Tattoo removal

Introduction to the treatment - what are they signing up for? what are their current expectations? 

Acknowledgement of the tattoo to be treated - ink, size, age, healing - allows you to start to piece together a plan. 

Process of laser tattoo removal including analysis of Fitzpatrick - how it works and why they have to stick to your proposed treatment plan. allows you to gauge parameters and risk (FP).

Appropriate consent forms/ medical forms - legal requirement, ensure safe treating for yourself and the client.

Reactions - what is expected and what is not? how do we manage it?

Recommended treatment planning - guidelines for minimum expected treatment, intervals and expected results. 

patching - parameters selection, safety, legal requirements, the client can establish the sensation.

Pre and post-treatment instructions - what can they do and not. why

Frosting - a white frosty look on the epidermal layers.

Normal and expected response.

Lasts - 15 to 30 minutes. 

result of carbon dioxide being procedure as a result of selective photothermolusis. 

the cell membrane regulates the active and passive transfer.

Pin point haemorrhaging

crusting

Blistering 

Scabbing 

Swelling

Erthema

Scarring

Hypo pigmentation 

Although bleeding and blistering can be expected - they are not clinical end points during treatment. if the client experiences blistering or bleeding, joules should be lowered as it indicates excessive energy delivery. 

due to the aggressive subsequent tissue damage is also a possibility.

• unrealistic expectation 
• double tattoos
• facial tattoos
• photosensitive/ hypersensititve medication
• fish oil, iron, ginseng and garlic
• topical acids/ retinoids
• psoriasis and eczema

• recent topical steroids
• oral steroids
• implanted medical device
• active skin infection on the treated area
• tanning enhancers use
• light-triggered seizure disorder
• herpes simplex virus in the area
• Roaccutane
• pregnancy
• history of keloid scarring
• anticoagulant drugs - aspirin
• moles in the treated area
• sun tan/ sun burn
• excessively dry skin
• gold therapy

The elimination of the ink particles takes place through the process of phagocytosis. 

the dermal fragments of ink are broken down and 'package together' for elimination through the lymphatic system and scavenged by dermal macrophages. 

Phagocytosis is a specific process that begins with the blinding of antibodies. 

The cell membrane then extends around the target, eventually enveloping it and pinching off to form and surrounds the bacteria with a phagosome. 

allowing the bacteria to be killed and transported through the lymphatic system.

Phagocyte - absorbs harmful bacteria. 

Phagosome - forms around a particle engulfed by phagocytes (within the phagocyte).

Phagocytosis - the process of the phagocytes engulfing the bacteria (ink) and the phagosome surrounding.

pigment absorbs the laser light.

The light passes harmlessly through the skin targeting only the ink resting in a liquid state within.  

As the laser light is absorbed, the heat crystalises the ink changing the physical state from a liquid to a solid.

The body’s natural reaction to this crystalised ink is to treat is as if it were a splinter.

The body forces the crystalised ink to the surface, sloughing away some of the tattoo and the lymphatic system metabolises the ink.

The body forces the crystalised ink to the surface, sloughing away some of the tattoo and the lymphatic system metabolises the ink.

Sanitise the skin with antibacterial wash such as Dettol

each colour of the ink should be test patched

test patches should be performed 2 weeks pre-treatment

fluence should be increased until the clinical endpoint is present

any bleeding must be cleaned post-treatment

Salvon can be applied to the tested area

sterile dressing with micropore can be applied to be treated area using a 'non touch' method - micropore to be cut by the scissors.

Expected around of treatments, on average 6-12 treatments but it is never guaranteed. 

colours: black, blue, red and brown.

treatment frequency 6-12 weeks

recommended use of guidance chart to provide minimum amount of treatment for client. 

RUBY 694NM - Black, blue, green and purple. 

ALEXANDRITE 755NM - Black, blue and green

Nd: YAG 1064NM - Black and blue

Nd: YAG 532NM - Red and orange

Wavelength indicates the distance between two points in a wave of electromagnetic energy that, in networking, encodes signals onto light to transmit data. 

distance from peak to peak

measured in nanometres (nm)

Alteration of the handpiece may be required for selective spectral absorption. 

- 1064nm: treats blacks and blue ink

- 532nm: treat red and brown ink. 

- we cannot treat yellow and green ink

The recommended minimum amount of treatments is based on Fitzpatrick, location, colour, scarring and layering.

 Fitzpatrick - I (1), II (2), III (3), IV (4), V (5), VI (6)

Location - head and neck (1), upper trunk (2), lower trunk (3), proximal extremity (4), distal extremity (5).

Colour - Black only (1), mostly black with some red (2), mostly black with some red and other colours (3) and multiple points (4).

Scarring - no scar (0), minimal (1), moderate (3) and significant (4).

Layering - none (0), layering (2)

Unable to provide an expected response due to ink compounds not often known.

the poor lymphatic system could result in treatment being less responsive - relying on the health of a client. 

desired treatment outcome may take longer to achieve due to increased wound healing response. 

higher risk of adverse reaction due to the penetrative nature of the treatment.

no treatment when suntan is active

- when were you last in the sun?

- tan enhances?

- how long does it last?

- any plan for upcoming hoildays

no treatment during pregnancy

- are you planning to breastfeed?

- how long?

- did you experience any pigmentary conditions during pregnancy. 

- no treatment whilst active, caution as heat may flare. 

- is it in the area to be treated?

- did you notice any trigger that causes a flare up?

- have you used any topical therapies to treat the condition, if so what are they?

- are you happy to consent knowing the heat may trigger an inflammatory outbreak?