Q – switched Laser

Selective photothermolysis
 Target chromophore
 Pulse duration
 Thermal relaxation time
Selective photothermolysis
Laser

absorption

Target chromophore
e.g. melanin, Hb, water
Thermal relaxation time
 Time taken for the target to dissipate about 63
% of the incident thermal energy
 Pulse duration < TRT selective photother
molysis
Q – switched laser
 Q - switched Ruby (694 nm)
 Q - switched Alexandrite (755 nm)
 Q - switched Nd:YAG (1064 nm)
 Frequency-doubled Q-switched Nd:YAG (532
nm)
Q-switched laser
 Pigmented lesion
 Tattoo removal
End point of Q-switched laser
 Immediate whitening
 Pinpoint bleeding
Tattoo removal
Tattoo removal
 Target : ink
 Fragmented ink gradual uptake by activated
macrophage
 Removed through lymphatic system or transe
pidermal elimination
Type of tattoo
 Professional tattoo : mid dermis
 Amateur tattoo : more superficial
 Traumatic tattoo
Tattoo removal
 Ruby : blue & black ink
: best for green ink
 Alexandrite : blue & black ink
 1064 Nd:YAG : blue & black ink in deep laye
r
 532 Nd:YAG : red ink
Patient selection for tattoo removal
 Natural, untanned skin
 Stop oral retinoid 12 months
 Hx. of HSV infection : oral antiviral prophyla
xis
Ideal Patient for tattoo removal
 Skin type 1-2
 Untanned skin
 Tattoo > 1 year
Treatment session for tattoo removal
 Professional tattoo : 6-10 session
 Amateur tattoo : 3-5 session
 6-8 wks apart
 Some tattoo still remain (ghost-like), even aft
er multiple session
Precaution in tattoo removal
 White & cosmetic flesh tone ink imme
diate, permanent darkening after laser and im
possible to remove
 Test spot 4-6 wks before treatment
Side effect of tattoo removal
 Pigment alteration
: hyperpigmentation
: hypopigmentation
 Tattoo darkening
:white, red, pastel ink
 Scarring
Post operative care
 Polysporin ointment, bacitracin, petrolatum dr
essing
 Dressing twice daily
 Keep moist
 Dry crust not allow to form
Pigmented lesion
Epidermal pigment
 Freckles
 Lentigenes
 Epidermal melasma
 Café-au-lait macule
Freckles
 Multiple small brown macule
 Size 1-5 mm
 Sun expose area
 Increase melanin basal melanocyte
 Melanocyte not increase
Lentigenes
 Well defined macule
 Size 1-3 cm
 Brown to black color
 Increase basal melanocyte
Epidermal melasma
 Brown to dark brown macule or patch
 symmetrical
 Increase melanin in melanocyte at basal & su
prabasal layer
 Normal number melanocyte
Café-au-lait macule
 Well define macule or patch
 Coffee like color
 Size 2-20 cm
 Found before 20 yrs
 Disappear with age
 May relate to neurofibromatosis
 Giant melanosome in keratinocyte & basal me
lanocyte
Dermal pigment
 Dermal melasma
 Nevus of Ota & Ito
 Nevus of Hori
Dermal melasma
 Gray macule or patch
 Melanin granule in melanophage at perivascul
ar area
Nevus of Ota & Ito
 Congenital
 90% Unilateral
 Blue black or gray macule
 May involve oral mucosa and ocular structure
 Affect forehead, temporal, malar, periorbital
 Melanin in dermal melanocyte
Nevus of Hori
 Bilateral symmetrical Ota like macule
 Blue brown
 Female
 Age > 20
 Malar region
Treatment for pigment lesion
 Epidermal pigment : Q-switched 523 nm
 Dermal pigment : Q-switched 1064 nm
Side effect of pigment laser
 Hypopigmentation
: transient : recover in 3-6 months
: permanent
 Hyperpigmentation