ATLANTA – Applying the topical fluorocarbon perfluorodecalin prior to Q-switched laser treatment for tattoo removal allows for immediate retreatment of the tattoo, thereby improving results while decreasing overall treatment time, according to Dr. Roy Geronemus.
The findings have important implications for improving outcomes and patient satisfaction, given that tattoo removal can require 10-20 sessions, depending on factors such as the age and colors of the tattoo, and that tattoos – and thus tattoo removal – continue to increase in popularity, he said. "For a busy practice or impatient patients like we have in New York, this has been a nice advance," Dr. Geronemus said at the annual meeting of the American Society for Dermatologic Surgery.
The approach builds on the "R20 technique" described earlier this year in a study published in the Journal of the American Academy of Dermatology. R20 involves the use of multiple treatment passes that are made at 20-minute intervals.
Typically, after an initial pass, tiny white bubbles form in the superficial papillary dermis, appearing as a whitening of the skin. Retreatment while these bubbles are present elicits a limited reaction.
The R20 technique was developed when investigators found that the bubbles disappear after 20 minutes, and, thus, tested the technique in a study of 12 adults. The patients were randomized to a single treatment pass with a Q-switched alexandrite laser (5.5 J/cm2, 755 nm, 100-nanosecond pulse duration, 3-mm spot size) or to four passes at 20 minute intervals.
The first treatment caused an immediate whitening reaction, but little or no whitening occurred after subsequent passes at 20-minute intervals. However, at 90-day follow-up, significant improvement was seen in the R20 group, compared with the single-treatment group, and light microscopy demonstrated greater dispersion of tattoo ink with the R20 approach. (J. Am. Acad. Dermatol. 2012;66:271-7).
Despite the increased efficacy using this approach, the time required to complete four passes at 20-minute intervals makes it impractical in the clinical setting, said Dr. Geronemus, a dermatologist in private practice in New York.
"So with this idea in mind, we began to look at a concept that would allow us to re-treat tattoos immediately without waiting 20 minutes," he said, explaining that topical perfluorodecalin helps dissolve the gas seen after the application of the Q-switched laser and speeds the resolution of the whitening.
"Rather than waiting 20 minutes, the gas dissolves almost immediately, allowing you to re-treat, and we’re now re-treating three or four times in a matter of minutes rather than waiting the 80 minutes that the R20 technique would take for a four-time treatment session," he said.
In his experience, results with perfluorodecalin are comparable to those seen with the R20 technique – but with greater convenience for the patient.
His observations were confirmed on optical coherence tomography scanning, which demonstrated that cavitation levels are indeed reduced by the use of perfluorodecalin.
Dr. Geronemus is an investigator for Cutera, Cynosure, Palomar, Solta Medical, and Syneron. He is also on the medical advisory board for Cynosure, Lumenis, Photomedex, Syneron, and Zeltiq. He reported that he is a Zeltiq shareholder.