History of Tattoos. Adolescents. Tattoo Removal 9/24/2012

Transcription

1 History of Tattoos Traced back to 3300 BC Name tattow from Captain Cook after trip to Polynesia (1700 s) Western King Harold II (1022) Edith/England U.S. it has been generally regarded as a marker for rebellious or antisocial behavior. First tattoo gun invented in 1891 Adolescents Tattoo Removal AB 99 no piercings under the age of 18 other than ear AB 186 illegal to tattoo or offer tattoo to anyone under the age of 18 Greg Mennie, PA-C, MSed PIH-UCI Family Medicine Residency Program Adapted from S. Murphy M.D. lecture 1

2 Demographics 15% of Americans are tattooed 18 to 29 = 36% 30 to 40 = 24% 40 to 50= 15% Sixteen percent had obtained their first tattoo before age18. People of lower educational status were more likely to have a tattoo and also more likely to have more than one tattoo than those of higher educational status. Drinking alcohol and using recreational drugs were related to having tattoos. Five types of tattoos: Amateur Professional Cosmetic Medicinal Traumatic Tattoos were seen in all ethnic groups but were more common among those with Hispanic ancestry than among all other ethnic groups combined. A permanent reminder of a temporary feeling Middle Class 25% had regrets about their tattoo. 5 % percent had already covered a tattoo with a new tattoo 17 % percent said they were considering tattoo removal. Individuals who were younger than 18 when they were first tattooed were more likely than older persons to have regrets. 2

3 9/24/2012 Prison/Gang Symbolism Teardrop tattoo This design is worn by the eye. It indicates the wearer has killed someone or that the person had a friend killed. a mother has lost her son Three dots arranged as a triangle This design is most commonly found between the prisoner s forefinger and thumb. The design stands for mi vida loca, which means my crazy life. Other - lightning bolts, viking horns, chains, locks, religious Numerology 13 This tattoo indicates membership with the Mara Salvatrucha 13 gang. 14 This tattoo indicates membership with the Nuestra Familia, which is a prison gang. This gang is affiliated with the Nortenos, a street gang. 88 eighth ltr of alphabet = HH Area codes Many gang members use the area code to their neighborhood as a tattoo, though this can become outdated as area codes are changed. Dates, prison id number, etc? The Art of Tattooing Artists use a tattoo gun and mix and blend various inks. The ink is placed into the dermis and thus permanent. 3

4 PrisonTattoos Amateur Tattoos Melted plastic Burned styrofoam Baby oil, conditioner, shampoo mixed with smoke carbon Pen Ink Guitar strings, pins, sewing needles Motors from walkmans, fans The World of Inks. 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" 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. Ink Placement in Skin History of Tattoo Removal Dermabrasion Carbon Dioxide Laser Surgical Excision Q-Switched Ruby Laser Q-Switched Nd:YAG Other- Infrared Coagulator 4

5 Dermabrasion Laser wavelengths break up ink Salabrasion L.A.S.E.R. is an acronym for Light Amplification by Stimulated Emission of Radiation 5

6 Selective Photothermolysis Selective - Discriminant Photo - Light Thermo Lysis - Heat - Damage Chromophore Attraction Tattoo Removal Lasers Currently 4 different Q-Switched lasers are available for tattoo removal: Q-Switched Ruby Lasers -Red 694nm> usually effective for most black, blue, and green pigments Q-Switched Alexandrite- Deep 755nm>usually effective for most black, blue, and green pigments Q-Switched Nd:YAG-Invisible effective for most black and dark blue pigments Q-Switched Frequency-Doubled Nd:YAG-Green light@ 532nm>usually effective for red, satisfactory for black, dark blue, and purple pigments 6

7 LASER SETTINGS Q-Switched YAG Laser Q:YAG laser settings Wavelength (nm) Spot size (mm) Direct Delivery Handpiece Fluence (j/c 2) Example: Red: Q532nm 4mm 3.5 j/c2 10hz (1st) Shorter Pulsewidth Yel-Green: Blend 4mm 3.2 j/c 2 10hz Black: Q1064 4mm 3.5 j/c 2 10hz Wavelength Mixing Mechanism Larger beam diameters have better penetration to treat deeper vessels. Mixed Wavelengths Smaller diameter beams have limited penetration due to scattering. Unique Wavelength Mixing Mechanism Allows user to mix 532 nm and 1064 nm wavelengths User can treat multiple colors simultaneously User can treat epidermal and dermal lesions simultaneously 7

8 Palomar Q-YAG 5 Q- Switched Nd:YAG laser will treat: Multi colored professional tattoos Amateur tattoos Pigmented lesions Age spots Café au lait birthmarks Becker s nevus Contraindications to Laser Pregnancy Aspirin, Motrin, Aleve Photosensitive meds Active Sun exposure Herpes pre-medicate Valtrex 1gm BID Laser Removal of Tattoos Side effects of tattoo removal Mechanism unclear Lymphatic clearing of tattoo particles, which are released on laser impact Carried off by macrophages POTENTIAL Hypopigmentation Hyperpigmentation Infection Scarring Incomplete clearing Sub dermal fibrosis ACTUAL Crusting Blood Blisters Allergic reaction to antibiotic cream Transient hyperpigmentation in dark skinned patients Always warn patient they may experience all of these side effects. 8

9 Anesthesia in Tattoo Removal Patient Treatment Tattoo to be treated (right) is covered with Topicaine Gel (center), and then occluded with plastic wrap (left). Topical anesthetics should be applied at least 1 hour, and preferably 3 hours before treatment. Occlusion is essential to keep the anesthetic cream or gel from drying and losing effectiveness. Topical anesthetics: EMLA LMX 5% (OTC) Betacaine Betacaine-Lido-Tetracaine compounds Apply before coming for treatment Clinician is gloved Area prepped Goggles on Place hand piece perpendicular to the skin Treat to tissue response Always start with reds Thick end of green bar is Q: 532/1064 for reds, yellows Blend for Greens, yellows, lavender Red bar=infrared 1064 black brown blue Clinical Endpoints of Treatment 1064nm erythema and edema 532/1064nm whitening, erythema, edema Do not treat until bleeding occurs 9

10 Caution: Metallic Ink May Oxidize Difficult colors may lighten Test Spot Metallic Glow in the dark Gold Pink Whites Complications of Tattoo Removal Tattoo Art Blistering ankles Do not debride Polysporin BID Incomplete clearing Infection Neosporin Allergy Crusting Hyperpigmentation Hypopigmentation 10

11 9/24/2012 Unless someone like you cares a whole awful lot, nothing is going to get better. It's not. ~Dr. Seuss 11

12 9/24/

13 9/24/2012 Homeboyindustries.org 13