The Laser Chronicles

It wasn’t long ago that the mention of lasers conjured up images of large-scale weapons that were definitely more science fiction than fact.

The Death Star has a formidable array of turbolasers giving it the firepower of greater than half the Imperial starfleet.

Planetary disintegration? Doubtful modern lasers will ever be used for that purpose. It’s true that the use of lasers to damage or destroy tissue has become more and more common in the medical field. Even in our business of tattoo removal, we harness the destructive property of laser energy to break down the tattoo ink so the body lymphatic system can remove the foreign particles. However, what about using a laser to create, rather than destroy?

Well, it appears that medical science recently made an amazing breakthrough: Laser-Bonded Nano Suturing

Irene Kochevar codirects research into healing surgical incisions with laser light at Massachusetts General Hospital.

After removing a small ellipse of tissue from an anesthetized rabbit, surgeon Ying Wang sews the deeper layers of the wound shut with traditional sutures; the laser that the team uses does not penetrate this deep tissue and so cannot bind it together.

Wang has closed the right half of the epidermal wound with cosmetic stitches. She then drips Rose Bengal dye onto the left half.

Wang and surgeon Min Yao position a metal frame that directs a green surgical laser over the incision. The frame keeps the instrument steady and at a measured distance from the skin. They shine the light onto the cut to activate the dye, leaving it on for three minutes.

A lens in the metal stand modifies the shape of the laser’s focal point so that it’s ideal for healing a long, thin surgical incision. Activated by the light, the Rose Bengal stain causes collagen fibers in the skin to link, sealing the wound.

Once the laser is removed, the left half of the incision remains closed without sutures; it requires no further care and will leave behind almost no scar. The stitches on the right half, however, must remain in place for up to two weeks and will result in small but visible cross-hatch scars.

Story by Lauren Gravitz / Photos by Porter Gifford

Before I get into any of the details, let me give a bit of background on the study and also make it very clear that the implements used are designed to burn and leave a scar, not to remove tattoos. My involvement in this study is to further the research of burn care, wound management and the reduction of scar tissue on burn patients.

It’s been a year now since my first communications with Dr. Vincent Gabriel, Clinical Director North Texas Burn Rehabilitation Model System. He approached me with a with a very radical idea. To find volunteers to receive small burns that could be studied to help future burn survivors. In his own words:

“Our center admits about 500 people per year with serious burns, and I see about another 1000 per year in our outpatient clinics. Overall, about one third are children. Our survival rate is over 94% and as such, scarring is a major problem for my patients.

I contacted you because of a major quandary that we have in researching burn care. As it turns out, hypertrophic burn scars and keloids are uniquely human conditions. Despite the best efforts of many laboratories around the world, there is no acceptable animal model that closely resembles human scars. The closest model is a female red duroc pig that makes a thick scar, but biologically, it is still significantly different from human scar.

Studying scarring is therefore rather difficult. From patients that present to the hospital, we never have pre-existing tissue to study and burns that we can study come from differing depths. As well, our treatments aim to minimize scarring.

As a result, I thought that if I could find a sample of people that wanted to make scars, perhaps I could work with them to study their wounds and scars to better understand the biology behind scarring.”

It’s taken almost a year and several revisions before the review board finally accepted his proposal, but his diligence and hard work finally paid off. The procedure may seem a bit barbaric, but let me assure the branding strikes are virtually painless.

Dr Gabriel taking an initial biopsy

As you can see the biopsy leaves a small hole

An iron being heated to strike the skin

A brand freshly done

The same brand just moments after the second biopsy

The sample collection phase of the study should be over by April.  After that it will take about another 6 months for the analysis done and the results to be published. Once it becomes public record, I will post a link in this blog.

To both Dr Gabriel and the volunteers involved in this study, I would like to thank you all for allowing me to participate. i honestly feel that the work we are doing will advance the understanding and treatment of burns to better the lives of burn survivors around the world.

In a previous blog post I touched on one of the more common tattoo removal creams: Wrecking Balm  People have been asking more about it.  So I decided to do a follow up with a bit more information.

Here are the instructions: (Visit the older blog for a full breakdown of the ingredients)
(I am paraphrasing as to not violate any copyright laws)

1. The first step involves buffing the skin with Suffusion Gel and a device called the DemoMatic with Erosion Head, 3 times a week. (The device is basically a vibrator with a sandpaper end attachment)
2. The second step is to spray the area with the Demo-Brasion spray.  After 90 seconds the area is rinsed.
3. The third step is to apply the HydraVescent Cream.
4. …and lastly the fourth and final step is to apply the Branding Butter Concealer to hide your tattoo.

Essentially the process involves mechanically buffing off layers of skin and using Salicylic Acid to help further exfoliate the deeper tissue.

From Wikipedia:
Salicylic Acid - Also known as 2-hydroxybenzoic acid, one of several beta hydroxy acids (compare to AHA), salicylic acid is a key ingredient in many skin-care products for the treatment of acne, psoriasis, calluses, corns, keratosis pilaris, and warts. It works by causing the cells of the epidermis to shed more readily, preventing pores from clogging up, and allowing room for new cell growth.

The 2 main advantages that laser removal has over these topical products are:

1. Laser energy can penetrate deeper into the dermis to breakup the ink that dermabrasion/acidic peals my not be able to reach.
2. The process of laser removal involves fracturing the ink without damaging the surface the skin.

If you have any experience, positive or negative, with this or any of the other tattoo removal creams, I would love to hear the feedback.

The real story here is that The Enigma and Serana drove up from Austin to have a tattoo removed from her foot. But in true Enigma fashion this story deserves a bit of embellishment. So for reading pleasure I give you, “Attack of The Enigma!”

It was an average day here at Fade Fast when a strange thing suddenly appeared in our office.

It seemed friendly and curious so we decided to let this strange blue creature stay and observe.

Suddenly it became extremely agitated.

But the gift of protective eyewear seemed to soothe the savage beast.

The creature became inquisitive. What was about to happen?

Its native language was strange, but I swear it said, “Why Would She?”

Questions soon turned to Confusion…Confusion turned to Horror.

“Why remove tattoo???”

“OOOOO Evil Green Light!!!”

It poised to attack.

I had to think quickly…or I new I was doomed!

Of course his only weakness.

Threatened by the awesome power of the laser, the giant blue puzzle stood quietly and watched.

Would the laser have stopped the Enigma? I guess we’ll never know.

In all seriousness, I would like thank The Enigma for making the trip to Dallas and trusting us to do a removal and his lovely girlfriend Serana Rose.

And of course thanks to Stacey Potter for coming in and shooting the photos.

Over the last few months Fade Fast has been testing a new product that is specifically designed for healing of tissue that has undergone laser treatments. We have now entered phase two of our trials and are looking for clients that are interested in using free samples of this product. If you would like to participate, you only need to meet two criteria:

1. You must have undergone at least one laser tattoo removal session prior. This will help establish a baseline to compare the differences in healing while using Humatirx.
2. You must be willing to answer a short survey. Either in person or by email.

So far, in phase one of the trials, we have received about an 85 percent positive response, 15% neutral and zero negative responses.

General Positive Response – Reduction of post treatment discomfort and shorten healing time.
General Neutral Response – Saw little to no difference between using Humatrix and other healing methods.

If you would like to participate in our product testing, please drop us a line or ask about it when you come in for a treatment. For more information on Humatrix, please visit Care Tech Labs website: http://www.caretechlabs.com/ctl-products-humatrix.html

Indications

Humatrix® Microclysmic Gel exhibits endothermic and biometric properties which cool traumatized tissue and aid in the homeostasis of healing. Humatrix® Microclysmic Gel provides the ultimate moisturization for burns, autograft procedures, radiation irritation, glycolic acid peel irritation, mechanical injuries, laser treatment, and chronic wound therapy. Advanced biochemical technology provides several unique benefits. First, the time release of water molecules provides the traumatized tissue a consistent level of humectancy to promote tissue regeneration. Secondly, Humatrix® provides a protein template to assist the biological regeneration of fibroblast cells necessary for wound healing. Thirdly, the cooling process of Humatrix® lowers the surface temperature 8 to 12 degrees within three minutes preventing further tissue damage caused by dehydration of cells. Humatrix® Microclysmic Gel is a bacteriostatic, protein enriched formulation designed to maintain a moist, sterile environment which promotes and accelerates cellular regeneration by replicating the natural fibro-connective template and promoting fibroblast activity, the precursor of collagen formulation. The fibron network maintains homeostasis via the product’s bio-chemical process by the addition of an analog of extracellular matrix. Humatrix® assists in the reduction of hyper-granulation, scarring, and hyper-contracture as well as increases both the extensibility and flexibility of human skin with the addition of the glycosaminoglycan matrix. Humatrix® is an excellent adjunct to wound treatment. Humatrix® maintains a sterile, moist environment for the healing of chronic and acute wounds by modulating the osmotic pressure of tissue by the timed release of moisture for cellular regeneration.

Channel 11 news was in the shop two days ago doing a story on story on Lilly and now it’s exploding all over the internet. I heard it even made the front page of Yahoo News and CNN.

span class=”cbstv_attribution”>DALLAS (CBS 11 News) ― According to Lilly Hibbs, tattoos are a way of life. Her mom works on body piercing and her dad is a tattoo artist. The 9-year-old said she just wants to follow in his footsteps.

“Monkey see, monkey do,” said Stephen Hibbs, Lilly’s dad. “I guess she watches us everyday she wants to be a part of it.”

Stephen said he just couldn’t be prouder. “Most parents would say, ‘I can’t believe your kid wants to be a tattoo artist.’ Where I say, ‘I can only be lucky if my kid turns out to be a tattoo artist,’” he said.

Lilly spends her day at Suffer City Tattoos in Dallas, doing what she says comes naturally, learning the skill of body art.

“When I was 7, my dad asked me if I wanted to tattoo him and I said yes,” she said. So, Lilly tattooed her dad with a picture of Patrick from SpongeBob SquarePants.

The video was posted on YouTube. “One person saw video of me tattoo. They just stopped in saying they wanted a tattoo by me,” Lilly said.

One person even drove from North Carolina to get a tattoo by Lilly. “He wanted an anchor, so she drew him an anchor,” said Stephen. “He loved it.”

But Lilly has a little help. The needle is heavy, so her dad holds on while she draws.

At only $5 for each tattoo, Lilly realizes that she won’t get rich any time soon, but she is saving up for something a little zany: a gigantic plastic gingerbread man.

“I don’t think I will ever buy her a plastic gingerbread man, she will buy it for herself,” said her dad.

Lilly has drawn about six tattoos and says she realizes she has a lot of art classes to take before she can perfect her skill. Meanwhile, her dad worries that, like most kids, she will rebel — throw in the needle and run off to join a sorority.

These last few weeks have been hectic with all our traveling. This past month the crew of Fade Fast attended the Masters of Tattooing, Philadelphia Tattoo Arts and Association of Professional Piercers annual conventions. We were out there speaking to the tattooed community about the science and art of laser removal, pigment reduction and tattoo editing. Until recently tattoo removal was thought to be the last option for poor quality and/or unwanted tattoos. Now, people are starting to accept and embrace the use of lasers to lighten existing artwork. In fact, the technology has improved so much that tattoos can now be easily covered in as few as one to four sessions. It’s truly amazing the options and flexibility laser treatments can give people when they choose to fix, rework or tattoo over an existing piece.

With over 16 years experience in the body modification industry, Fade Fast is one of the few tattoo removal clinics that has earned the trust and respect of the tattoo community.

Tattoo removal is more than just science. At Fade Fast, better artwork is our passion.

Some you win and some you lose, and this was definitely true for today. I’m not talking about paying taxes, but I’m sure many of you are thinking that, being that it’s April 15th. No I’m talking about today’s test of a pneumatic skin-flattening (PSF) device, the Candela Serenity PRO.

First let me say, it really is an ingenious device. It’s basically a vacuum system that pulls the skin up into a clear, disposable plastic lens. The idea is that when the skin is compressed, pain signals are blocked. In clinical tests, it appears to work amazingly well. However, these tests have focused mainly on laser hair removal. From my understanding, we were the first studio in the United States to test the unit’s effectiveness on pain reduction in conjunction with laser tattoo removal, at least the first to use the disposable hand piece.

Sadly, the results weren’t anything close to what we hoped. The unit was tested on three people. (Two clients and I also volunteered my arm and hip) Pain reduction seemed to be almost nonexistent when using the device in conjunction with our Palomar QYAG5. In fact, at times the pain seemed more intense. Here are the basic results:

Person 1: (same energy output for each test)

• Inside of forearm arm treated directly with laser to determine baseline of pain.
• Area treated with PSF – Similar pain.
• Hip treated directly with laser to determine baseline of pain.
• Area treated with PSF – Similar pain.

Person 2: (same energy output for each test)

• Buttocks treated directly with laser to determine baseline of pain
• Area treated with PSF – Similar pain, possibly slight reduction
• Area iced for five minutes and treated – Dramatic reduction of pain
• Iced area treated with PSF – Increased pain

Person 3: (same energy output for each test)

• Back treated directly with laser to determine baseline of pain
• Area treated with PSF – Increase of pain
• Area iced for five minutes and treated – Medium reduction of pain
• Iced area treated with PSF – Dramatic increase of pain

So what does all this mean? The device has proven to work with laser hair removal, but it appears to have a different reaction to laser tattoo removal. After some discussion with the representative, we may have come to a fairly reasonable, yet hypothetical conclusion.

As the device sucks the skin into the lens, the epidermis and upper levels of the dermis are compressed making the tattoo ink a much clearer target. Logically, this means the ink might absorb the energy that could be reflected and/or absorbed by the skin during a normal treatment. If this is the case, then testing the area with an identical laser energy output may not have been a true comparison. In fact, the tattoo treated with the PSF may have been absorbing a dramatically larger amount of energy.

In conclusion, although presently the Candela Serenity PRO-PSF might not be a good companion machine for tattoo removal, I am grateful that the company allowed us to be one of the first laser removal studios to test the device. Plus, if the unit becomes available again for different energy comparisons, we might be giving it another try down the line.

Still waiting to post the Masters of Tattooing convention blog. I just need a few photos to complete the entry. Until then, here are some recent treatment result photos:

Click for larger image

In other news, Fade Fast may soon be offering laser removal treatments in Austin, Houston and other Texas cities. More info soon to come.

This week I tested my Palomar QYAG5 against the Hoya Conbio Revlite laser. I planned to demo the Medlite C6, which is almost the same unit, but the Revlite is Conbio’s top of the line machine and of course they want to show the more expensive unit. The touch screen that the Revlite offers over the Medlite C6 is very cool, but when it comes right down to it, the Medlite C6 is really just as good for tattoo removal.

Before I get into the full results, I was honestly shocked how similar the systems really are. I was actually able to produce almost identical results with just one exception that I will address here in a minute.

Here are the results:

Power – The Revlite is a 220V machine, where mine is a 110V. As with the last laser I demoed this machine produces a lot of heat. Also, the Revlite took a while to warm up, whereas the Palomar starts immediately.

Energy – The Revlite does seem to be able to produce more energy, although, the Palomar appears to be able to match it within certain parameters. Looking at the display, the Revlite can produce more power in a larger spot size, but it was more energy than needed to treat the two test clients.

Wavelength – The Revlite has two dye polymer hand pieces that allow the machine to produce 585 and 650 wavelengths that the Palomar cannot. The Palomar has a wave-blending feature that the Revlite does not. Testing light blues the machines have similar results. However, the Revlite does seem to react slightly better to greens.

Spot Size – In 1064 and 532 modes the Revlite does have a 8mm spot size, where the Palomar only has 6mm. When it comes to doing very big black or red pieces, the Revlite can do them a bit faster. However, in 585 and 650 mode the Revlite spot size drops down to 2mm to 3mm making progress super slow going.

Speed – First, as mentioned above, the Revlite needs to warm up, where the Palomar is ready to operate when it’s turned on. Simple, but clients don’t like to wait. As for the operation, in 1064 and 532 modes, both machines operate at the same speed, 10HZ, they fire 10 shots a second. When the Revlite is in 585 and 650 mode it drops down to 1 or 2 HZ making treatment of large blue/green tattoos incredibly time consuming.

Ergonomic – The Revlite articulated arm is slightly more comfortable to use than the larger Palomar lasing unit. The Revlite might be easier to use for some people, but the Palomar also comes with an arm to hold the large hand piece. My thoughts are that the Revlite is more ergonomic, but only slightly.

Function – Side by side these machines are so similar. The only complaints I got from the clients were that the Revlite is just too slow in blue and green modes. When the Palomar operates in the wave blending mode to treat these colors it is so much faster.

Results – I worked on two clients and the results are yet to be seen, give me a week or two. I can tell you from first glance, the results seem almost identical.

Pain – Because the machines operate in the same way, pain seems similar as well. Both clients gave almost identical reviews about the sensation.

Hair Removal – Another reason I wanted to review this machine is its hair removal feature. Not that I plan to delve into this business, but if the machine has the option I might offer it as well. As it turns out, this laser really isn’t designed to do hair removal. During the machine’s initial testing, they found less hair growth in areas that were treated for tattoo removal. So, does the machine do hair removal? Well a bit, but then again, the Palomar does the exact same thing.

In final review, the machines look and operate very differently, but the core physics are extremely similar. Prior to testing the machine I was convinced the Hoya Conbio Revlite and Medlite C6 would have so much more to offer than the Palomar QYAG5. The final test will be in the results, but for now, I see such little difference that I doubt I will be in any hurry to change lasers.

Coming soon, a review of a new pain reduction device.