

Epidermal melasma

Caf-au-lait macule

8/7/2019 Removal Tatto

35/54

Freckles Multiple small brown macule

Size 1-5 mm

Sun expose area

Increase melanin basal melanocyte

Melanocyte not increase

8/7/2019 Removal Tatto

36/54

Lentigenes Well defined macule

Size 1-3 cm

Brown to black color

Increase basal melanocyte

8/7/2019 Removal Tatto

37/54

Epidermal melasma Brown to dark brown macule or patch

symmetrical

Increase melaninin melanocyte at basal &suprabasal layer

Normal number melanocyte

8/7/2019 Removal Tatto

38/54

8/7/2019 Removal Tatto

39/54

Dermal pigment Dermal melasma

Nevus of Ota & Ito

Nevus of Hori

8/7/2019 Removal Tatto

40/54

8/7/2019 Removal Tatto

41/54

Nevus of Ota & Ito Congenital

90% Unilateral

Blue black or gray macule

May involve oral mucosa and ocular structure

Affect forehead, temporal, malar, periorbital

Melanin in dermal melanocyte

8/7/2019 Removal Tatto

42/54

Nevus of Hori Bilateral symmetrical Ota like macule

Blue brown

Female

Age > 20

Malar region

8/7/2019 Removal Tatto

43/54

8/7/2019 Removal Tatto

44/54

Treatment for pigment lesion Epidermal pigment : Q-switched 523 nm

Dermal pigment : Q-switched 1064 nm

8/7/2019 Removal Tatto

45/54

8/7/2019 Removal Tatto

46/54

8/7/2019 Removal Tatto

47/54

8/7/2019 Removal Tatto

48/54

8/7/2019 Removal Tatto

49/54

8/7/2019 Removal Tatto

50/54

8/7/2019 Removal Tatto

51/54

8/7/2019 Removal Tatto

52/54

8/7/2019 Removal Tatto

53/54

8/7/2019 Removal Tatto

54/54