Laser Treatment of Pigmentary Disorders and Tattoos

Q-Switched Nd: YAG Laser

• The Q-Switched Nd: YAG Laser is a type of laser developed to remove blue, brown, black and possibly other colours of tattoo pigment and certain brown pigment growths and birthmarks from the skin.
• Although laser sugery is effective in most cases, no guarantee can be made that a specific patient will benefit from the treatment.
• Treatment of the tattoo or pigment will be done in stages. Initially a test dose may be done to determine the necessary energy settings of the laser. Once this dose is determined, the entire tattoo or pigmentation will be treated at the next visit. The tattoo or pigmentation will be re-examined and re-treated if necessary at two months or longer intervals until either the entire pigment is removed or it is decided that the pigment will not be capable of being removed by the laser.

• The number of treatments with the Q-Switched Nd: YAG Laser will vary depending on the lesion, size, location, colour and age of the patient and age of the tattoo. Most likely a total of 3-7 visits/treatments or more will be necessary.

Instructions for Skin Care after Q-Switched Nd: YAG Laser Treatment

You have been treated with the Q-Switched Nd: YAG Laser. The treated area is very delicate and should be treated with care. Please read and follow instructions given.

• Care of the Treated Area

1. Keep the treated area dry for 24 hours following the Q-Switched Nd: YAG Laser treatment.
2. Remove the dressing after 24 hours.
3. If it is difficult to remove the dressing, soak it in saline solution (salt water) to loosen.
4. Clean the wound with cotton balls with prescribed cleansing solution.
5. Apply gentle pressure and clean the edges and the wound.
6. After cleansing the wound, dry the wound.
7. Apply antibiotic ointment with cotton applicators. (Q tips)
8. Cover the wound with non-stick dressing (eg. Melolin). This will prevent the dressing from sticking to the wound. Secure the dressing with tape.
9. Apply antibiotic ointment to the treated area twice a day for 7 days or until the surface is totally healed.
10. Showers are permitted but gently pat the area dry. Do not rub with a towel or wash cloth because the area is extremely delicate while any crusting is present.
11. You may experience some discomfort after the Q-Switched Nd: YAG Laser treatment. For adults take two tablets of paracetamol (eg. Panadol) every six hours when needed for pain (if you are not allergic to it).
12. If swelling occurs, an ice pack wrapped in a soft cloth can be applied.

• Precautions to take following your Laser Treatment

1. Avoid direct exposure to the sun. Use a sunblock.
2. Do not rub, scratch or pick at the treated area. A protective dressing should be applied if the area is irritated by clothing or jewellery.
3. Do not apply make-up until the crust disappears. (Usually 2 to 4 days)
4. Avoid swimming and contact sport while any crusts are present.
5. If the treated area shows signs of infection (tenderness, redness, swelling or pus), notify your doctor at National Skin Centre or Operating Theatre Nurse-in-Charge.

What are the Side Effects and Possible Complications of Laser Surgery?

• Pain

1. You will feel some pain during treatment. The pain is mild and
2. It is similar to snapping the skin with a rubber band. Some areas are more sensitive than others.

• Healing Wound

1. Laser surgery may cause a superficial burn on the surface of the skin which takes several days to heal. This may result in swelling, weeping and crusting of the treated area. This usually takes 4 to 10 days to heal.

• Pigmentary Changes

1. In most patients the treated area loses pigmentation (hypopigmentation) and becomes lighter in colour than the surrounding skin temporarily. This type of reaction tends to gradually fade away and return to normal over a period of 2-4 weeks. With repeated treatments the pigment loss may become more persistent and take time to heal, up to 6 to 8 months. There is some risk of permanent loss in the area of treatment, leaving a white shape similar to the original tattoo or pigment lesion being treated, but this is rare and usually avoidable by allowing adequate healing time between treatment.
2. There is some risk of increased pigmentation (post-inflammatory hyperpigmentation) as a healing reaction. However, this type of change is very rare. If this should occur, the increased pigment usually fades away over a 2-6 month period.

• Scarring

1. Scarring is a very rare occurrence but it is a possibility.
2. To minimize the chances of scarring, it is important that you follow the post-operation instructions carefully.

• Persistence of Tattoo or Pigment

1. Some tattoo ink or pigment is located too deep in the skin to be removed completely in spite of repeated treatments and may leave vague spots of colour remaining after treatment.
2. There may be some ink colours that change colour prior to removal and others that simply will not respond to this laser (eg. green tattoo).
3. This means that it may not be possible to completely remove all tattoo and skin pigmentations with this laser. If this situation arises, there may be other treatment alternative available.