Biomedical Engineering Reference
In-Depth Information
(
A
)
(
B
)
(
C
)
Figure 4.10
Transient hyperpigmentation. (
A
) Before treatment; (
B
) transient hyperpigmentation following four laser treatments; and (
C
) complete resolution of
both ink and hyperpigmentation.
to fl ame (Fig. 4.13). These tattoos also respond extremely well
to Q-switched laser treatment.
Cosmetic Facial Tattoos
The use of facial cosmetics for ornamental purposes is an
ancient art, first traced to around 3500 BCE from evidence in
Egyptian tombs and limestone caves (253). The merger of this
art form with modern tattooing occurred in 1984, when
Angres (254) popularized tattoo blepharopigmentation (per-
manent eyeliner). Although originally promoted as an alter-
native to eyeliner application for women crippled with
arthritis or other physical impairments, it quickly became a
popular procedure for general cosmetic purposes (255). In
addition, tattooing of eyebrows, lip lines, and cheeks to simu-
late facial cosmetics was introduced in 1987 (256). Like non-
facial tattoos, traditional techniques reported for removal of
permanent cosmetic tattoos include surgical excision
(257,258), scraping the pigment off with a chelation curette
(202), ablation of the tattoo with an argon laser (200), and
injection of tannic acid with a tattoo needle (103). Surgical
excision of a few misplaced dots is feasible and can be accom-
plished with a punch excision or a tiny ellipse or curettage of
spots (202). The removal of unwanted cosmetic facial tattoos
can be accomplished with the use of Q-switched lasers, but
extreme caution should be used and special consideration
should be paid to the anatomical boundaries as avoidance
of scarring secondary to treatment in these delicate areas is
essential.
Figure 4.11
Bulla. Bulla following treatment with a neodymium-
doped:yttrium-aluminum-garnet laser.
iron oxides to alter its composition without any structural
change accounts for their ready interconvertibility (197).
These reactions may require extreme temperatures known
to be generated during the very short pulse of Q-switched
lasers, estimated at several hundreds to thousands of degrees
Celsius. Patients should be informed that the color of their
tattoo ink may change and/or darken with treatment by a
Q-switched laser and that the subsequent color may or may
not respond to continued treatment.
Oral Tattoos
Very rarely patients request removal of intentional tattoos on
the mucosal side of the inner lower lip (Fig.
4.14). Orolabial
mucosal tattoos respond extremely favorably to Q-switched
Nd:YAG laser treatment (259). There are also several reports of
successful Q-switched removal of amalgam tattoo created by
the accidental displacement of metal particles during dental
procedures (151,260).
special situations
Traumatic Tattoos
While the vast majority of tattoos are purposeful, occasionally
a patient will present with a traumatic tattoo. “Blacktop”
asphalt is a common culprit in these situations and responds
very favorably to Q-switched laser treatment (Fig. 4.12).
Unintentional Tattoos from Syringes
Tattoos may arise from legitimate medical syringe use (252),
and patients who have been intravenous drug users may pres-
ent with “track mark tattoos, which are multiple 1-mm unin-
tentional tattoos at the injection site from the carbon-based ash
that accompanies attempted needle sterilization via exposure
Radiation Therapy Tattoos
Before undergoing radiation therapy for cancer treatment,
skin tattoos are often placed so that the radiation therapist can
accurately aim the radiation device. These 1- to 2-mm tattoos
are either blue or black in color and can be treated with
