Novel laser uses span scars, striae, tattoos

New York - Alone or in combination with other lasers, the picosecond laser can treat a variety of cosmetic concerns including tattoos, scars and striae, an expert says.

The picosecond laser represents one of the most significant recent advances in tattoo treatments, says Roy G. Geronemus, M.D., director of the Laser & Skin Surgery Center of New York. This laser provides a pulse width 100 times shorter than that of the typical Q-switched laser and delivers both photothermal and photomechanical effects, he says.

In a study of an early picosecond alexandrite laser (755 nm) that Dr. Geronemus co-authored, “We saw significant removal of green and blue ink with a single treatment (Brauer JA, Reddy KK, Anolik R, et al. Arch Dermatol. 2012;148(7):820-823),” he says. 

Three treatments essentially cleared most patients’ green and blue tattoos, Dr. Geronemus adds. With traditional lasers, he says, treating these colors could require 10 to 15 treatments - if the treatments worked at all. As such, he says the picosecond laser outperforms Q-switched lasers for all tattoo colors except red, where the 532 nm laser remains the standard.

Additionally, “One of the things we found when working on the picosecond laser was the ability to treat some scars and striae,” Dr. Geronemus says. These treatments required a special diffractive lens array.

“It’s like a fractional adapter to the picosecond device, allowing you to deliver zones of injury without injuring the skin’s surface. It was originally designed to treat patients with darker skin types, which you can also do,” he says.

Scar study results

At press time, Dr. Geronemus and his colleagues were completing an 11-patient scar study with the device. “Two patients asked for topical anesthesia, but the rest did not require any anesthesia. Side effects included mild erythema and swelling after each procedure; both resolved very quickly. Patients’ results were quite impressive,” in the estimation of blinded investigators and patients themselves.

Some patients required up to six treatments, he adds, “But it’s very easy to do. It requires no preparation and causes no downtime - patients can go home and put makeup on. We were somewhat surprised to see the degree of improvement. Why this happens is not exactly clear.”

Based on biopsies, Dr. Geronemus says, “There is some fragmentation of the dermis, particularly the elastin. Whether that’s significant or not, time will tell as we evaluate further.”

Although this research continues to evolve, he says, “I believe the picosecond laser will play a relatively large role in our practice, particularly for those patients with darker skin types who are concerned about postinflammatory hyperpigmentation, and for patients who want to avoid downtime.”

Combining lasers

Another tattoo-removal approach Dr. Geronemus and his colleagues have been using involves combining ablative fractional lasers with Q-switched lasers or picosecond lasers. Used sequentially, he says, such combinations provide faster healing, with fewer changes in skin pigmentation and less blistering.

“And it really doesn’t matter which laser you use first,” he says. “We started by doing ablative fractional first, followed by the Q-switched laser,” believing that first opening channels in the skin through microthermal ablation would reduce blistering and speed healing, which appears to be true. However, he says, the combination works in reverse order, as well.

Another new concept involves performing multiple tattoo treatments in one day, known as the R20 method.

“When you wait 20 minutes in between, you get a whitening effect on the skin. If you wait for that white appearance to disappear, then retreat, you get a faster response in terms of more clearing per session (Kossida T, Rigopoulos D, Katsambas A, Anderson RR. J Am Acad Dermatol. 2012;66(2):271-277). The downside is that it’s very cumbersome. The patient has to stay in your office for 80 minutes,” Dr. Geronemus says.

To speed these treatments, Dr. Geronemus and his colleagues attempted to dissolve the gas bubbles that cause the whitening by applying perfluorodecalin to the treatment area before and after treatment.

“We found that we were able to dissolve the gas very quickly, in such a way that we could retreat immediately, without waiting 20 minutes,” he says. Accordingly, this treatment method is now in development for wider use.

Dissatisfaction from cosmetic tattoos

Among tattoo types, Dr. Geronemus says he increasingly sees patients dissatisfied with permanent cosmetics such as lip- and eyeliners. To treat such patients, “Use ocular shields. Also, make sure that the ink itself is black only, not mixed with iron oxide,” because the latter (which originally appears as burnt sienna or brown) will darken when treated with a Q-switched Nd:YAG laser.

If this happens, “Some physicians will start over and treat the blackened tattoo as though it were black ink,” using the Q-switched laser. However, he and his colleagues have found that using an ablative CO₂ laser with a very fine beam works faster and more safely. When treating eyeliner tattoos, he adds, “Patients will experience temporary alopecia, but it won’t last permanently.”

Disclosures: Dr. Geronemus is an investigator for Cynosure.