Combination Technique Significantly Speeds Up Tattoo Removal

Safe and effective tattoo removal has a sketchy history, but a new study in Lasers in Surgery and Medicine suggests that a new technique can clear unwanted ink more rapidly than conventional methods. The technique involves a combination approach to a well-known and widely accepted technique — removal with Q-switched lasers — with a perfluorodecalin (PFD)-infused silicone patch.

It is well-known that removal for some particularly tough tattoos can take years and many laser removal sessions. The duration of these sessions can be difficult to predict and depends on a number of factors, including the age, color, size, depth, and location of the tattoo. Recent techniques, including what’s known as the R-20 multiple pass technique, have shown promise by allowing several laser passes in a single session. However, the technique is cumbersome and time-intensive, making it difficult to implement in a busy clinical environment.

According to the study authors, “PFD is a stable, metabolically inert fluorocarbon liquid… that has the unusual properties of simultaneously being both lipophobic and hydrophobic, yet it is freely flowing with an extremely low surface energy that allows it to rapidly wick into porous materials.”

PFD’s unique properties make it well-suited to the task of tattoo removal: PFD can absorb half its liquid volume of gaseous oxygen as well as other gases such as nitrogen and steam. Although it is a heavy molecule, PFD readily evaporates when exposed to room air, an effect exacerbated by warm skin.

The controlled study combined the PFD patch with a conventional nanosecond pulse duration Q-switched Alexandrite 755-nm laser. The PFD patch side received rapid multiple laser passes as clinically indicated, typically three or four, with an average of 3.6. The control half received a single laser pass due to the immediate development of persistently opaque epidermal whitening following exposure to laser energy, which renders additional treatments impossible. Upon completion of each treatment, subjects were given complete wound care instructions including clinic contact information.

Repeat treatments were performed at four to six-week intervals until the tattoo was either fully resolved on the patch side or until no further clinical benefit was deemed likely. At that time, subjects continued to receive laser treatments to the control side until the tattoo reached the maximal perceived clinical benefit.

“It is worth noting that although subjects were given the choice of continuing treatment with or without the Patch on the Control side after the Patch side had cleared, all chose to continue with the Patch,” the study authors wrote.

In 11 out of 17 tattoos, those treated through the PFD patch showed more rapid clearance with higher subject satisfaction than standard treatment. The patch allowed three or four rapid multiple passes in all subjects as opposed to only a single pass on the control side.

Adverse events, including erythema, edema, pain, and crusting, were similar across the patch and control groups. There was a wide array of responses ranging from dramatic superiority after only two treatment sessions with over 90% clearance on the patch side compared to less than 20% on the control side (to marked superiority which became apparent after a few treatments, to cases in which superiority of the patch was not demonstrated.)

“Even in cases where superiority of clearance relative to control was not demonstrated, the control side never achieved better clearance than the Patch side,” the study authors concluded. “Although this study was limited by its modest sample size and by the use of only one laser wavelength and pulse duration, the potential benefit of the PFD Patch with other wavelengths and pulse durations (including picosecond lasers) warrants further investigation.”