Tattoos used for cosmetic rather than artistic purposes are a special class of tattoos. The ink colors tend to be pink, white, light brown or rust-colored. The tattoo pigments used to make the inks may or may not contain iron ores. Through an unknown chemical reaction, iron-containing inks may darken irreversibly to black or dark grey when treated with a q-switched laser normally used for laser tattoo removal, such as a YAG or Ruby laser. Attempts to further remove the tattoo may succeed after multiple treatments or may fail altogether, requiring surgical excision. The mechanism is thought to be the reduction of the ferric oxide (Fe2O3, “rust”) to ferrous oxide (FeO, black) but it is unknown exactly why it occurs with q-switched laser exposure.

There is a great degree of variability in inks used for cosmetic tattooing. Some artists also do tattooing and cosmetic tattooers may use artistic ink or ink that doesn’t contain any ferric oxide. In that case, the tattoo should respond to tattoo removal similarly to another artistic tattoo anywhere on the body. For this reason, when approaching the treatment of cosmetic tattoos, especially on the face, extreme caution is used. At Tattoo MD Laser Clinic, patients are warned about the risk of irreversible conversion of their cosmetic tattoo from flesh or rust-colored to black. With that in mind, a test spot is then performed in the least exposed part of the tattoo (about 3 millimeters wide). The patient is then brought back in 1-2 weeks for a re-examination. If there is no darkening and/or if the patient wants to continue treatment for the rest of the tattoo then the rest of the tattoo may be treated.

The process of laser tattoo fading can be painstaking.� Research has therefore also focused on the use of adjuvants, or chemicals that can make the process go faster and more effective.� One of these that has gotten a lot of attention is topical imiquimod cream.� Imiquimod’s mechanism of action is not fully known, but it is throught to stimulate the immune system, by causing the production of molecules such as interferon alpha.� Thus, it was thought, applying imiquimod to the skin over a tattoo that is getting removed by laser might speed up the rate of clearance.

A recent animal study from March, 2007 in Dermatologic Surgery held promise.� Imiquimod used in pigs getting laser tattoo removal showed improved ink removal compared to laser alone.� However there was significantly more scarring noted in the imiquimod sites.� A more recent human study from September, 2007 in Dermatologic Surgery was less encouraging.� This study in 20 patients found no difference between imiquimod and placebo in the rate of tattoo removal by laser.

At this time, there is no known adjuvant or chemical that will speed the process of laser tattoo removal.� However, future research is bound to find alternatives to imiquimod that will be safer and more effective.

These days, the field of laser hair removal is highly developed. There are a multitude of lasers that can be used for the reduction of unwanted body hair, but there is conflicting information on which laser is best for a particular individual. For instance, a person with light skin and dark coarse hair has the most options, while an African American has the fewest due to the safety restrictions based on hair color and skin type.

The four most common laser technologies that are in use for laser hair removal are Alexandrite, Diode, IPL, and long-pulse-YAG. At Tattoo MD Laser Clinic, purchasing the right laser for hair removal required doing proper research into the available technologies. Scientific articles comparing the different types of lasers were reviewed. What follows is a summary of scientific research that was used to help make the decision.

A study from 2001 by Handrick, et al in Dermatologic Surgery showed that Alexandrite and Diode lasers were essentially equivalent in skin types I-IV. Another study by Tabatabai et al in 2004 from the same journal compared diode, YAG, and Alexandrite and found that both Diode laser and Alexandrite were equivalent and that both were more effective than YAG. A Chinese study by Chan, et al in 2001 compared YAG and diode laser and found the two to be equivalent in efficacy but the YAG was associated with more treatment pain.� Finally, a study by Toosi, et al in 2006 compared IPL, Alexandrite and Diode and found that Diode was the most effective.

In summary, lasers used for hair removal show a similar effectiveness profile, with the diode being at least as good as any of the others.� A main difference between the diode and the Alexandrite is that the latter is more restricted in the darker skin types such as dark Hispanics and African-Americans.� A YAG can be used in any skin type but there is a trade-off for lower effectiveness in the lighter skin types.� The Diode laser, such as the Comet by Syneron, in use at Tattoo MD Laser Clinic, is the most effective for the greatest range of skin types.