title: Treatment of resistant tattoos using a new generation Q-switched Nd:YAG laser: influence of beam profile and spot size on clearance success.
abstract: OBJECTIVE
  Multiple treatments of resistant tattoos often result in fibrosis and visible textural changes that lessen response to subsequent treatments. The aim of this study is to evaluate the influence of beam profile and spot size on clearance rates and side effects in the setting of resistant tattoos.
  
  
  METHODS
  Thirty-six professional, black tattoos (32 patients) were treated unsuccessfully with a Q-switched Nd:YAG laser (MedLite C3, HoyaConBio Inc., Fremont, CA). Because of therapy resistance all tattoos were re-treated using a new generation Nd:YAG laser (MedLite C6, HoyaConBio Inc.). Maximum energy fluence (E (max)), mean energy fluence, mean spot size, level of clearance, side effects and beam profile (irradiance distribution) of both laser systems were assessed and evaluated in a retrospective study.
  
  
  RESULTS
  All tattoos were previously treated with the C3 laser at 1,064 nm using a mean E(max) of 5.8+/-0.8 J/cm(2) (range 3.8-7.5 J/cm(2)) as compared with a mean E(max) of 6.4+/-1.6 J/cm(2) (range 3.2-9.0 J/cm(2)) during the C6 treatment course. Corresponding spot sizes were larger during C6 treatments as compared with C3 (5.0+/-0.9 and 3.6+/-0.2 mm, respectively). The C6 laser had a "flat top" and homogenous profile regardless of the spot size. For the C3 laser the beam shape was "Gaussian," and the homogeneity was reduced by numerous micro-spikes and micro-nadirs. After the C6 treatment course 33.3% of the tattoos showed clearance of grade 1 (0-25%), 16.7% of grade 2 (26-50%), 16.7% of grade 3 (51-75%), 30.5% of grade 4 (76-95%), 2.8% of grade 5 (96-100%). The total rate of side effects due to C6 treatment was 8.3% in all tattoos (hyperpigmentation 5.6%, hypopigmentation 2.7%, textural changes/scars 0%).
  
  
  CONCLUSIONS
  This clinical study documents for the first time the impact of a 1,064-nm Nd:YAG laser with a more homogenous beam profile and a larger spot size on the management of resistant tattoos. Only a few treatment sessions were necessary to achieve an additional clearance with a low rate of side effects.
authors.affiliation: Laserklinik Karlsruhe, Karlsruhe, Germany.
authors.forename: Syrus
authors.initials: S
authors.lastname: Karsai
authors.forename: Gudrun
authors.initials: G
authors.lastname: Pfirrmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Hammes
authors.forename: Christian
authors.initials: C
authors.lastname: Raulin
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053844:Lasers, Solid-State; D028022:Low-Level Light Therapy / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D012189:Retrospective Studies; D013653:Tattooing; D016896:Treatment Outcome