SEPTEMBER 1903
TATTOOS--". The practice has been defined by Maurice Berchon as 'that strange and very ancient custom which consists in the introduction under the cutaneous epidermis, at different depths, of coloring matter, in order to produce some design which will be of very long duration.'
Source: Scientific American, Sep2003, Vol. 289 Issue 3, p22, 1p

Abstract Tattoos are placed for different reasons. A technique for tattoo removal which produces, with minimal risk of scarring, is needed. Nonspecific methods have a high incidence of scarring, textural, and pigmentary alterations compared with the use of Q-switched lasers.
With new advances in Q-switched laser technology, tattoo removal can be achieved with minimal risk of scarring and permanent pigmentary alteration.
There are five types of tattoos:. Amateur tattoos require less treatment sessions than professional multicolored tattoos. Other factors to consider when evaluating tattoos for removal are: location, age and the skin type of the patient.
Treatment should begin by obtaining a pre-operative history. Since treatment with the Qswitched lasers is painful, use of a local injection with lidocaine or topical anaesthesia cream may be used prior to laser treatment.
Topical broad-spectrum antibacterial ointment is applied immediately following the procedure.
Three types of lasers are currently used for tattoo removal: Q-switched ruby laser
(694nm), Q-switched
Nd:YAG (Neodymium-doped Yttrium Aluminum Garnet) laser (532nm, 1064nm), and Q-switched alexandrite laser (755nm). The Q-switched ruby and alexandrite lasers are useful for removing black, blue and green pigments. The Q-switched
532nm Nd:YAG laser can be used to remove red pigments and the 1064nm Nd:YAG laser is used for removal of black and blue pigments.
The most common adverse effects following laser tattoo treatment with the Q-switched ruby laser include textural change, scarring, and pigmentary alteration. Transient hypopigmentation and textural changes have been reported in up to 50 and 12%, respectively, of patients treated with the Q-switched alexandrite laser.
Hyperpigmentation and textural changes are infrequent adverse effects of the Qswitched Nd:YAG laser and the incidence of hypopigmentary changes is much lower than with the ruby laser.
The development of localized and generalized allergic reactions is an unusual complication following tattoo removal with the Q-switched ruby and Nd:YAG lasers.
Since many wavelengths are needed to treat multicolored tattoos, not one laser system can be used alone to remove all the available inks and combination of inks. While laser tattoo removal is not perfect, we have come a long way since the advent of Q-switched lasers. Current research is focusing on newer picosecond lasers,

which may be more successful than the Q-switched lasers in the removal of the new vibrant tattoo inks.
REVIEW ARTICLE Am J Clin Dermatol 2001; 2 (1): 21-25
1175-0561/01/0001-0021/$22.00/0
© Adis International Limited. All rights reserved.
Tattoos are placed for different reasons:[1]
• cultural (tribal and gang-related);
• medical (delineating a radiation port);
• cosmetic (lip, eyebrow, and eyeliner and flesh tones);
• recreational;
• traumatic.
A technique which produces selective removal of each tattoo pigment, with minimal risk of scarring, is needed. Nonspecific methods, such as surgical excision, dermabrasion, and carbon dioxide laser vaporization, as well as salabrasion, electrosurgery, and cryosurgery have a much higher incidence of scarring, textural, and pigmentary alterations than the Q-switched lasers.[2-7]
Our ability to treat tattoos has been enhanced by the development of the Q-switched ruby, Q-switched Nd:YAG, and Qswitched alexandrite lasers. This article will summarize the traditional and modern methods for laser tattoo removal.
In 1964, Dr Leon Goldman development the first laser for tattoo removal, a normal mode ruby laser. However, this technique for tattoo removal was soon abandoned. Interest was reawakened in the 1980s and 1990s. In the 1980s, in Scotland, Reid and coworkers[
8] reported that the Q-switched ruby laser was useful for the removal of both amateur and professional blue-black tattoos with minimal cutaneous adverse effects. Amateur tattoos were found to clear in 4 to 6 sessions, while professional tattoos required
1 to 3 more additional sessions.[9] Eighty percent of amateur and 65% of professional tattoos were found to lighten considerably after 6 to 8 treatments.[10]
Researchers have compared the carbon dioxide laser and the argon laser for tattoo removal. The carbon dioxide laser is a continuous- wave laser that emits light at 10 600nm. Its main chromophore is water. The argon laser is also a continuous-wave laser emitting blue-green light at 488 to 514nm. Since these modalities cause nonspecific thermal injury, there is a high potential for scarring.
The argon laser was shown to be less injurious than the carbon dioxide laser to the surrounding tissue, but thermal damage caused by the long exposure time still led to scar formation in many cases.[11]
In 1983, Drs Rox Anderson and John Parrish described the theory of selective photothermolysis.[12] Selectivity is achieved by choosing a laser wavelength that is maximally absorbed by the cutaneous chromophore. Then damage can be confined to that

target by limiting the pulse duration to less than the thermal relaxation time of the cutaneous chromophore. The thermal relaxation time is the time that it takes for the target tissue to lose 50% of its incident heat without conducting heat to the surrounding tissue. Thermal relaxation time varies directly with the square of the diameter. This is determined only by the size of the chromophore, that is, the larger the size, the longer the thermal relaxation time.[7] Since there is only minimal absorption by the surrounding tissue, peripheral injury is limited.[12] In tattoos, the target chromophore is the exogenous tattoo ink.
The mechanism of tattoo clearance has been analyzed and studied extensively. Prior to treatment, tattoo pigment is found in membrane bound granules in fibroblasts, macrophages, and mast cells, which are located perivascularly.[9] The photoacoustic effect, produced by the Q-switched laser, ruptures these pigment containing cells, sending a ‘shock wave’ throughout the tissue. A neutrophilic response occurs shortly thereafter and the altered tattoo pigment is repackaged in fibroblasts, macrophages, and mast cells while some is taken to the lymphatic spleen. This accounts for some lightening. In addition, some pigment is eliminated by transepidermal migration. The tattoo pigment that remains may also be less visible due to change in its optical properties.
1. Treatment
A pre-operative history should be obtained in all patients. It should include a history of keloidal scarring, treatment with isotretinoin in the past year, and allergies to antibacterial ointments.
Written information regarding the procedure is useful and should be given to the patient preoperatively. Representative before and after photographs are also helpful. The patients should be advised that many treatments will be required and total removal of tattoo pigment may not be possible. Patients should also be advised that if they think they will be unsatisfied with only partial removal of their tattoo that it may not be wise to pursue treatment.
Since treatment with the Q-switched lasers is painful, many patients request local injection with lidocaine (xylocaine) prior to laser treatment. For some patients topical anaesthesia using
‘EMLA’ cream (eutectic mixture of lidocaine-prilocaine) may be adequate. Topical broad-spectrum antibacterial ointment is applied immediately following the procedure. Postoperative wound care consists of normal saline or hydrogen peroxide 3% used to gently clean the wound and the application of a topical antibacterial ointment, twice daily, until the wound has reepithelialized.
Strict sun avoidance and sunblock is advised to minimize hyperpigmentation.
However, if it does occur, hydroquinone therapy with sunblock is started twice daily until resolution occurs.[13]
There are many issues that are important in evaluating the

candidate for successful tattoo removal. Several generalizations can be made that are useful in this process. Amateur tattoos require less treatment sessions compared with professional multicolored tattoos. Tattoos that are distally located are more difficult to remove which may be related to lymphatic drainage. The age of the tattoo is also relevant since over time the body slowly disperses the ink via lymphatic drainage. In general, older tattoos are easier to remove and require fewer treatments. Patients with darker skin types have a higher risk of pigmentary alteration and possible scarring. For these patients, longer wavelength lasers may be more appropriate because there is less interference with melanin.[13]
1.1 Type of Tattoo
The laser surgeon must consider the type of tattoo to be removed because this will affect the clearance and complication rates. The 5 major types of tattoos are amateur, professional, cosmetic, medicinal, and traumatic.
1.1.1 Decorative Amateur Tattoos
Some examples include those placed by tribal and gang members. The amateur tattoo usually consists of black India ink.
Since these tattoos are placed unevenly and superficially in the dermis, they respond well to laser treatment, with fewer treatments and more complete clearance.
1.1.2 Professional Tattoos
In the past, these types of tattoos were commonly seen in military men and bikers. However, with today’s changing trends people of all ages and socioeconomic strata are obtaining professional tattoos. Unfortunately, these tattoos do pose difficulties for the laser surgeon. These tattoos are placed more deeply in the dermis with a greater density of pigment. The colors are very vibrant and diverse in shade. Since there is no government regulation on tattoo pigment or control over the adulteration of the pigments, the tattoo artist may mix or even overlay the inks so that it is difficult to identify which pigments have been utilized.
Therefore, it is complex, not only to identify the multiple color combinations, but also to choose the appropriate lasers for these colors. Black pigment is best treated with Q-switched Nd:YAG, ruby, or alexandrite lasers. Red pigment responds to Q-switched
Nd:YAG 532nm; blue and green is best treated by Q-switched alexandrite and Q-switched ruby.[14]
1.1.3 Cosmetic Tattoos
Cosmetic tattoos are applied for a variety of reasons including disguising scars, broadening lips, eye and lip liners, covering periorbital pigmentation, or providing rosy cheeks. The colors that are used most frequently are off-white, reddish-brown, red, flesh tones (skin-colored), or dull orange. Many of these cosmetic

tattoos are made with iron pigments. Iron has 2 different oxidation states: as ferrous oxide which is black, and ferric oxide which is a red-brown color. Upon exposure to the Q-switched laser energy the ferric oxide undergoes a reduction reaction to become ferrous oxide, a black pigment.
The adverse effect known as ‘paradoxical darkening’ was first described by Anderson et al.[15]
While it can occur following Q-switched laser treatment of any tattoo with brown, white, or flesh-tone colors, it is usually seen with cosmetic tattoos. A test treatment of all cosmetic tattoos should be performed since this gray-black color will then require many more treatments for removal.[16-18]
1.1.4 Medicinal Tattoos
These types of tattoos are often placed to designate a radiation port during cancer therapy.
After patients are in remission, they are often anxious to remove these signs of illness. Fortunately, these India ink blue-black tattoos are often easily removed in 1 to 2 sessions.
1.1.5 Traumatic Tattoos
Traumatic tattoos can occur following different types of injury to the skin. This method of introducing tattoo pigment can occur following abrasion or explosion. Gunpowder and particulate matter following motorcycle and bicycle accidents are examples of these types of tattoos.
1.2 Types of Laser
Three lasers are currently used for tattoo removal: Qswitched ruby laser (694nm), Q-switched Nd:YAG laser (532nm,
1064nm), and Q-switched alexandrite laser (755nm). The wavelength, pulse duration, and colors for each laser system are shown in table I.
1.2.1 Q-switched Ruby Laser
The Q-switched ruby is composed of a ruby crystal (aluminum oxide), which has a crystal lattice with a chromium impurity inside of it. The crystal is surrounded by a helical flashlamp. In the Q-switched mode, very high power is achieved by allowing the energy to build up inside the optical cavity. The laser has a wavelength of 694nm, a 28 to 40 nsec pulse width (over 108
W/cm2), and injures to a depth of about 1mm into skin. The laser has a mirrored articulated arm and a choice of two spot sizes
(5mm and 6.5mm) and has a frequency of 1Hz. Treatment of tattoos is usually started at 6 to 8 J/cm2 with a 5mm spot size and performed ideally with 10% overlap of pulses. The ideal tissue response is whitening without epidermal injury. This whitening is due to high temperatures generated causing the accumulation
Table I. Summary of characteristics of lasers used for tattoo removal[14]
Laser Wavelength Pulse duration Tattoo colors that can be treated

Alexandrite 755nm (Q-switched) 50-100ns Black, blue, green
Ruby 694nm (Q-switched) 28ns Black, blue, green
Nd:YAG 532nm (Q-switched) 10ns Red
1064nm 10ns Black, blue
Laser Tattoo Removal 23 of water vapor in the skin. If tissue perforation occurs, then the fluence may need to be lowered. The 694nm wavelength is well absorbed by melanin, blue-black and green tattoo pigment. When
Levine and Geronemus[19] compared the Q-switched ruby with the Q-switched Nd:YAG lasers, they concluded that both lasers were effective in removing black amateur and professional tattoos.
The Q-switched Nd:YAG was less effective in removing green pigment.
1.2.2 Q-switched Nd: YAG Laser
The Q-switched neodymium: yttrium-aluminum-garnet
(QSNd:YAG) laser was developed in 1989. It is a solid state, high fluence laser containing a crystal rod of yttrium-aluminum-garnet doped with 1 to 3% neodynium ions. Its emission is in the near infrared range at 1064nm, with a pulse duration of 10 to 20 nsec.
The laser emission can be doubled in frequency by placing a potassium-titanyl-phosphate (KTP) crystal inside the laser cavity and focusing the beam through the crystal, producing a green light at 532nm. The laser has a mirrored articulated arm; spot sizes vary according to the exact model from 0.8 to 8mm and fluences from
1 to 12 J/cm2. Treatment is performed with 10% overlap of pulses.
At a wavelength of 532nm fluences of 2 to 4 J/cm2 are used to treat red tattoos. When the 1064nm wavelength is used, fluences of 5 to 6 J/cm2 (3 to 4mm spot size) are appropriate.[13] The 1064nm option is best suited to black and blue-black tattoos, and the
532nm wavelength is used for red pigment.
Given its longer wavelength, this laser does not have as high an affinity for melanin as does the Q-switched ruby laser. It may be more useful in the treatment of tattoos in darker skinned individuals.
Gravelink et al.[20] performed a small comparative study using the Q-switched ruby laser and Q-switched Nd:YAG laser in the treatment of tattoos in patients with Fitzpatrick skin types
V and VI. They showed the Q-switched Nd:YAG laser to be superior in pigment removal with a lower risk of hypopigmentation.
1.2.3 Q-switched Alexandrite Laser
The Q-switched alexandrite laser (755nm, pulse duration from 50 to 100nsec) delivers its energy via a flexible fibreoptic arm. Target chromphores include blue, black, and green tattoo pigments.
Fitzpatrick and Goldman[21] used the Q-switched alexandrite laser (3mm spot size, fluences from 4 to 8 J/cm2) to treat 17

patients with professional, and 8 patients with amateur tattoos.
More than 95% of the tattoo pigment was removed in an average of 8.9 sessions. Alster[22] examined the Q-switched alexandrite in conjunction with a 510nm pulsed dye laser. 24 multicolored professional tattoos and 18 blue-black amateur tattoos were treated with the 755nm, 100nsec Q-switched alexandrite; the 510nm laser was used to treat the red tattoos. Removal of amateur tattoos required 4.6 treatments, professional tattoos required 8.5, and red tattoos required 2 treatments. No adverse sequelae were noted.
2. Adverse Effect Profiles
The most common adverse effects following laser tattoo treatment with the Q-switched ruby laser include textural change, scarring, and pigmentary alteration. Since the wavelength of
694nm is well absorbed by melanin, the most common adverse effect reported is hypopigmentation. While it is usually transient, it may be permanent. Depigmentation is much rarer. This is particularly important when treating patients with Fitzpatrick types
IV and V skin.[21] Textural changes have also been noted with both the Q-switched ruby and Nd:YAG lasers.[23] While higher fluences may be successful in tattoo pigment removal, the risk of adverse effects is greater.
The development of localized and generalized allergic reactions is an unusual complication following tattoo removal with the Q-switched ruby and Nd:YAG lasers. Ashinoff et al.[24] reported
2 women were treated with both laser systems simultaneously and developed delayed, pruritic reactions. One of the patients was biopsied revealing spongiotic dermatitis consistent with an id reaction. The reactions responded to treatment with antihistamines and topical and/or systemic corticosteroids. In patients experiencing such reactions, an alternative treatment should probably be implemented, since it cannot be predicted when a more severe systemic reaction might occur.[24]
While the etiology of these allergic reactions is unknown, it is known that since tattoo pigment has an intracellular location prior to laser treatment, it is therefore in an immune protected site.
Following laser treatment when the pigment becomes extracelluar, it can now be recognized by the immune system as a foreign antigen.
The safety profile of Q-switched Nd:YAG laser and ruby lasers is very similar although the incidence of hypopigmentation is much lower, with the Q-switched Nd:YAG laser.[19,23] Hyperpigmentation and textural changes are infrequent adverse effects of the Q-switched Nd:YAG laser.
Transient hypopigmentation in as much as 50% of patients and a 12% incidence of textural changes has been reported with the Q-switched alexandrite laser.[21]

3. Conclusion
Since many wavelengths are needed to treat multicolored tattoos, not one laser system can be used alone to remove all the available inks and combination of inks. While laser tattoo removal is not perfect, we have come a long way since the advent of Q-switched lasers.
Since the newer vibrant tattoo colors can be quite resistant to all Q-switched lasers currently available, current research is focusing on newer picosecond lasers, which may be more successful in the removal of these tattoo inks.[25]

TattooedCouple.jpg
Source: National Review, 06/05/2000, Vol. 52 Issue 10, p55, 2p
Who in the rainbow can draw the line where the violet tint ends and the orange tint begins? Distinctly we see the difference of the colors, but where exactly does the one first blendingly enter into the other?
H. Melville, Billy Budd, Sailor
The word "tattoo" (from the Polynesian tatau, from ta, meaning to strike or collide with) became part of the English vocabulary in 1769, when James Cook visited the Pacific island of Tahiti on his first voyage around the world. "Both sexes," he wrote, "paint their bodys Tattow as it is called in their language, this is done by inlaying the Colour of black under their skins in such a manner as to be indelible. Some have ill design'd figures of men birds or dogs, the women generaly have this figure Z simply on ever joint of their fingures and toes."
Source: Natural History, Nov99, Vol. 108 Issue 9, p80, 2p
The Maoris began tattooing as early as the 11th century, using chisels made of bone and a mixture of water or fat and charcoal for ink. Women were tattooed on the lips and chin, while men were often marked all over the face. (Unlike needle tattooing, chisel tattooing makes a grooved scar in the skin in addition to the pattern.)
In the 18th century, Capt. James Cook, astounded by the detailed blue patterns inscribed on the faces of the Maoris, brought their word "tattow" back to Europe, where it evolved into the English "tattoo."
Source: Civilization, Jul/Aug95, Vol. 2 Issue 4, p27, 1p
ABSTRACT
Background. The use of lasers has assumed an increasingly important role in the treatment of a variety of cutaneous lesions over the past few decades. Because of their effectiveness, physicians from a variety of specialties have incorporated lasers into their

practices. Unfortunately, widespread availability of lasers and the public's fascination with their potential uses have created extraordinary, often unrealistic, expectations.
Methods. We review the laser systems most frequently used to treat skin conditions.
Results. We discuss lasers with specificity for vascular malformations and pigmentary disorders as well as for tattoos and scars. Also, we review the latest techniques for cutaneous laser resurfacing with carbon dioxide and erbium: YAG lasers. Last, we briefly outline future uses of lasers and ongoing investigations, including laser treatment of leg veins and laserassisted hair removal.
Conclusions. Lasers, when properly used, offer clear advantages when compared with older, traditional approaches. Laser technology is clearly at its best when the characteristics of selectivity and specificity apply. Significant improvement and even elimination of many cutaneous lesions can now be accomplished with reduced risks to the patient when proper patient selection and laser treatment parameters are chosen.
As LASER TECHNOLOGY continues to evolve, treatment options for a variety of cutaneous lesions expand and improve. The advent of new lasers with innovative technology will continue to set high standards in the treatment of vascular, pigmented, tattooed, and scarred lesions. We review the different lasers available for use in various cutaneous conditions.
LASER BASICS
The first laser was developed in 1959, 32 years after Einstein had proposed the concept of stimulated emission. In 1963, dermatologist Leon Goldman was the first physician to test this prototype ruby laser in human skin.(n1)
Laser, an acronym for light amplification by stimulated emission of radiation, has several therapeutically physical properties: (1) monochromaticity--the ability to selectively target chromophores with an appropriately single wavelength; (2) coherence--the proper alignment of light waves, allowing high intensity to be focused over a small area; (3) compressibility--the use of ultra short pulses that delivers localized energy; and (3) collimation--the transmission of parallel rays of light without divergence or loss of intensity as the distance increases, thus creating a spot size that is maintained over a wide distance. Selective target destruction occurs if the laser wavelength is appropriate and the light exposure time (pulse duration) is shorter than the time it takes for heat to diffuse from the target (thermal relaxation time).(n2,n3)
This theory of "selective photothermolysis" is important when treating small cutaneous targets to prevent unnecessary tissue damage that could lead to scarring or unwanted pigmentary changes.
LASER TYPES
Continuous wave (CW) lasers (argon, krypton, older Nd:YAG and CO2 lasers) emit a constant beam of light in contrast to the pulsed lasers (510 and 585 nm pulsed dye,
Q-switched or QS ruby, QS Nd:YAG, QS alexandrite) that produce interrupted

bursts of high energy light. In general, selective photothermolysis of various cutaneous lesions is better achieved using pulsed laser technology because of the short thermal relaxation times of cutaneous chromophores such as hemoglobin and melanin. Each laser system has different clinical applications, depending on its wavelength and pulse duration
(Table 1).,
PIGMENT LASERS
Q-Switched Ruby Laser (694 nm)
The ruby laser was the first to be shown effective in the treatment of dermal pigmentation without scarring. Quality or "Q"-switching of the laser light permitted the production of energy densities (fluences) of up to 10 J/cm2, thereby improving tissue heating and destruction. Because melanin absorbs light well in the deep red portion of the electromagnetic spectrum, the 694 nm wavelength of the ruby laser with a 20 to 40 nanosecond (ns) pulse duration is perfect for selective absorption by melanosomes.
Another benefit of this laser is the greater dermal depth of penetration of its long wavelength, being particularly useful for the treatment of deep pigmented lesions such as nevus of Ota.
The laser-irradiated skin shows immediate and transient whitening, lasting up to 30 minutes, followed by erythema and swelling for 30 to 60 minutes. Vesiculation may occur in 24 to 36 hours, and healing is complete by 10 to 14 days.
The ruby laser is successfully used for the treatment of solar lentigines (5 to 6J/cm2, 1 to
2 treatments) and ephelides,(n4) isolated labial lentigos or in association with Peutz-
Jeghers syndrome,(n1,n5,n6) nevus of Ota (5 to 6J/cm2 4 to 6 treatments),(n7,n11) blue nevi, as well as other melanocytic nevi.(n12,n13) Ruby laser irradiation of Becker's nevus, nevus spilus, and cafe-au-lait lesions (5 to 6 J/cm2, 3 to 4 treatments) are associated with a high rate of recurrence, usually seen within 6 to 12 months after treatment.(n4,n14) Post-inflammatory hyperpigmentation and melasma are not typically responsive to the ruby laser.(n15) Complications of treatment are temporary hypopigmentation (lasting 2 to 6 months), transient hyperpigmentation (in 15% of cases), and rarely permanent depigmentation. The incidence of scarring or epidermal atrophy is
< 5%.
Q-Switched Alexandrite Laser (755 nm)
The Q-switched alexandrite laser emits red light at a slightly longer wavelength (75.5 nm) and pulse duration (50 to 100 ns) than the ruby laser. Treatment is usually initiated at a thence of 6.0 to 6.5 J/cm2 with a 3 mm spot size. Repeat treatments are delivered at 6- to 8week intervals to allow for adequate tissue healing. As with the ruby laser, the Qswitched alexandrite laser can also be used to treat epidermal and dermal pigmented lesions, such as solar lentigines (Fig 1), benign melanocytic nevi, and nevus of
Ota.(n16,n17) Similar to other pigment-specific lasers, recurrence of cafe-au-lait macules has been reported after treatment. Transient hypopigmentation after treatment is not as commonly observed as after ruby irradiation.

Q-Switched Nd:YAG Laser (1,064 nm, 532 nm)
The Nd:YAG laser emits an infrared light at 1,064 nm with a pulse duration of 10 ns.
Frequency doubling of the 1,064 nm wavelength will result in a 532 nm visible green light. The shorter 532 nm wavelength is better used for the treatment of lentigines, cafeaulait macules, and other epidermal pigmented lesions,(n18,n20) whereas the longer
1,064 nm wavelength is used for treatment of deep dermal pigment, such as in nevus of
Ota and other melanocytic nevi. Typically, 2 to 5 treatments are required at an average fluence of 8 J/cm2 with a 3 mm spot size to effect the desired degree of lightening.(n19)
Complications include hypopigmentation or hyperpigmentation and transient textural changes at higher fluences.
Pigmented Lesion Dye Laser (510 nm)
The pigmented lesion dye laser emits a green light at 510 nm with a 300 ns pulse duration. It is proven effective in the treatment of epidermal pigmented lesions, including cafe-au-lait spots and solar lentigines.(n21-n26) Unlike solar lentigines, which clear after
1 to 2 treatments at 2.5 J/cm2, cafe-au-lait macules usually require multiple laser sessions
(6 to 8 treatments) at 2-month intervals, using fluences of 2.5 to 3.5 J/cm2. Transient pigmentary changes are observed in 15% of treated cafe-au-lait lesions.
Copper Vapor Laser (578 nm)
The copper vapor laser emits a green light at 510 nm and a yellow beam at a wavelength of 578 nm. Brief 20 ns pulses are delivered with 67 Mu s intervals between pulses. The ability of this laser to emit pulses at a high repetition rate (15,000 pulses/sec = 15 kHz) qualifies this system as a quasi-CW laser. At 510 nm, lentigines, cafe-au-lait macules, and dermatosis papulosa nigra can be successfully treated, whereas at 578 nm, vascular lesions such as telangiectasias can be targeted.(n27) Because of the quasi-CW nature of this laser system, nonspecific tissue thermal damage may occur with increased risk of pigmentary and textural skin changes.
TATTOO LASERS
Before laser technology, exogenous pigment was treated with more damaging techniques such as dermabrasion and excision, resulting in scar formation or pigmentary changes.
Lasers have revolutionized the treatment of tattoos, offering acceptably desirable results.
The older laser systems, such as the CW CO2 and argon lasers, also led to scarring due to excessive thermal injury of normal skin. The Q-switched lasers that produce ultra short pulses of high energies literally shatter tattoo ink particles without destruction of the surrounding tissue. The resultant injury is followed by phagocytosis, lymphatic transportation, and/or transepidermal extrusion of the fragmented ink particles.
Professional tattoos are more difficult to treat than the amateur variety, because they are comprised of multicolored organometallic dyes that are placed deeper and more densely

packed in the skin. Amateur tattoos often require 4 to 6 laser treatments, whereas professional ones require 8 or more sessions.
All previously described pigment-specific Q-switched lasers can be used in the treatment of tattoos with varying efficacy, depending on the ink color (Table 2). The three Q-switched laser systems previously mentioned (ruby, alexandrite, Nd:YAG) can all remove blueblack tattoo ink with equal efficacy(n28-n40) (Fig 2). Fluences of
6 to 8 J/cm2 are used, leading to immediate tissue whitening of the treated area. The ruby laser is least effective in treating red ink; however, the alexandrite and 1,064 nm Nd:YAG lasers are also relatively ineffective. Red tattoos can be easily removed within two to four sessions using green wavelength lasers (510 nm pulsed dye or 532 nm frequency-doubled Nd:YAG). Complications observed after Q-switched laser irradiation of tattoos include hypopigmentation (due to concomitant melanin destruction), systemic allergic reaction (due to release of extracellular ink particles with high antigenicity, eg, chromium-containing red or yellow inks),41 and tattoo ink darkening (due to Q-switched induced oxidation-reduction reaction of iron oxide or titanium oxide-containing tattoos).(n42)
VASCULAR LASERS
The peak absorption wavelength of oxyhemoglobin occurs in the yellow portion of the electromagnetic spectrum. In accordance with the principles of selective photothermolysis, a pulse duration shorter than 1 ms is needed for targeting small caliber blood vessels and effecting blood coagulation.
Flashlamp-pumped Pulsed Dye Laser (585 nm)
The initial reports on the vascular effect of the flashlamp-pumped pulsed dye laser used a
577 nm wavelength. However, subsequent research revealed that at a longer wavelength of 585 nm tissue penetration could be increased without losing vascular specificity.
Furthermore, unwanted hypopigmentation was less frequently observed due to decreased absorption of 585 nm light by melanin. Nonetheless, it is always important to remember that since epidermal melanin interferes with absorption of the 585 nm pulsed dye laser pulses, energy delivery will be lower through more deeply pigmented skin. Spot sizes vary from 5 to 10 mm and fluences range from 4 to 9 J/cm2. By increasing the spot size, deeper tissue penetration is obtained. If a smaller spot size is used, a higher fluence is needed to produce the same clinical results.
The vascular-specific pulsed dye laser was developed primarily for the treatment of portwine stains (6.0 to 7.0 J/cm2, spot size 5 to 7 mm),(n43-n47) but it is now considered to be the standard for the treatment of several different vascular lesions, including telangiectasias, spider angiomas, superficial hemangiomas, and pyogenic granulomas.(n48-n80) Purpuric macules develop immediately after treatment and typically resolve within 1 to 2 weeks. Scaling (12%) and crusting (4%) may occur after treatment. Blistering and scarring are complications reported in fewer than 1% of cases and are associated with delivery of excessive heat energy to a particular area.

Quasi-continuous Wave Lasers
Although these lasers have less vascular specificity, their use may be preferable in some patients because of the lack of post-irradiation purpura produced. Thus, patients with discrete areas of facial telangiectasias (rather than diffuse) are often considered to be good treatment candidates for quasi-CW lasers.
Argon-pumped Tunable Dye Laser (5 77 nm, 585 nm). In essence, this laser differs from its CW predecessor by the ability of the light beam to be pulsed using a robotized scanner device. The appropriate technique requires the use of a spot size as small as 0.1 mm to trace each blood vessel. Good clinical results have been obtained using this system in telangiectasias and, to a lesser extent, port-wine stains.(n61,n62)
KTP Laser (532 nm). The KTP (Potassium Titanyl Phosphate) laser produces a 532 nm light beam in millisecond pulses that can be used to successfully treat telangiectasias despite its lower vascular-specificity. Using fluences of 15 to 20 J/cm2 at these longer pulse durations effects elimination of telangiectasias without purpura in 1 to 3 treatment sessions (Fig 3).(n63-n65)
Copper Vapor or Copper Bromide Laser (5 78 nm). Clinical results using the copper vapor system for facial telangiectasias are comparable with those obtained with the argon-pumped tun able dye laser.(n66,n67) A small 150 Mu m spot is advanced along the vessels to effect blanching. Mild swelling and minimal crusting occurs within the irradiated areas with resolution within 1 week. Repeated treatments are delivered at bimonthly intervals.
Krypton Laser (568 nm). Small vascular lesions such as telangiectasias are generally treated using a 1 mm spot and 0.7 to 0.9 watts power with a 0.2 second pulse.(n68)
Similar to the other quasi-CW laser systems, mild cutaneous erythema and edema result from treatment.
LASERS FOR HYPERTROPHIC SCARS AND KELOIDS
Initially, various CW lasers (argon, Nd:YAG, carbon dioxide) were used to treat hypertrophic scars and keloids; however, recurrences within 2 years were uniformly observed.(n69-n75) In the past decade, the vascular-specific 585 nm pulsed dye laser has been shown in several studies to successfully treat the erythematous component of hypertrophic scars and keloids (Fig 4).(n76-n84) Furthermore, improvement has been observed in scar texture, pliability, thickness, and symptoms, after pulsed dye laser irradiation.(n79,n84) Selective destruction of the capillaries entrapped in these abnormally proliferative scars and an observed increase in tissue mast cell number in postlaser irradiated scars appear to influence collagen turnover and deposition.(n79)
EPIDERMAL (KERATOTIC) AND DERMAL (PAPULAR) LESION LASERS
Various keratotic lesions, including verruca vulgaris, actinic cheilitis, seborrheic keratoses, and epidermal nevi can be treated with CO2 laser vaporization.(n85,n87)
Verrucae have also been successfully eliminated through selective destruction of the

nurturing blood vessels by 585 nm pulsed dye laser irradiation.(n88-n90) Dermal lesions such as trichoepitheliomas, sebaceous hyperplasia, xanthelasma, and syringomas are most responsive to CO2 laser vaporization.(n87,91-n93)
CUTANEOUS RESURFACING LASERS
Pulsed C02 (10,600nm) and Erbium:YAG (2,940nm)
Continuous wave CO2 lasers had significant limitations due to heat transmission to nontarget tissue, with subsequent scarring and hypopigmentation.(n94) In recent years, noteworthy advances in CO, laser technology have now permitted successful skin resurfacing to be achieved without these undesirable complications.
Pulsed CO, lasers have been developed to achieve the desired amount of tissue ablation necessary for successful cutaneous resurfacing. High energy, short-pulsed, or scanned (<
1 ms) CO2 laser systems can deliver up to 500 m of energy per pulse to vaporize tissue so quickly and completely that transmission of heat to non-target tissues does not occur.
These pulsed or scanned CO2 lasers can be used to resurface skin with rhytides (Fig 5) and/or atrophic scars.(n95-n102) The most significant drawback to the use of these lasers is prolonged erythema (lasting 2 to 4 months). Newer short-pulse erbium:YAG
(2,940nm) laser systems have recently entered the cutaneous resurfacing treatment arena and have been shown to produce less skin redness because of reduced residual thermal damage. Because of the limited thermal effect on tissue and decreased collagen contraction, however, the clinical results obtained with erbium:YAG laser resurfacing is often less dramatic than with the pulsed CO2 systems.(n104-n106) The cutaneous resurfacing lasers can also be used in conjunction with blepharoplasties, facelifts, and hair transplantation to reduce intraoperative bleeding and postoperative recovery time.)(n107-n111)
NEW TRENDS
Photodynamic therapy has been used to treat cutaneous malignancies and psoriasis unresponsive to conventional therapy. It involves using lasers in conjunction with exogenous photosensitizers.(n112) Long-pulse ruby, alexandrite, and Nd:YAG lasers are being used to target terminal hair for the purpose of achieving prolonged hair removal after multiple successive laser sessions.(n118-n119) Early
(erythematous) striae atrophicae have shown favorable clinical response to 585 nm pulsed dye laser irradiation when compared with CO2 laser vaporization.(n120n121) Infraorbital dark circles have been improved with the use of pigmentspecific(n122,n123) and resurfacing lasers.(n124) Photothermolysis of lower extremity telangiectasia is under investigation(n125) and is already a useful adjunct to current sclerotherapy techniques.
A wide range of lasers is now available for dermatologic treatment. Future developments and advances in laser technology will continue to expand therapeutic options, improve clinical outcomes, reduce complications, and offer a more efficacious way of treating a variety of skin conditions.

TABLE 1. Different Lasers and Their Applications
Laser Type Wavelength
Ruby (Q-switched) (Long-pulsed)
Alexandrite (Q-switched) (Long-pulsed)
694 nm
755 nm
Nd:YAG (Q-switched) (Long-pulsed)
Frequency-doubled Nd:YAG
1,064 nm
532 nm
Pulsed dye
Potassium titanyl
Copper vapor/bromide
510 nm
585 nm
532 nm
Tunable dye argon
510 nm
578 nm
577/585 nm
Erbium:YAG (pulsed)
CO2
CO2
2,940 nm
10,600 nm
10,600 nm
(*) Rhytides, atrophic scars, epidermal/dermal lesions.
Applications
Pigment, dark tattoo, hair
Pigment, dark tattoo, hair
Pigment, dark tattoo, hair
Superficial pigment, red tattoo
Superficial pigment, red tattoo
Vascular, scars, warts, striae
Pigment, vascular phosphate (quasi-CW)
Pigment (quasi-CW)
Vascular
Vascular (quasi-CW)
Skin resurfacing(*)
Actinic cheilitis, verrucae (continuous wave)
Skin resurfacing(*), (high-energy, pulsed)

TABLE 2. Laser Treaatment of Different Color Tattoo Inks
Laser Type Black
Ruby/694
Alexandrite/755 nm
Nd: YAG/1,064 nm
Frequency-doubled Nd:YAG/532 nm
Flashlamp-pumped pulsed dye/510 nm
+++
+++
+++
-
-
Source: Southern Medical Journal, Sep98, Vol. 91 Issue 9, p806, 9p
Green
++
+++
+
-
-
Red
-
-
-
+++
+++
Tan
Darkening
Darkening
Darkening
Darkening
Darkening

What’s In Tattoo Ink?
The vast majority of tattoo pigments are derived from metals, which makes them a potential source for developing a skin reaction.
Some pigments do have non-metallic options for those who have concerns or a past history of allergic reactions to these compounds.
Red is the color most commonly associated with reactions within a tattoo. Mercury is the base metal in red tattoo dye, and may be known by the names mercury sulphide, cinnabar, vermillion and red cinnabar.
Reactions within the tattoo may be eczematous or granulomatous. These reactions are often seen several years from the time the tattoo is placed and may be associated with exposure to cross reactants. These include such chemicals as thimerasol (a widely used preservative), mercurochrome and some vaccines that also contain thimerasol. For those with known thimerasol allergies who are set upon having red within their tattoos, there are a variety of non-metallic pigments that lend a red color to the skin such as carmine
(derived from dried insect carcasses) and scarlet lake, sandalwood and brazilwood which are organic red pigments.
Another option, cadmium red is related to the metal family and may have potential reactivity and cadmium sulfide may be a byproduct within some red dyes which may result in a phototoxic swelling of the area when exposed to light.
Black is most commonly achieved from carbon. Sensitivity to carbon is rare. Other sources of black tattoo color may be found in black ink and logwood. Neither of these are metal derivatives, however, the black waterproof ink contains phenol solution in which charcoal particles are suspended and may be the source of other reactions.
Yellow is achieved from the use of Cadmium and is a common cause of reactions within tattoos. Not only may cadmium produce local or generalized eczematous reactions; it has also been associated with phototoxic reactions when exposed to light. Cadmium sulfide is the most common material used in yellow tattoo ink.
Blue dyes are derived from a variety of Cobalt salts and is notorious for deep granulomas as well as causing localized hypersensitivity reactions and a few reported cases of uveitis (an inflammation of the eyes). Light blue colors are also derived from cobalt and may again cause granulomas. Watch for the names cobalt blue and cobaltous aluminate that are terms for this blue pigment.
Green comes from Chromium and is a common cause of eczematous reactions both within the tattoo, as well as generalized eczematous reactions on the body. Chromium oxide has a variety of names including Chrome green, Casalic green and Guignet’s green. These variations while mixed in different suspensions may all cause such significant and long term itching and other eczematous reactions that complete removal of the tattoo may be required. The allergic reaction may arise several years after the tattoo

has been placed. Other shades of green such as emerald green are formed from another type of chromium salt called chromium sesquioxide (aka veridan) or copper salt derivatives.
Purple is derived from the metal Manganese which may cause the formation of tattoo granulomas.
Violet again comes from Manganese and may also result in granulomas.
Brown dye may be formed via the use of either Venetian Red which is derived from Ferric Oxide or from Cadmium salts, associated with phototoxic swelling upon exposure to sunlight.
White tattoos are achieved usually from titanium or zinc oxide or from the use of lead carbonates. These may have the potential to contain metallic derivatives.
New trendy colors
I have seen in tattoos such as “hot” turquoise, pink, coral, etc. may also be potential allergens, depending upon the compounds mixed to achieve these colors. I have seen patients who are allergic to fluoroscene used to give some highlighter colors a neon appearance and this may also be used in some tattoo dyes, so take this into account as well. Should you have a past history of a tattoo reaction, make sure you discuss the chemical make-up of the specific dye your artist uses before you go ahead with your tattoo.
There may be other pigment options available to you.
Since most tattoo inks contain metal, MRI exams may cause tattoos to have a burning or stinging sensation. Redness may even occur.
This should be temporary and the presence of a tattoo is not a contraindication to having an MRI. http://www.dermadoctor.com/pages/newsletter113.asp?AID=1067
Body Painting
Body painting can transform a person into a spirit, a work of art, another gender or even a map of a sacred place. It can emphasize visual appeal, express allegiance or provide a protective and empowering coating. Protective body paints often feature in initiation rituals, weddings and funerals -- all occasions of transition and of spiritual danger. People everywhere adorn the living, and some also treat the dead, with body paint. To make body paint, pigments composed of plant extracts or

mineral clays and powders can be mixed with vegetable oil or animal fat. Throughout history, the substances used for body paint have been important trade items. Ochre, camwood, cinnebar, and kaolin were traded throughout Asia, Africa and Europe.
Henna, used as a temporary skin dye, was widely traded in the Muslim world along with patterns and designs used to apply it.
Commercially manufactured body paints, now available in a wider palette, may be adopted for their visual appeal but they rarely take on the symbolic significance of natural paints and dyes.
Henna
The crushed leaves of the henna plant, when mixed with other natural ingredients, yields a thick, fragrant paste used for painting hands and feet. The olive green, dried henna powder, once mixed with such ingredients as black tea and coffee, cloves and tamarind, turns dark. Once the paste is applied on the skin, it is allowed to dry, sometimes overnight. The dried henna is scrapped off the skin resulting in a maroon-red stain. Henna has traditionally also been used for hair conditioning and dyeing, skin antiseptic and tonic, and as cloth and leather dye. Henna is a cosmetic and a medicine, but most importantly, it is a marker of beauty, auspiciousness and celebration.
Henna painting is considered a woman's art form, often to mark special events in a woman's life, especially marriage. The painted bride is denoted special by the intricate, elaborate henna patterns on her hands and feet, attesting to the liminal occasion in which she is transported from one stage of life to another. Henna designs add beauty and decoration to the parts of the body that are in view, namely hand and feet, but patterns usually extend towards the elbows and knees, causing erotic curiosity for the concealed parts.
Designs vary with each culture, and even within cultures. Generally speaking, Arabic Swahili women's designs consists of large, bold floral patterns, whereas Moroccan Berber women paint geometric, linear designs. In India, Hindu women prefer paisleys, vines and birds such as peacocks. Muslim women do not paint figurative images due to the Islamic prohibition on representational art.
In the past decade, henna painting has experienced an immense popularity in the United States. Although ethnic communities residing in the West have always practiced the art of henna, the acceptance of this form by Westerners, especially celebrities, is a relatively new phenomenon. Popularly called "temporary tattoo," henna painting does function like tattoos. People who are reluctant to acquire a real tattoo, test out a location and design by first having an ephemeral henna version of what will eventually become a permanent part of their skin. Also like tattoo, henna designs in the US resemble "tribal" bracelets and anklets, belts and rings. The practice of wearing henna as jewelry was born in the West.
Kaolin

White clay used as body paint. Among various African groups it used for healing, for protecting a newborn and its mother; and to help a healer communicate with spirits in the "other world."
Moko
The art of tattoo as practiced by the Maori of New Zealand. Worn by both men and women, moko was a sign of distinction, reserved for those who were the most noble and accomplished.
Pigment
A dry substance that when mixed with liquid does not dissolve, but becomes a paint, ink, or other coloring agent.
Tattooing
Tattoo involves puncturing the skin with a sharp instrument and inserting pigment through the outer layer, the epidermis, into the second layer, the dermis. Tattoos are intended to be permanent; only recently have expensive laser techniques allowed people to remove them. Tattoo patterns and techniques have varied with different cultures. Traditional Polynesian tattooists tap a needle with a small hammer, while the Japanese work with bundles of needles set in wooden handles. In the West, the electric tattoo machine has revolutionized tattooing, expanding the ease of application and the range of colors and designs. Besides being decorative, tattoos send important cultural messages: a commitment to some group, an emblem of a rite of passage, even a fashion statement.
Tattooing has been used to indicate high rank in some societies, rebellion and low status in others. Despite numerous religious and social injunctions, tattooing has been a popular form of body art throughout the world. http://www.amnh.org/exhibitions/bodyart/glossary.html

1) Teens, tattoos and body piercing
Journal of Pediatric and Adolescent Gynecology, Volume 17, Issue 3, June 2004, Pages
215-216
Angela Nicoletti http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6W68-4CBV0W6-
C&_origin=SDEMFRASCII&_version=1&md5=57c4876b1586f34eea97990a444421ec
2) Venous lakes of the vermillion lip treated by infrared coagulation
British Journal of Oral and Maxillofacial Surgery, Volume 42, Issue 3, June 2004,
Pages 251-253
A. Ah-Weng, S. Natarajan, S. Velangi and J. A. A. Langtry http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B7G7V-4BRTCWF-
2&_origin=SDEMFRASCII&_version=1&md5=3f0629471c2e98f56fd6cb41ebde60dd
3) Paleodermatoses: lessons learned from mummies*1
Journal of the American Academy of Dermatology, Volume 50, Issue 6, June 2004, Pages
919-936
Eve Judith Lowenstein http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WM8-4CDYMV3-
14&_origin=SDEMFRASCII&_version=1&md5=0f2d9c5b6ece8ea2e65705c80a4e40b7
4) Surgical pearl: the use of methylene blue temporary tattoos for tissue orientation in Mohs micrographic surgery*1
Journal of the American Academy of Dermatology, Volume 50, Issue 4, April 2004,
Pages 640-641
Norma S. Magee and Richard F. Wagner, Jr http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WM8-4BYK094-
P&_origin=SDEMFRASCII&_version=1&md5=4dc08b5f8799b0a4ef7a436074cbca39
5) Abstracts
European Journal of Surgical Oncology, Volume 30, Issue 2, March 2004, Pages 119-165

http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WF4-4BW0D3V-
1&_origin=SDEMFRASCII&_version=1&md5=ec5a767396ea44c9ee76e50795358e5b
6) Q-switched laser management of an explosion tattoo
Journal of the American Academy of Dermatology, Volume 50, Issue 3, March 2004,
Pages 479-480
Douglas N. Naversen and J. David Igelman http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WM8-4BRK75T-
1M&_origin=SDEMFRASCII&_version=1&md5=677b3918def1714d0544243472540fbe
7) Clinical facts & curios
Current Problems in Pediatric and Adolescent Health Care, Volume 34, Issue 2, February
2004, Pages 114-118
James A. Stockman, III http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B7584-4BVP42T-
2&_origin=SDEMFRASCII&_version=1&md5=ae7cb3ac1d48480f0b07cafa0ef4372f
8) Temporary henna tattooing--a risky procedure: Case report and literature review
Burns, Volume 29, Issue 8, December 2003, Pages 866-867
M. Jindal and B. Davis http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6T52-49M0NT6-
2&_origin=SDEMFRASCII&_version=1&md5=e28cdeee85a3e2497297cb0259906668
9) "Girl talk": gender, equity, and identity discourses in a school-based computer culture
Women's Studies International Forum, Volume 26, Issue 6, November-December 2003,
Pages 561-573
Jennifer Jenson, Suzanne de Castell and Mary Bryson http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6VBD-49YCX54-
2&_origin=SDEMFRASCII&_version=1&md5=0e672e5b4c1d81d1afb71b2c1224158e
10) Traumatic tattooing of the skin and ocular surface
Journal of Cataract & Refractive Surgery, Volume 29, Issue 9, September 2003,

Pages 1845-1846
Michael Ehrenhaus, Richard Najac, Laurence Weissman and Cono Grasso http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6VSF-49M5WYJ-
1J&_origin=SDEMFRASCII&_version=1&md5=9f758d18f99285d6ec11be004bca686a
11) Lasers in dermatology: Four decades of progress*1
Journal of the American Academy of Dermatology, Volume 49, Issue 1, July 2003, Pages
1-31
Elizabeth L. Tanzi, Jason R. Lupton and Tina S. Alster http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WM8-490H4NJ-
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12) Tattoos and body piercings: marks and markers?: Carroll ST, Riffenburgh RH,
Roberts TA, Myhre EB. Tattoos and body piercings as indicators of adolescent risk-taking behaviors. Pediatrics 2002;109:1021\N7
Journal of Midwifery & Women's Health, Volume 48, Issue 3, May-June 2003, Page
235
T. A. Roberts and S. A. Ryan http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6W6R-48MW4RN-
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13) Temporary tattoo dermatitis
The Journal of Pediatrics, Volume 142, Issue 5, May 2003, Page 586
Robert J. Leggiadro, Jeffrey R. Boscamp and Allen N. Sapadin http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WKR-48S456M-
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14) Tattooing ears--a simple method
British Journal of Plastic Surgery, Volume 56, Issue 3, April 2003, Page 312
I Al-Basri and V. Rose http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WC6-48GP41M-
3&_origin=SDEMFRASCII&_version=1&md5=49a91aee1d0579c37bad4c3d57e98946

15) FROM MY PERSPECTIVE: The future of clothing
Technological Forecasting and Social Change, In Press, Corrected Proof, Available online 26 March 2003
Joseph F. Coates http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6V71-4876B8F-
1&_origin=SDEMFRASCII&_version=1&md5=d4f13e33a3e0065752a359934d882c3e
16) Tattoo as an additional tool for diagnosing of mental and behavioral disorders associated with psychoactive substance use
European Neuropsychopharmacology, Volume 13, Supplement 1, March 2003, Page S18
A. Borokhov, R. Y. A. Bastiaans and V. Lerner http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6T26-4930KSX-
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17) Festival as creative destination
Annals of Tourism Research, Volume 30, Issue 1, January 2003, Pages 7-30
Richard Prentice and Vivien Andersen http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6V7Y-47SV18N-
2&_origin=SDEMFRASCII&_version=1&md5=8e292d8a8d55bd23e7cb7551927eaf91
18) Sensitisation to red tattoo pigment
British Journal of Plastic Surgery, Volume 56, Issue 1, January 2003, Page 73
Mairi Macarthur and Michaela Davies http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WC6-483SP1S-
3&_origin=SDEMFRASCII&_version=1&md5=24c5e42e3dec9548489acae4436f3294
19) African aromatherapy: past, present and future applications
International Journal of Aromatherapy, Volume 13, Issue 4, 2003, Pages 185-195
Stephanie Rose Bird http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WN7-4B2CJK3-
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20) Got you under my skin

The Lancet, Volume 360, Issue 9331, 10 August 2002, Page 495
Kelly Morris http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6T1B-46HDGR8-
1Y&_origin=SDEMFRASCII&_version=1&md5=08a39fd55a1555102f002514d105ed50
21) Successful treatment of an allergic reaction in a red tattoo with the Nd-YAG laser
British Journal of Plastic Surgery, Volume 55, Issue 5, July 2002, Page 456
R. Dave and P. J. Mahaffey http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WC6-46WVH4S-
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22) Lipstick and pearls
Surgery, Volume 131, Issue 6, June 2002, Pages 663-664
Nancy D. Perrier http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WXC-46571XK-
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23) Oral pigmented lesions
Clinics in Dermatology, Volume 20, Issue 3, May-June 2002, Pages 286-288
Giovanni M. Gaeta, Rocco A. Satriano and Adone Baroni http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6T5G-4625GTT-
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24) Surgical Pearl: Removing skin-colored cosmetic tattoos with carbon dioxide resurfacing lasers
Journal of the American Academy of Dermatology, Volume 46, Issue 5, May 2002, Pages
764-765
Iltefat Hamzavi and Harvey Lui http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WM8-45XTG88-
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25) Patch testing over tattoos

American Journal of Contact Dermatitis, Volume 13, Issue 1, March 2002, Pages 19-20
Joseph F. Fowler and M. Kathleen McTigue http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6W9J-45V1YDH-
5&_origin=SDEMFRASCII&_version=1&md5=3dc3fc990acd0164123aa75af450d585
26) Clinical picture: An unexpected tattoo
The Lancet, Volume 359, Issue 9307, 23 February 2002, Page 649
Jonathan C R Bowling and Richard Groves http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6T1B-457VN6D-
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27) "Tooth worms", poverty tattoos and dental care conflicts in Northeast
Brazil
Social Science & Medicine, Volume 54, Issue 2, January 2002, Pages 229-244
Marilyn K. Nations and Sharm
� nia de Ara
� jo Soares Nuto http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6VBF-44HTGB4-
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28) Induced transmittance in alexandrite laser eye-protectors--a survey of different types of laser filters
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A. Schirmacher and E. Sutter http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6V4H-43G3M5G-
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29) Examination of Tattoos on Mummified Tissue using Infra-red Reflectography
Journal of Archaeological Science, Volume 28, Issue 4, April 2001, Pages 395-400
Annalisa Alvrus, David Wright and Charles F. Merbs http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WH8-45BT6MH-
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30) Tattoo pigment masquerading as secondary malignant melanoma
British Journal of Plastic Surgery, Volume 53, Issue 4, June 2000, Page 359

H. Hannah, S. Falder, P. R. M. Steele and S. K. Dhital http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WC6-45FCCYK-
3X&_origin=SDEMFRASCII&_version=1&md5=b693fb076d48ec3ec5469ece6c217e00
31) Pulsed dye laser treatment of port-wine stains in pigmented skin
Journal of the American Academy of Dermatology, Volume 42, Issue 4, April 2000,
Pages 667-671
Sabine Sommer and Robert Alexander Sheehan-Dare http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WM8-4C0KM4K-
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32) Colour shift following tattoo removal with Q-switched Nd-YAG laser (1064/532)
British Journal of Plastic Surgery, Volume 52, Issue 6, September 1999, Pages 482-487
A. H. S. Peach, K. Thomas and J. Kenealy http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6WC6-45M2SBJ-
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33) P079 Tattoos: Sala-microdermabrasion with radiobistury
Journal of the European Academy of Dermatology and Venereology, Volume 9, Supplement
1, September 1997, Page S172
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34) FC086 Lichenoid tattoo reaction
Journal of the European Academy of Dermatology and Venereology, Volume 9, Supplement
1, September 1997, Page S135
H. E. Gore, D. J. Eedy and J. Somerville http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6T92-3Y5FY4Y-
78&_origin=SDEMFRASCII&_version=1&md5=9e8b4610b9377396895e8b3fa7392620
35) WS092 A review of treatment of pigmented lesions and tattoos
Journal of the European Academy of Dermatology and Venereology, Volume 9, Supplement

1, September 1997, Page S98
S. W. Lanigan http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6T92-3Y5FY4Y-
DR&_origin=SDEMFRASCII&_version=1&md5=1e43da7b7bf7d05e46dc12c55cd6418e
36) 1311 Corneal tattoo: Ultrastructural and immunohistochemical observations of a case
Vision Research, Volume 35, Supplement 1, October 1995, Page S67
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Most will agree that permanent makeup has been in existence since the Ice Age, when crude natural substances were used to create color and instruments for placing colorful art in the skin. Cleopatra is believed to have been adorned with permanent makeup and
Egyptian mummies have been recovered with face and body tattoos intact. The ancient
Japanese art of Tebori boasts full-body tattooing intricately done by hand.
http://www.lastingmakeup.com/History%20of%20Permanent%20Makeup.htm
You on a motorcycle. Shades. Sleeve rolled up over your bicep.
That screamin' eagle tattoo says you are ready to rumble.
Of course, 15 years later maybe you don't want to rumble.
With tattoos making a big impression on young people, doctors with laser treatments are making big bucks taking the impressions off. Young women, especially, later regret the permanent reflection of their adolescence marked in living color on their shoulders and hands.
Laser treatments can permanently remove up to 95 percent of a tattoo, but they are very expensive and take several treatments. The laser works by shooting short bursts of light into the tattoo pigment. The laser breaks up the pigment and the tiny pigment particles are removed by the body's immune system.
With laser treatments, tattoo ink color matters. Black is the easiest to remove since it absorbs the most of the laser wavelengths. Green is harder to remove. Research has created lasers specifically designed to remove various tattoo colors, but, the more obscure the colors in your tattoo, the harder the tattoo will be to remove.
If laser treatment doesn't work, the other permanent options are more invasive. The tattoo can be sanded off (dermabrasion), cut off (surgery) with or without skin grafting, or burned off
(chemical peels).
No method is painfree. All are expensive. http://halife.com/living/health/maytattoo.html

Tattoo Pigments: Throughout history, diverse materials have been used as tattoo pigment, most notably carbon particles (as in soot), plant derived pigments, and various metal oxides and salts. Aetius of Amida published a recipe for tattoo pigment consisting of Acacia wood, gall, and vitriol (sulphuric acid) mixed with ground corroded bronze treated with vinegar, which was rubbed in over a pattern pricked by needles. In contrast to drugs and cosmetics, tattoo pigments have never been controlled or regulated in any way, and the exact composition of a given tattoo pigment is often kept a "trade secret" by the manufacturer.
In most cases, neither the tattoo artist nor the tattooed patient have any idea of the composition of the tattoo pigment.
"Traditional" Tattoo Pigments: Until recently, most coloring agents in tattoo pigment were inorganic heavy metal salts and oxides, many of which were also used in paints and dyes.
Cadmium, Chromium, Cobalt, Iron, Lead, and Mercury all figured prominently in these pigments, with a high incidence of allergic and phototoxic reactions, as well as scarring.
Compostion of "Traditional" Tattoo Pigments
Compostion of "Traditional" Tattoo Pigments
Color Materials Comment
Black
Iron Oxide (Fe3O4) occurs in nature as magnetite crystals
Iron Oxide (FeO) Jet Black powder, wustite
Carbon
Logwood
Bone Black; amorphous carbon from combustion; soot, as in indian ink
Brown
Red ochre
Cinnabar
Cadmium Red
Heartwood extract from Haematoxylon campechisnum , of
Central America and the West Indies
Iron Oxides mixed with clay; raw ochre is yellowish-heating causes reddening through dehydration; used since ancient times
Mercury sulfide (HgS)
Cadmium selenide (CdSe), cadmium seleno-sulfide (orange)
Iron Oxide (Fe2O3) common rust; Dried Fe2O3 is intense red
Yellow
Cadmium yellow various ochres
Curcuma yellow
Chrome Yellow
Cadmium sulfide (CdS), cadmium zinc sulfide (CdZnS) see ochre curcurmin
Derived from plants of the ginger family; aka tumeric or
Lead Chromate (PbCrO4) , often mixed with lead sulfide

Green
Chromium Oxide
(Cr2O3)
Malachite
Ferrocyanides and
Ferricyanides
Aka Casalis Green, Anadomis Green
Copper Carbonate Hydroxide derived from the mineral
Malachite (Cu2(CO3)(OH)2); Malachite Green is an aniline dye with a similar color also used as a fungicide/bacteriocide
Various admixtures, such as Potassium Ferrocyanide (yellow or red), Ferric Ferrocyanide (Prussian Blue)
Blue
Azure Blue
Cobalt Blue
Various, including copper(II) carbonate (azurite), sodium aluminum silicate (lapis lazuli), calcium copper silicate
(Egyptian Blue) cobalt aluminum oxides, chromium oxides
Violet Manganese Violet
Manganese ammonium pyrophosphate, also used in paints and cosmetics
White
Lead White Lead Carbonate (2 Pb(CO3)2 · Pb(OH)2); used since antiquity as a white pigment
Titanium dioxide
(TiO2) Derived from anatase or rutile; may be used as a primary pigment or to dilute or modify color of other pigments
Barium Sulfate
(BaSO4) Often used to dilute or modify color of other pigments
Flesh various ochres see ochre
NB: This list is by no means inclusive-almost anything that can be used as a pigment, HAS been used as a pigment!
Because of the potential toxicity of heavy metal -containing pigments, there has been a shift in recent years away from these agents, and toward industrial organic pigments, especially azo- and polycyclic compounds. These pigments are considered safer and well tolerated by the skin, although allergic reactions and phototoxicity can and do occur. With laser treatment, these complex molecules may be cleave into smaller molecules, some of which are considered possible carcinogens.
Composition of Organic Tattoo Pigments
Composition of Organic Tattoo Pigments color chemical structure Peak
Absorption
Comment red Napthol-AS pigment 500-540nm Aka Napthol reds, synthesized from Naptha.
Used mainly in printing inks and interior paints.
yellowish-red Napthol-AS pigment 500-540nm reddish-yellow disazodiarylide 410-440nm Formed from the condensation of 2 monoazo

yellowishorange yellow disazopyrazolone 410-440nm pigment molecules. Large molecular size with excellent thermal stability and color fastness. disazodiarylide 410-440nm
Primarily used as a coloring agent in plastics and paints.
greenish-yellow Monoazo pigment 410nm green bluish-green blue
magenta
Cu/Al phthalocyanine
600-725nm
Cu-phthalocyanine 600-725nm
Cu-phthalocyanine
Quinacridone
600-725nm
530nm purple Dioxazine/carbazole 650nm
NB: This list is by no means all-inclusive! Many tattoo colors are mixtures of 2 or more individual pigments, and colors may be modified or lightened by adding inorganic fillers such as TiO2 or BaSO4
NB: This list is by no means all-inclusive! Many tattoo colors are mixtures of 2 or more individual pigments, and colors may be modified or lightened by adding inorganic fillers such as
TiO2 or BaSO4
As with paints and dyes, 2 or more individual pigments may be mixed to make different colors. For Q-Switched Laser treatment to be effective, the absorption peak of the pigment must match the wavelength of the laser energy. Similar colors may contain different pigments, with different responses to a given laser wavelength, and not all pigments absorb the wavelengths of currently available medical lasers.
For more information on industrial organic pigments and their properties, click here
Recent market analysis identified 41 trade colors from 16 chemical entities.
Similar colors may contain different pigments not all pigments absorb laser wavelengths well
694nm well absorbed by Cu-pthalocyanine (blue), Cu-hexadecachloro pthalocyanine (blue green)
1064/532 not well absorbed by monoazo pigment (greenish yellow), diazopyrazolone (yellow orange), Cu-hexadecachloro pthalocyanine (blue green)
532 is well absorbed by azo pigment (yellow red) but not quinacridone (blue red) http://www.shorelaser.com/LaserTattooDet.html check out 5 .gif line charts http://www.shorelaser.com/IndOrgPigments.html

The choice of design is a matter of personal taste. You should make your decision with care and forethought and remember, the tattoo you get will be with you for the rest of your life. When picking your design think in terms of ten, twenty or fifty years from now.
You can check out different designs and styles by viewing our gallery. We have provided both a historical look at design styles as well as a general gallery of tattoos.
Here are the various tattoo styles;
Black & Gray Wash - This style uses black ink and various shades of black to 'round' out the design. Strong light source and subtle shading is used to render the tattoo and will usually hold up well over time. This is the preferred method for portraits (which should be done by someone adept at portrait rendering).
New School - Bright colors and bold outlines give this style its distinctive look. Based on graffiti art, New School tends to have exaggerated poses and proportions and contrasting color hi-lites. This is a very 'trendy' tattoo style.
Old School (Traditional) - Taking its roots from the early days of tattoos, this style uses simple lines and flat shading with a minimum of colors. The traditional colors are black, red, green, yellow and blue. These are the tattoos of your grandfather's time.
Irezumi - Otherwise known as 'Japanese' or 'Oriental' tattoos. The theme usually defines an Irezumi tattoo and include such things as koi fish (carp) swimming in 'finger' waves, oriental dragons, buddhas, samurais and geishas, kabuki masks and other traditional oriental icons and images. The colors are bright and simple with a conscientious use of black areas.
Tribal - A very popular style, tribal work tends to be decorative lines and shapes that invoke a 'feel' rather than depict an object. Usually rendered in solid black but can be done with a mixture of color or shading for interesting variations. The term 'tribal' is also often misused. The term originally refered to any tattoo design taken from indigenous people from other parts of the world, in particular from the Pacific Islands and Africa. Today it is often used to refer to any solid black decorative design having a 'tribal' feel. Some artists refer to this variation as 'neo-tribal'.
Celtic Knotwork - Taken from the old Celtic manuscripts from Ireland this style can be as complex or as simple as you like. Celtic knotwork requires skill in rendering it properly and should be done by an artist that specializes in this art form. Usually done just in black but can use solid, bright primary colors for interest.
Bio-mechanical - This style became popular through the work on the 'Alien' movies by
Swedish artist H.R.Geiger. This style combines anatomical flesh intertwined with some sort

of mechanical parts. This style requires some rendering skill by the artist and should be done by someone who specializes in this art form.
Fine Line - A more contemporary style of tattooing, this style relies on thin tines and finer detail than the old traditional forms. Fine line is particullarly good for small, feminine tattoos and realistic tattoos where line as well as form help create a more natural rendering. http://www.msu.edu/~krcmari1/individual/gallery.html

***
Believe it or not, some scientists say that certain marks on the skin of the Iceman, a mummified human body dating from about 3300
B.C., are tattoos. If that’s true, these markings represent the earliest known evidence of the practice. Tattoos found on Egyptian and
Nubian mummies date from about 2000 B.C., and classical authors mention the use of tattoos in connection with Greeks, ancient
Germans, Gauls, Thracians and ancient Britons.
Tattooing was rediscovered by Europeans when exploration brought them into contact with Polynesians and American Indians. The word tattoo comes from the Tahitian word tattau , which means "to mark," and was first mentioned in explorer James Cook’s records from his
One busy physician who specializes in tattoo removal estimates that 50 percent of people who get tattoos later regret them. We discuss the implications of getting tattooed as well as the tattoo removal process in the article How
Tattoo Removal Works.
1769 expedition to the South Pacific. Because tattoos were considered so exotic in European and
U.S. societies, tattooed Indians and Polynesians drew crowds at circuses and fairs during the 18th and 19th centuries.
The practice of tattooing means different things in different cultures. In early practice, decoration appears to have been the most common motive for tattooing, and that still holds true today. In some cultures, tattoos served as identification of the wearer’s rank or status in a group. For example, the early Romans tattooed slaves and criminals. Tahitian tattoos served as rites of passage , telling the history of the wearer’s life. Boys reaching manhood received one tattoo to mark the occasion, while men had another style done when they married. Sailors traveling to exotic foreign lands began to collect tattoos as souvenirs of their journeys (a dragon showed that the seaman had served on a
China station), and tattoo parlors sprang up in port cities around the globe.

This Tahitian tattoo tells about rights of passage in the wearer's life.
Thousands of tattoo designs, or "flash," are available.
Custom tattooing (like freehand drawing without a stencil) is increasingly popular with customers, especially those with multiple tattoos.
Tattoo artists enjoy creating custom designs like this one.
Tattoo artists say they like the custom work -- that it’s more challenging and artistically satisfying to create something new rather than using a stencil to reproduce a time-worn image such as a rose or an eagle.
An amazing variety of tattooing methods developed in different cultures. In North and South
America, many Indian tribes routinely tattooed the body or the face by simple pricking , and some tribes in California introduced color into scratches .
Many tribes of the Arctic and Subarctic, mostly Inuit, and some people in eastern Siberia, made needle punctures through which a thread coated with pigment (usually soot) was drawn underneath the skin. In Polynesia and Micronesia, pigment was pricked into the skin by tapping on a tool shaped like a small rake.
The Maori people of New Zealand, who are world famous for their tattooing, applied their wood carving technique to tattooing. In the moko style of Maori tattooing, shallow, colored grooves in distinctive, complex designs were produced on the face and buttocks by striking a small bonecutting tool (used for shaping wood) into the skin. After the Europeans arrived in the 1700s, the
Maori began using the metal that settlers brought for a more conventional style of puncture tattooing.
The Maori had a custom of preserving the heads of their tattooed leaders after death as precious family possessions. Over time, they began to trade some of the heads to collectors for firearms and iron tools. This practice, which is why there are some of these heads in European museums, was short-lived because of the fighting and political turmoil it caused.

Today, tattoos are created by injecting ink into the skin. Injection is done by a needle attached to a hand-held tool. The tool moves the needle up and down at a rate of several hundred vibrations per minute and penetrates the skin by about one millimeter.
HowStuffWorks would like to thank Sean Beck of the Naked
Art tattoo parlor (located in
What you see when you look at a tattoo is the ink that's left in the skin after the tattooing. The ink is not in the epidermis , which is the
Raleigh, NC) for his help in creating this article.
layer of skin that we see and the skin that gets replaced constantly, but instead intermingles with cells in the dermis and shows through the epidermis.
The tattoo needle inserts ink into the skin's dermal layer.
The cells of the dermis are remarkably stable, so the tattoo's ink will last, with minor fading and dispersion, for your entire life!
None of the 50-plus colors and shades of pigment used in tattooing are currently regulated by the
U.S. Food and Drug Administration. http://missourifamilies.org/features/adolescentsarticles/adolesfeature6.htm
Revising scars with lasers is very much dependent on the height and the size of the scar. In most instances, it is the carbon dioxide, or erbium laser that is used to smooth scars. But, whenever a scar is revised, whether a laser is used or scalpel surgery, you trade the original scar in for another. Sometimes it's an improvement, sometimes it is not. If the scar that the person is talking about is a small round scar and he/she wants it to be more of a lined scar instead of a circular, round bump, in most instances, that is better revised with scalpel surgery than a laser. It seems
'lower tech' but is often a better choice because it creates a narrower scar.
With regard to the solar keratosis, that is another word for a sun damaged spot or a "precancer."
People that have solar keratoses are at somewhat higher risk for skin cancer because they are a reflection of long-term sun exposure in the past. Sun exposure is the main risk factor for getting skin cancer. Now, a single solar keratosis does not increase the person's risk dramatically.
However, if there are many solar keratoses, the risk goes up, especially if there has been a prior

history of skin cancer in that person. The cost depends on the region of the country, whether inpatient or outpatient setting, a whole host of factors that come into play with regards to the cost. Typically this would be in the hundreds of dollars (not thousands of dollars), lots of different factors are involved (how many sutures, inpatient, outpatient).
Lasers are not typically used to treat melanomas. However, with regard to melanoma, the chance of recurrence is most dependent on the thickness of the cancer at the time of diagnosis. This thickness is typically described in millimeters. Lasers can be used to treat a variety of skin conditions, most commonly they are used to treat broken blood vessels or reddish birth marks/skin lesions, excess hair or unwanted hair, tattoos and some brown or tan birth marks, and wrinkles and other surface signs of photoaging.
Traditional scalpel surgery, or topical therapy, among other forms of therapy, should also be considered when a person seeks care for these conditions. Laser surgery is not always the answer for every skin condition, a person should leave their options open and realize that lasers are one tool used by the doctor to treat these conditions and that a thorough discussion with their health care provider, their dermatologic surgeon, would give them additional information as to whether laser surgery might be helpful for them. The inks used in tattoos and permanent makeup (also known as micropigmentation) and the pigments in these inks are subject to FDA regulation as cosmetics and color additives. However, FDA has not attempted to regulate the use of tattoo inks and the pigments used in them and does not control the actual practice of tattooing. Rather, such matters have been handled through local laws and by local jurisdictions. But with the growth in popularity of tattooing and permanent makeup, FDA has begun taking a closer look at related safety questions.
Among the issues under consideration are tattoo removal, adverse reactions to tattoo colors, and infections that result from tattooing. Another concern is the increasing variety of pigments and diluents being used in tattooing -- more than fifty different pigments and shades, and the list continues to grow. Although a number of color additives are approved for use in cosmetics, none is approved for injection into the skin. Using an unapproved color additive in a tattoo ink makes the ink adulterated. Many pigments used in tattoo inks are not approved for skin contact at all. Some are industrial grade colors that are suitable for printers' ink or automobile paint.
Nevertheless, many individuals choose to undergo tattooing in its various forms. For some, it is an aesthetic choice or an initiation rite. Some choose permanent makeup as a time saver or because they have physical difficulty applying regular, temporary makeup. For others, tattooing is an adjunct to reconstructive surgery, particularly of the face or breast, to simulate natural pigmentation. People who have lost their eyebrows due to alopecia (a form of hair loss) may choose to have "eyebrows" tattooed on, while people with vitiligo (a lack of pigmentation in areas of the skin) may try tattooing to help camouflage the condition. Of course if the skin around this permanent makeup lightens or darkens to changing the sun conditions the results will still be unsatisfactory.
(information resources include ... www.burnsurvivor.com and www.aad.org) http://www.colortration.com/keratosis.htm

methods.A 48-year-old woman requested removal of permanent makeup (cosmetic tattoos) of her eyebrows and around her lips. Physical examination revealed a brown tattoo of both eyebrows and dark red lip liner around both lips. A test area was performed on the red tattoo of the lips. A frequency-doubled Nd:YAG laser (532 nm, 2.0 J/cm2, 2 mm spot size) was used for the lip area, while the same laser at 1064 nm, 3.9 J cm2, 2 mm spot size was utilized for the eyebrows. The lip area immediately turned black. The patient returned for follow-up 1 month later; the black ink on the lip was treated with the same laser at 1064 nm, 3 mm spot size, 4.2
J/cm2, with satisfactory resolution in two monthly treatments. Both brown eyebrow turned bright orange and were treated with 532 nm, 3 mm, 3.0 J/cm2. One month later the eyebrows were a mixture of yellow ink and dark green. The yellow area was treated with 532 nm, 3 mm, 2.3
J/cm2, while the dark green was treated with the 1064 nm, 3 mm spot size, 4.2 J/cm2. One month later little improvement was noted, so Q-switched ruby laser at 694 nm, 6 mm spot size,
16 J/cm2 was utilized. An additional four monthly treatments were given utilizing a combination of both ruby and 532 nm ND:YAG lasers for green and yellow pigment, respectively. http://www.blackwell-synergy.com/links/doi/10.1046/j.1524-4725.2002.00161.x/abs/
ARE THERE GLOW-IN-THE-DARK INKS OR FLUORESCENT INKS?
Fluorescent ink is not the same as glow-in-the-dark ink. Fluorescent inks glow under ultraviolet light. Phosphorescents glow after being exposed to light, and glow-in-the-dark things that glow without any outside stimulus are almost unknown.
There are *no* glow-in-the dark inks.
There are *no* phosphorescent inks.
For a brief time around 1991, some tattoo artists experimented with fluorescent inks that glow under UV light. At the time, it was thought that these could be used to make tattoos that would only be visible under UV light. As it turned out, these inks did not perform as expected. They were not invisible under normal light, and in some cases turned brown. At the same time, many people reported skin irritation problems. As a result, we are not currently aware of any tattoo artists still using these inks.
There is a collection of information about these inks at: http://www.bme.freeq.com/spc/experiences/glow/
WHAT COLORS ARE AVAILABLE?

There are a lot more colors available now than just "Popeye green and red." Just about every color imaginable can be obtained for your design.
If your artist does not have a pre-mixed color, s/he will mix the colors on the spot for you. It is not an exaggeration to say that you could specify your design by Pantone color, especially since many artists have fine arts degrees and are familiar with the various Pantone shades
[Pantone shades are used by professional artists and are standard numbered colored].
ARE THERE GOLD OR SILVER INKS FOR TATTOOS?
While there are some metallic inks available, these are very rare and a general answer to this question is a simple "no." If you have a design that needs to look metallic, a good artist can use other colors to make it look metallic without actually using gold or silver ink.
My understanding is that artists shy away from metallic colors because of their toxic properties under the skin.
CAN I GET A WHITE INK TATTOO?
Most artists use white ink to highlight certain parts of your tattoo design. However, white ink is a special color that requires your artist to work closely with you. The effect of white ink differs greatly among clients, and its visibility and retention on the skin has much to do with the natural coloration of your skin.
White ink seems to work best on very light-skinned people.
Unfortunately, this means people with dark skin would not able to get a white ink tattoo on their skin to have a "photo negative effect" that looks like a negative of a dark colored tattoo on light skin. This is because the ink sits under your skin, and the layer of skin over the ink is tinted with your natural skin color. So if you have very dark skin, the white will be overwhelmed with your natural melanin.
Those who have very light skin however, may use white ink exclusively to get tattoo designs that are very difficult to discern at first glance.
This might be an interesting option for ankle or wrist tattoos, or other areas where a regular non-white tattoo would show up too easily and possibly cause problems for the wearer.

Researchers at Texas A&M are developing technology that will give diabetics a new way to monitor their glucose levels. A "smart tattoo" that changes color intensity depending on glucose levels is being developed by Gerard Cote, associate professor for the Department of Biomedical
Engineering at A&M.
The National Institute of Health states that more than 100 million people worldwide are afflicted with diabetes, 17 million of whom are from the United States. About 19 percent of all deaths in the United States are diabetes-related, making it the sixth leading cause of death among people aged 25 years or older. Cote said he hopes his technology will help people manage their glucose levels, effectively preventing the progression of diabetic complications such as eye, kidney, heart and nerve disease.
"It is actually fluorescent particles that we hope to implant underneath the skin," Cote said.
The particles are polyethylene glycol beads that have a fluorescent coating. Glucose displaces the fluorescent molecules, therefore when the glucose level is low, the fluorescence is high.
It is recommended that glucose levels be checked six or more times a day. Currently, diabetics have to test their blood sugar level using finger-prick instruments. Because of the pain and inconvenience of testing, many diabetics fall short of correctly monitoring their glucose levels.
The "smart tattoo" would eliminate the need for such invasive devices.
Nicole Parish, a 25-year-old Bryan High School teacher and 20-year diabetic, says she greatly dislikes the current glucose monitoring methods.
"I hate, I hate, I hate checking my blood sugar. I hate pricking my finger all day long. For me it's the hardest thing to deal with having this disease," Parish said.
But the days of finger-pricking may soon be coming to an end. Once the fluorescent beads are implanted, according to Cote, the change in glucose levels would be detected noninvasively by an external device that may be as small as a watch.
A sensor examines the light emitted from the tattoo. The higher the intensity of the light, the higher the glucose level. Cote said he feels that the varying intensity of the displaced fluorescence will be just as accurate as current monitoring devices.
The idea, Cote said, is that the particles, along with the external device after calibration, would replace the finger-sticking instrument for the day-to-day readings.
One of the features of this technology that allows it to work is its fundamental difference from common ink tattoos.
"A normal tattoo is made of ink particles that get taken up by the cells, and our particles are intended to be in the interstitial space, not in the cells," Cote said.
The ink in standard tattoos is small enough to be absorbed into the cells of the skin, but the fluorescent particles are much bigger. This allows the particles to occupy the interstitial fluid surrounding the cells, which is important because the glucose levels in the interstitial fluid are directly related to the levels in the blood.
Cote says the particles would last about one year before needing to be replaced and would need to be injected in a part of the body where continuous exposure to the sun could be avoided.
Cote acquired his idea for this technology when he was attending a conference where a doctor, who removes tattoos with lasers, joked that "it would be nice to have a tattoo that actually did something."

"I was working in the glucose monitoring area and so I thought why not a glucose monitor," Cote said. "We have since got funding from NSF-REU Interdisciplinary Chemistry Research Program,
Texas ARP (Advanced Research Program), and most recently NASA to further the idea."
In the end, it is up to the individual to decide what glucose monitoring method he or she prefers.
But as Parish said, compared to endless finger-pricking, "getting a little tattoo would be a small price to pay." http://www.thebatt.com/news/2003/09/18/Scitech/smart.Tattoo.Makes.Life.Easier-469164.shtml
Tattoo Removal at Mayo Clinic in Rochester
Tattoos may be accidental, caused by dirt or foreign material being driven into a wound, or they may be purposely applied in either an amateur or professional setting by using various inks and techniques.
Successful removal of a purposely applied tattoo depends on its cause, size, method of placement, and type of pigment. A simple cutting out and closure often treat very small tattoos that are seldom visible. A scar will result, but the scar is often less objectionable than the tattoo itself.
Historically, physicians treated larger, multicolored, purposely applied tattoos in two ways: dermabrasion and carbon dioxide laser. Dermabrasion sands the skin down below the level of the tattoo ink. The carbon dioxide laser vaporizes the entire tattooed area. In most patients, these treatments result in objectionable scars.
Treatment
Mayo physicians remove tattoos with a laser known as a Q-switched YAG laser. This laser fires an intense beam of light, either invisible or green-colored, into the tattoo in a very rapid burst. This heats the pigment within the tattoo and triggers its eruption from the skin. The laser color depends on the color of the ink. Certain colors, like fluorescent yellow, are extremely difficult to remove.
The procedure time varies from 15 to 45 minutes, depending on the tattoo size and the area treated. Topical anesthesia is occasionally used depending on tattoo location, size and the patient's tolerance for the brief burning discomfort associated with each laser burst. Oral or intramuscular sedation can be used at the patient's request.
Following treatment, the wound may ooze small amounts of blood for several hours. The wound must be covered with a dressing for 24 hours and maintained in a moist environment for seven to
10 days.
The risks of scarring with this treatment are low. However, complete removal of the tattoo is rare. Although multiple treatments are usually required to obtain successive lightening of the tattoo, final results depend on the depth of the tattoo pigment within the skin. On rare occasions,

certain uncommon tattoo inks react with the laser to form a darker-colored chemical, which is untreatable. http://www.mayoclinic.org/tattooremoval-rst/
Ink particles and colors
Tattoo particles are initially dispersed diffusely as fine granules in the upper dermis, as well as in vertical foci at sites of injection, but they aggregate to a more focal, concentrated appearance from days 7-13. In one study, black ink granules had a mean diameter of 4.42 mm, while Taylor et al found black pigment granules in tattoos to be polymorphous and varying from 0.5-4.0 mm in diameter. Turquoise and red pigment particles are approximately twice as large as black granules. In both amateur and professional tattoos, the depth of the pigment ink varies greatly, with a greater variability in size, shape, and location noted in amateur tattoos. Regardless of the diverse origins of tattoo pigment, the light and electron microscopic appearance of all pigments are similar, except for color.
Tattoo pigment granules are composed of 3 kinds of loosely packed particles, ranging from 2-
400 nm in diameter. The most common particle size is 40 nm, a particle size of 2-4 nm is less common (slightly more electron dense), and a particle size of 400 nm is least common (very electron dense with a crystalline structure). A study of freshly implanted eyeliner tattoo ink revealed a particle size in the extracellular matrix of 0.1-1.0 mm, although the average particle size in the pigment vial prior to implantation was 0.25 mm.
A prominent network of connective tissue surrounds each of the fibroblasts that contain ink particles, effectively entrapping and immobilizing the cell. The life span of these fibroblasts is unknown and may persist throughout the individual's life.
Although these studies provide considerable detail regarding the architectural morphology and physiology, they do not fully explain the natural history of dermal tattoo ink. Commonly, a tattoo appears duller, bluer, more indistinct, and blurred with time, presumably as a consequence of ink particles moving deeper into the dermis through the action of mobile phagocytic cells. Random biopsy samples of older tattoos demonstrate pigment in the deep dermis, in contrast to the more superficial location of newer tattoos. Eventually, tattoo ink appears in the regional lymph nodes of patients with tattoos.
Tattoo ink is remarkably nonreactive histologically, despite the frequent use of different pigments of unknown purity and identity by tattoo artists. Amateur tattoo inks consist of simple, carbon particles originating from burnt wood, cotton, plastic, or paper, or from a variety of inks, including India ink, pen ink, and vegetable matter. Although it rarely occurs, red (mercury), yellow (cadmium), green (chromium), and blue (cobalt) tattoo pigments have elicited a persistent, localized allergic or photoallergic dermatitis and, more infrequently, systemic reactions. Interestingly, the colors most commonly involved in allergic reactions (red and yellow) often spontaneously disappear from a tattoo without clinical signs of a reaction.

TATTOO REMOVAL TECHNIQUES Section 4 of 9
Author Information Overview Histology Tattoo Removal Techniques Pulsed Laser Treatment Of
Tattoos Adverse Effects Comparative Studies Of Q-switched Lasers Laser Ablation Of Facial
Cosmetic Tattoos Bibliography
Over the centuries, different methods for tattoo removal have been explored. The earliest report of removal was from Aetius, a Greek physician who described salabrasion in 543 AD. Less modern tattoo removal techniques involve the destruction or removal of the outer skin layers by mechanical, chemical, or thermal means, accompanied by inflammation. Transepidermal elimination of pigment occurs through denuded skin and via an exudative phase that allows tattoo pigment to migrate to the wound surface. The inflammatory response may also promote macrophage activity, with increased phagocytosis enabling additional pigment loss during the healing phase. http://www.emedicine.com/derm/topic563.htm