Future Developments

Noninvasive, real-time optical diagnostic tools (like optical coherence tomography, confocal microscopy, multispectral digital imaging, polarized multispectral imaging) are being studied for their role in the accurate prelaser diagnosis of pigmented lesions as well as a tool for determining efficacy and safety following treatment.

Current tattoo laser research is focused on newer picosecond lasers. The systems may be more successful than the Q-switched lasers in the removal of tattoo inks (Ross 1998). Such lasers, because they emit picosecond pulse widths, cause optimal photomechanical disruption of the tattoo ink particles. Another tattoo approach would be the development of laser-responsive inks. In this case, tattoo removal might be feasible with only one or two treatment sessions.

It is also possible that a laser that emits trains of low-fluence, submicrosecond pulses might cause even more selective injury to pig-mented cells by limiting mechanical damage modes. The use of pulse trains, specifically designed to selectively affect pigmented cells in skin, has not yet been tested.

Since the clearing of tattoo pigment following laser surgery is influenced by the presence of macrophages at the site of treatment, it has also been suggested that the adjuvant use of cytokines like macrophage colony-stimulating factor, other chemotactic factors such as topical leukotrienes, or the use of a topical immunomodulators like imiquimod might recruit additional macrophages to the treatment site. This could expedite the removal of tattoo pigment following laser surgery.

The extraction of magnetite ink tattoos by a magnetic field has been investigated after Q-switched laser treatment. When epidermal injury was present, a magnetic field, applied immediately after Q-switched ruby laser treatment, did extract some ink. Magnetically-extractable tattoos may therefore become feasible one day. Delivery of intradermally-focused, small energy nanosecond laser pulses might become another approach for more efficient and safer tattoo removal. Finally, optical clearing of skin with hyperosmotic chemical agents is currently under investigation. This approach reduces optical scattering in the skin, thereby enhancing the effective light dose that reaches the tattoo particles.

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