Q - Switched Laser
Q - Switched Laser
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