Increased Tattoo Fading in a Single Laser Tattoo Removal Session Enabled by a Rapid Acoustic Pulse Device: A Prospective Clinical Trial

Abstract

Background and objectives: The ability to provide improved tattoo fading using multiple laser passes in a single office laser tattoo removal session is limited. In part, this is due to the loss of laser effectiveness caused by epidermal and dermal vacuole "whitening" generated during the initial laser pass at the tattoo site. The Rapid Acoustic Pulse (RAP) device generates acoustic shock wave pulses that clear epidermal and dermal vacuoles to enable multiple laser passes in a single office laser tattoo removal session. The objectives of this study were to determine if the RAP device, when used as an accessory to the 1064 nm Nd:YAG Q-switched (QS) laser can enable delivery of multiple laser passes in a single office laser tattoo removal session, and therefore result in increased tattoo fading compared to the clinical standard single-pass QS laser tattoo removal session.

Study design/materials and methods: The RAP device was evaluated in a single-center (SkinCare Physicians), prospective, IRB approved study. A total of 32 black ink tattoos, from 21 participants, were divided into three zones and treated with either multiple QS laser passes, each followed by 1 minute of RAP device application (Laser + RAP) in zone one and single-pass QS laser treatment (Laser-Only) in zone two, separated by an untreated control zone. The treatment sites were assessed for the number of laser passes and adverse events immediately, 6 weeks, and 12 weeks following the treatment session. Photographs of the treatment sites were assessed for percent fading at 12 weeks post-treatment by three blinded reviewers.

Results: When the RAP device was applied as an accessory to the QS laser in a multi-pass laser tattoo removal treatment, an average of 4.2 laser passes were delivered in a single session, with no unexpected or serious RAP device-related adverse events. At the 12-week follow-up, tattoos treated with Laser + RAP showed a statistically significant increase in average fading (44.2%) compared with tattoos treated with Laser-Only (24.8%) (P < 0.01). Additionally, a significantly higher overall proportion of tattoos treated with Laser + RAP (37.5%) had a response of >50% fading compared with tattoos treated with QS Laser-Only (9.4%) (P < 0.01) as well as a response of >75% fading from Laser + RAP treatment (21.9%) compared with Laser-Only treatment (3.1%) (P < 0.05).

Conclusions: The RAP device, applied as an accessory to the 1064 nm Nd:YAG QS laser, safely enables multiple QS laser treatments in a single office laser tattoo removal session by clearing the whitening caused by the previous QS laser pass. Enabling multiple QS laser passes results in a statistically significant increase in tattoo fading in a single office laser tattoo removal session compared to the clinical standard single-pass QS laser tattoo removal session. © 2019 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Keywords: Q-switched laser; acoustic pulse; acoustic shock wave; tattoo removal.

Figure 1

Single‐pass laser “whitening” (left), untreated black tattoo (right).

Figure 2

The Rapid Acoustic Pulse device components.

Figure 3

Hand Piece of Rapid Acoustic Pulse device being applied for 1 minute after a laser tattoo removal treatment to dissipate the laser whitening and allow an additional laser pass.

Figure 4

(A) Pre‐treatment, (B) laser whitening, and (C) whitening resolved by 1 minute of Rapid Acoustic Pulse application.

Figure 5

Example of a suitable tattoo treatment area layout within a tattoo.

Figure 6

Before treatment (top picture) and 12 weeks after treatment (bottom picture). (A) Laser‐Only and (B) Laser + RAP. RAP, Rapid Acoustic Pulse.

Figure 7

Before treatment (top picture) and 12 weeks after treatment (bottom picture). (A) Laser‐Only and (B) Laser + RAP. Tattoo “outline” of paw not treated with Laser + RAP. RAP, Rapid Acoustic Pulse.

Figure 8

Before treatment (top picture) and 12 weeks after treatment (bottom picture). (A) Laser‐Only and (B) Laser + RAP. RAP, Rapid Acoustic Pulse.

Figure 9

Tattoo fading distribution at 12 weeks post‐treatment in a single office laser tattoo removal session. Tattoos treated with Laser + RAP achieved higher percentages of fading than Laser‐Only treated tattoos. RAP, Rapid Acoustic Pulse.

Figure 10

The number of tattoos that were greater than 50% faded from a single office laser tattoo removal session was significantly greater for Laser + RAP than for Laser‐Only with t = 2.77 (df = 50.87, P < 0.01), and the number that were greater than 75% faded was significantly greater for Laser + RAP than for Laser‐Only with t = 2.33 (df = 41.65, P < 0.05). RAP, Rapid Acoustic Pulse.

Figure 11

Average percent tattoo fading scores from three blinded reviewers 12 weeks after a single office laser tattoo removal session (shown as columns) overlaid with scatter plots of the average percent fading for each tattoo evaluated. Laser + RAP was associated with significantly greater tattoo fading than Laser‐Only with t = 3.38 (df = 54.30, P < 0.01). RAP, Rapid Acoustic Pulse.