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Interviewer: The picosecond laser is the first advancement in laser tattoo removal in the last 20 years. Faster recovery and fewer treatments. Coming up on The Scope, more about the laser capable of bursts as short as one-trillionth of a second to better remove your ink.

Announcer: Health tips, medical views, research and more for a happier and healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: The picosecond laser is one of the most advanced pieces of dermatological equipment in decades. There's only a handful of these lasers in the state, and we have one. We're here with Dr. David Smart, dermatologist at the University of Utah. Dr. Smart, how common is tattoo removal in this day and age?

Dr. Smart: Tattoo is extremely common. Just go ahead and look around at how many people you know or see that have tattoos. Just as many of those people end up thinking, "Maybe I should've done something differently with this tattoo" and they like it altered, changed, or removed somehow.

Interviewer: So how exactly does laser tattoo removal work? When we're talking about, you know, it's in the skin. How do you just make it disappear?

Dr. Smart: So, we'll talk a little bit first about how tattoos stay in the skin because I think that's probably the most important part. So what happens, there are certain cells in the skin that don't go anywhere. They stay there, they're always there. They don't go, they don't change, and they eat up the tattoo pigment that's placed deep in the skin with needles. The tattoo artist puts the pigment deep in the skin. It gets eaten up by these permanent cells and then it stays there for years and years and theoretically forever. The lasers are designed to attack the pigment particle within those cells, to get them to break up into small enough pieces that the cells will then clear them rather than just keep them around.

Interviewer: And you said lasers there, so there's multiple lasers? It's not just like you have one?

Dr. Smart: Oh you bet, yeah. And sort of what we mentioned in the first, the newest technology, which is actually very exciting, is the picosecond lasers, of which there are a few different companies making them. The picosecond lasers are very, very short. The way lasers work for laser tattoo removal, they target these very small pigments. To make that target more specific, you try to make the laser pulse, meaning the length of which the laser is on, as small as possible. The same size or smaller than the particle you're going after. So picoseconds are a trillionth of a second. If you think about that, a trillionth of a second, a picosecond is to a second what a second is to 32,000 years. It is incredibly, incredibly small. And the picosecond lasers do a much, much better job than their previous counterparts.

Interviewer: In what ways? Like what are we talking about here? What can someone expect if they're getting a picosecond Ferrari laser versus a . . .

Dr. Smart: Very much the Ferrari of tattoo removal. So laser tattoo removal in general, imagine if you were at a shooting range. You've got this laser, and you've got a target 20 feet down. And you're trying to hit just the bullseye, but your laser is in fact bigger than the entire target so you're shooting this bazooka down and hitting the target. You hit your target, you hit the middle, you hit the bullseye, but you also took out the entire target, everything surrounding it as well. That's similar to what older, longer pulse lasers used to do. They would take out the target, not as effectively, but also you'd get quite a bit of other damage: blistering, redness, and burn. Picosecond lasers are able to be much more precise and hit their targets with less surrounding damage.

Interviewer: And what does that mean in the end for a patient? Is that quicker recovery, less damage, you know what are we talking about?

Dr. Smart: Definitely. So you're dealing with a quicker recovery and a speedier time to resolution of your tattoo. Laser tattoo removal is not a once and done tattoo treatment. In fact, the average black tattoo probably takes, with older technology, around 6 to 10 different treatments. The picosecond laser is able to remove those black tattoos in less than half of that in most cases. So rather than 10 treatments, you're doing more like 4. It's really quite impressive.

Interviewer: The patient's going in to get their tattoo removed, what kind of side effects or risks are they going under by wanting to get their tattoo removed?

Dr. Smart: The biggest risk in laser tattoo removal is it not working. There are some patients, especially with the older lasers, where they will come in 20 times or even more, and we'll treat it again to try and get it to lighten further and further. And some are just resistant. That hasn't happened quite with the picosecond laser because when they become resistant to those older technologies, well, the picosecond laser will get better improvement than what you've gotten before. So the biggest risk is it's not going to work. Second biggest risk is that you are shining, you're firing this powerful laser on the skin, trying to hit the color, the pigment. And like I said before, you also get some surrounding skin burn-type injuries, so blistering and like a really good sunburn - not just a light one, but a good sunburn appearance is not that unusual of a side effect from laser tattoo removal, especially with the older technologies, less so with the pico.

Interviewer: So what you're saying is that some of these older lasers have a bigger chance of causing this type of damage?

Dr. Smart: They're less specific. They're hitting everything in their path, so you're getting more blistering.

Interviewer: And considering those types of dangers and . . . what would you say to a patient. You know, do you hop in a laser center at the mall? Like why is it important with dealing with this type of stuff to go to a real dermatologist rather than just a laser center?

Dr. Smart: Going somewhere that's inexperienced . . . so laser technology is fascinating. Clearly, I love it. I'm biased. I'm a skin doctor. But there are a lot of intricacies, a lot of nuances with what you're trying to hit and why. For example, the picosecond lasers they're pigmented in general. We use them to treat birthmarks of all kinds, scars, moles, and just aging - age spots, sunspots - they work phenomenal for just rejuvenation of the skin, evening out tone and pigment, not just tattoos. But you have to know what you're treating. You have to know what's in there - what pigments, what birthmark. And you tailor your laser settings and your laser choice, what laser you'll actually use, based very much on that. The laser companies do a very good job to give you a rote cookbook. Say, if person A comes in, here are settings. Use these settings. It's in their best interest to make it so that anyone can use these lasers. But be careful.

Interviewer: That's actually one of the bizarre things I came across while I was researching for this segment, was there are places online that are selling these lasers and like anyone can do it with a quick 19-hour course. How do you respond to that as a dermatologist?

Dr. Smart: Well, I think the biggest issue is that you get into it. There's a lot of people that are doing these lasers and we could get into a discussion about state laws and who can actually operate these Class 4 lasers and you can't. But I think most importantly, you will be able to tell if you're going to someone who has the knowledge and the science underlying what they're trying to do because they will be able to tailor the treatment very much to you and your situation. The better chance for a good outcome and less chance of negative side effects.

Interviewer: How would a patient know? How would a patient know that they are getting a good laser and they are going to a person who knows how to use this laser?

Dr. Smart: So honestly I would say talk to your dermatologist because while not all dermatologists do these things, all dermatologists know about these things because they're trained in it. It's on their board exams. They know about skin. They are the experts on skin, so they will be able to recommend and say, "Hey, what laser is this medi-spa using? Well, we don't have one, but if you're wanting to get this laser done at a medi-spa of some kind, tell me what they're doing. What settings are they using? I can help you out that way." As far as it relates to the picosecond laser, there are only a handful of those. I'd be very surprised if there were more than literally three or four in the entire state of Utah. They're very expensive. The downside of the new technology is you're paying for it. Not very many places can afford that kind of investment. So with the new toys, you want to have the new knowledge to handle them.

Interviewer: All right, so have a patient want to get their tattoo removed, what should they be doing?

Dr. Smart: The picosecond technology, that will get you the best results fastest, no question. There's a lot of great scientific evidence behind that. There's not a lot of picosecond lasers available so do your research and talk to your dermatologist.

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