More and more aesthetic practitioners, aware of the damaging effects caused by repeated exposure to lasers for tattoo removal prefer thermal abrasion with and without osmosis to lasers. This has long been done with devices operating in either elecrofulguration or electrodesssication mode. Electrofulguration is the technique we are going to be focusing on in this section which is also recently referred to as “fibroblast” or plasma tattoo removal.

 

In this section we will refer to Electrical Thermabrasion, Plasma, Fibroblast or Electrical arcing interchangeably. These terms mean the same thing in this section. Electrical Thermabrasion is a more general term as it can also refer to professional high power radio frequency devices.

 

Tattoo Removal with Electrical Thermabrasion (Fibroblast) without osmosis.

The first stage to learn when it comes to tattoo removal using electrical arcing is thermabrasion without the use of osmosis. We will look at how osmosis is applied later on in this section.

Electrical arcing tattoo removal without osmosis is applied in those cases where the risks of scarring are increased by the use of osmosis .

Those areas of the body are those parts of the skin subject to continuous stretching and creasing. Like knees, wrists, elbows etc, this is because the continuous creasing and stretching of the skin makes it difficult for the area to heal speedly and therefore more prone to infection and delayed healing.

In these cases the use of electrical arcing or electrical thermabrasion on its own may be the best course of action.

However when we use electrical thermabrasion on its own the degree of tattoo fading is rather low after each session. In other words the degree of tattoo fading after each electrical arcing session without osmosis is comparable to that of most Q-Switched lasers for tattoo Removal procedures.

 

 

Plasma or Fibroblast for Tattoo Removal with Osmosis.

If performed correctly, electrofulguration, or electrical arcing, provides an effective way to remove tattoos while minimizing the number of sessions required to achieve the desired effects, also minimising the risks of collateral damages or scarring. The risks to the skin are minimized drastically because thermal abrasion with osmosis allows attenuating tattoos, in most cases halving the number of sessions otherwise required with laser treatment.

Although different tattoos present different levels of difficulty in their effective attenuation, depending on the type of ink and instrumentation used to draw it, experience has shown that thermal abrasion with osmosis can remove tattoos within 2 to 4 sessions. If thermal abrasion is applied without osmosis the number of sessions required for tattoo removal increase dramatically and the number of treatments and results can be comparable to those of lasers.

Therefore, it has to be noted that there are clinical advantages to using Electrical thermal abrasion with osmosis over laser treatment for tattoo removal. Electrical Thermal abrasion with osmosis is far far more effective and efficient than  lasers and it has the following advantages:

• Less potential harm to the client because less sessions are required.
• No collateral damage associated to the repeated use of lasers on the skin.
• The cost of the instruments required for tattoo removal are a fraction of specialized tattoo removal lasers.

Additionally, from a clinical stand point, it is important to try and find any possible way to minimise the number of exposures to burns or to any similar skin abrasions. The more the skin is exposed to laser treatment or any other thermal abrasion techniques the more damage can be caused to the skin. Since fibroblast with Osmosis drastically reduces the number of sessions required to achieve the desired tattoo fading results it is usually one of the best options.

The importance of Salation or Osmosis when using fibroblasting for tattoo removal.

Salabrasion or salation  is one of the first known effective techniques to remove  tattoo and it had been around for several hundreds years. Originally Salabrasion was used by literally rubbing the tattoo using salt until the upper part of the dermis become exposed to the sodium chloride.

Modern technology has not made this technique obsolete because it is still more effective than most Q-Switched lasers and inexpensive on top of it. Thermal skin resurfacing before applying salt is key for effectively applying the osmotic effect induced by the sodium chloride.

When it comes to tattoo removal (or Tattoo fading), the most important part of electrical thermabrasion with osmosis is the osmosis itself. This is the most important ingredient in the recipe of tattoo fading using electrical arcing or Fibroblast. Without osmosis the results would be poor, comparable to those with Q-Switched lasers.

However, whenever mentioning the use of salt for tattoo fading (or tattoo removal) people firstly raise their eyebrows. What do you meal by salt? Yes, we mean sodium Chloride nothing fancy. Too simple and too down to earth to be taken seriously at first, but once you see the results and you will take it extremely seriously because it outperforms any every expensive Q-Switched lasers’ results not by a little but by miles. The results of only one tattoo removal session using electrical arcing coupled with osmosis is often as good as 4 to 5 laser sessions.

The inherent simplicity of osmosis is possibly the reason for this technique, although several times more effective than most expensive Q -Switched lasers,  not to be as popular as laser tattoo removal. The first time we saw the results after one session of tattoo removal using electrical arcing with osmosis we were gobsmacked. The results were several times better than with any other laser.

Also, as we will wee the use of salt is not as straightforward as the use of lasers alone and you have to time it well. Too long of an application the higher the risks of a scar occurring, too short the duration the less the tattoo fading.

Like with laser treatment, thermal abrasion causes the colour pigments to be broken down and reabsorbed. However the protocol of thermal abrasion involves also packing the area treated with sodium chloride for a period of half to a full hour after thermal abrasion. The timing of the application of the sodium chloride depends on whether fine salt or a salt paste is used.

Sodium chloride is applied because it causes osmosis. Osmosis draws the broken tattoo pigments to the surface of the skin removing them from the deeper part of the dermis. In other words the osmotic process pulls out as much as the broken pigments as possible so that the more of the unwanted pigments will be trapped in the scab which will subsequently forms during healing. Osmosis therefore facilitates and further speeds up the tattoo discoloration process and hence eventual removal whenever possible (because as we know not all tattoos can be completely removed seamlessly).

In other words tattoo salation has the effect of drawing up the colour pigments towards the surface of the skin. This is why this technique is also referred to as “tattoo osmosis”.

 

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Salation or Osmosis has also its degree of treatment intensity. The longer the sodium chloride is left on the exposed tattoo the more the colour pigments are drawn towards the surface, therefore the more the tattoo will fade after each treatment. The intensity of the treatment using sodium chloride on its own is mainly dependent on the duration of the application of the salt on the tattoo itself. Additionally Osmosis can be carried out in two main ways:

1 By applying a dense paste made of sterile saline solution and sterile fine sodium chloride. This has relatively high-intensity results if compared to applying only sterile fine salt. Also the longer the salt is applied on to the tattoo the higher the intensity of the treatment.

2. By applying sterile fine salt on its own. The salt is usually applied on to the tattoo for a predetermined period of time. The duration of the sodium chloride application has a direct impact on the intensity of the treatment. The longer the salt is applied the higher the treatment intensity and the more the osmotic effect on the tattoo pigments, therefore the more the fading of the tattoo after each session.

Keeping the time of application the same the two different osmosis methods have different osmosis intensity. Generally, the sterile sodium chloride paste has a stronger efficacy than fine sterile salt on its own. This is why a sterile paste of sodium chloride is used for permanent make-up removal.

In permanent makeup removal it is not practical to bandage the area treated due to the location of the tattoo, therefore the sterile paste is applied so that the osmotic effects are so effective that the application is only a few minutes in order to achieve the desired result.

 

 

Why using electrical arcing for skin resurfacing before Salabration (or Osmosis)?

Radio frequency or electrical arcing devices have the double function of removing the epidermal layer (necessary for the osmosis to take place) and also heat up and break down the tattoo pigments at the same time. In other words electrical arcing devices  have the double effect of not only performing the required skin abrasion necessary for the osmotic effect to take place (once the salt is placed on the tattoo) but it also breaks down part of the tattoo pigments (like lasers do). The latter contributes to speeding up the tattoo fading process.

Not only Plasma fibroblast devices but also other devices can be used for effective resurfacing before applying salation (or Osmosis). Such as microdermabrasion devices, micro-needling devices injecting the saline salt solution directly into the dermis and any method currently known to expose the upper dermal layer.

The upper dermal layer needs to be exposed for the osmosis to be effective. Osmosis on its own is not sufficient in order to remove or fade the tattoo pigments. If the sodium chloride is not in contact with the dermis or at least upper dermis in order to induce an effective osmosis no tattoo fading will take place.

There are several ways to remove the epidermal layer and allow the salt to get in contact with the tattoo pigments. The use of electrical arcing (also referred to as Plasma)  and the use of radio frequency devices is one of the best options due to the fact that fibroblasting causes:

1. the dermabrasion necessary to expose the dermis
2. and also it injects heat into the skin at the same time helping break down the tattoo pigments.

This is because the electrical arcing have the double effect of not only abrading the area like microdermabrasion etc, but it also has the effect of breaking down the tattoo pigments by using the heat injected by the electrical arc. Because of this thermal effect the broken pigments will be more easily drawn to the surface by the osmotic effect.

 

 

Intensity of the treatment when using Fibroblasting before osmosis.

Usually it is the tattoo removal practitioner the one who decides the degree of ablation and the intensity of the treatment. This is done assessing the client’s desires and the aesthetic practitioner’s own previous experience. For example, if the client is happy incurring in a higher likelihood of developing a scar but going through fewer treatments then a higher degree of ablation can be carried out.

The intensity of the Electrical thermabrasion is controlled by the depth of the ablation. This in turn is controlled by three factors:

1. the power level of the arc,
2. the sweeping speed of the arc during the spraying operation
3. and of course the number of passes on the area.

The deeper the ablation the more the tattoo will fade after each treatment. This is keeping the intensity of the osmosis the same. Remember that the intensity of the osmosis is dependent by the length of the salt application and whether fine salt is applied or the saline paste.

The electrical arcing ablation for tattoo removal or tattoo fading can be carried out at different intensities.

1. The first level of intensity consists in simply removing the epidermis. This is done by setting the specific device at very low power levels to ablate the epidermal layer and then removing the carbon residues with a cotton pad impregnated with non-flammable antiseptic. This is repeated until the carbon residues are removed and the upper dermis is exposed. This alone will suffice to then apply osmosis either by applying sterile salt or a sterile salt paste.
2. The second level of intensity consists not only in removing the epidermal layer as required by the epidermal abrasion, necessary for the osmotic effect to take place, but also break down the tattoo pigments inside the dermal layer where they reside. This can be done in stages by first removing the epidermal layer as described above and then spraying the voltaic arc (fibroblast) into the already exposed upper dermal layer. This has the function of breaking down the tattoo pigments inside the dermis. This technique is called “double pass” this is because the aesthetic practitioner is required to perform two passes on the tattoo in order to apply the osmosis. The first pass is used to remove the epidermis and it exposes the upper dermis. The second pass is used to breakdown the pigments by spraying the electrical arc directly on the dermal layer which is now being exposed.  Two passes in total, hence the term “double pass”.

Please note that the second  intensity level “double pass” can be carried out also by directly increasing the power level of the electrical arcing device to the point where the arc instantly carbonises the epidermal layer and injects the required heat into the dermal layer to break down the tattoo pigments at the same time.

In other words the pigments rooted deeply inside the dermis can be broken down with a single ablation. This is done by setting the device at the relatively high power level and hence the arc has enough power to reach and break down the pigments located in the lower part of the dermis within a single pass.

The tattoo pigments can be also distributed relatively deeply inside the dermis therefore a deeper ablation can be required in order to have an impact on the deeper pigments. In order to do this usually a double pass is performed on the upper dermis. When this is done normally the area treated starts bleeding, this is normal. Please bear in mind that the deeper the ablation the higher the likelihood of permanent adverse effects including scarring.

 

 

Adverse reactions to Tattoo removal by applying electrical thermal abrasion with osmosis.

It has been extensively shown that thermal abrasion with osmosis is very effective in removing tattoos without leaving any scars and within only few sessions and in doing so it is more effective than most Q-Switched lasers.

However, scars could develop when:

• thermal abrasion had been carried out to cause extensive damage to the dermis.
• the treated area had become infected.
• the client has a particular predisposition to developing Keloids or hypertrophic scars.

One of the main differences between this type of treatment and laser tattoo removal is that with Electrical Thermabrasion the likelihood of contracting an  infection are higher. This is because the treatment will leave an open wound which during the healing process is susceptible to localised inflammatory infections. On the other hand lasers only cause a burn which is not easily susceptible to infections.

The main adverse reaction is scarring caused by infections contracted after the tattoo removal procedure during the healing process. Scarring can happen if the treatment has been carried out at too high intensively overall or the treated area has contracted an infection. Although the former eventuality has been rarely reported as being the cause of scarring the latter is more likely to be the leading cause of scarring. This is because a prolonged infection can cause sometimes severe damage to the dermis, hence being the real cause of scarring.

The likelihood of infections are easily minimised by using the appropriate aftercare and keeping the area clean until the scab have formed fully. Once the scab have formed the likelihood of contracting a localised inflammatory infection is very low because the scab pose an effective barrier to bacteria and avoids infections. The scab must not be removed forcefully by picking it or otherwise. These scabs are usually relatively thick and sometimes contain a relatively large amount of the tattoo colour removed by the procedure..

A Common adverse reaction of osmosis is the formation of a temporary hypertrophic scar. This forms especially if the area has been subject to an infection but it can also form even if an infection has not occurred.  Usually, this hypertrofic formation subsides on its own over a few weeks.

So far no cases of hypo-pigmentation have been reported after fiblroblast with osmosis. As we know hypo-pigmentation is a common adverse reaction to lasers tattoo removal treatments and if it occurs after laser treatments it is permanent.

Hyper-pigmentation is also possible after the use of electrical arcing with osmosis, this is because this treatment involves skin regeneration and skin resurfacing. All skin resurfacing treatments require total sun protection in order to avoid hyper pigmentation. Hence, in order to minimise this likelihood, the client must avoid direct sun exposure while applying sunscreen an up to three months after the last treatment like after any other type of plasma aesthetic treatment.

 

 

About the results. How many treatments are required to remove a tattoo?

After Electrical thermabrasion with osmosis the tattoo fades according to the type of tattoo and its location on the body (see kirbey Desai scale). And mainly also depending on the overall intensity of the treatment. Usually the higher the overall intensity of the treatment the more the pigments are drawn from the dermis into the eventual scab. Usually the scab will visibly contain the colours of the tattoo that has been treated. The higher the intensity of the treatment the more the pigments inside the scab. It is not unusual to see scabs containing green, yellow and blue colours after the treatment of multicolour tattoos.

The aesthetic practitioner has double control over the intensity of the overall treatment by varying:

1. the intensity of the electrical thermabrasion treatment and
2. the osmosis intensity.

As we have seen tattoos are all different. The usual rule of the lower the points on the Kirbey desai scale the more quickly the tattoo will be be faded or removed still applies. Always remember that it is sometimes impractical to achieve complete removal of the tattoo without leaving a scar. However all tattoos are often faded more easily than othewise would with lasers due to the double fading effect of electrical thermabrasion and salation. The average number of treatments required varies between 1 to 3 for an average tattoo.

In general one medium intensity treatment can fade the equivalent amount of 4 Q-Switched tattoo removal laser sessions. In other words on average, 1 treatment with electrical thermabration is the equivalent of 4 lasers tattoo removal sessions.

 

 

How much of an area can be treated at a time?

Like with laser treatments, also in electrical thermabrasion with osmosis, large tattoos are split into different small areas in order to fade it.

There is no limit to the size of area which can be treated using electrical thermabrasion with osmosis. The wider the area treated the more likely it is to contract an infection due to the extent of the area treated. The larger area treated the more difficult it is to protect the wound against bacterial infections during the healing process.

It is up to the aesthetic practitioner to decide what may be appropriate for each individual case.

 

 

Multicolour tattoos.

As we know multi colour tattoos are very challenging to be faded with lasers. Some colours cannot be faded by lasers at all.

This is not the case using electrical plasma with osmosis because this type of treatment is colour blind and it is capable to fade all tattoo colours indiscriminately. Since this type of treatment is colour blind it is one of the preferred methods to fade multicolour tattoos. It is not unusual to see scabs literary green of yellow depending on the colours of the original tattoo.

 

Tattoo Removal Aftercare.

Aftercare after tattoo removal with electrical arcing and osmosis is very important but very simple at the same time.

1. Keep the area clean
2. Do not use any creams on the area
3. Do not use any bandaging on the area treated or  any plaster. This is because  bandaging or plasters can cause a worm moist environment were bacteria proliferate and hence cause infections and delayed healing.
4. Disinfect periodically up until the area has developed a scab.

Remember that scabs should not be picked and must peel off on their own accord.

Healing time.

The healing time depends on the overall intensity of the treatment. The higher the overall intensity of the treatment the longer the treated area will take in order to recover fully. Usually the scab form within 3 to 4 days from the treatment and falls off on its own accord within 10 days. However, the area may still feel tender to the touch in or tender in general up to a few weeks after the scab has fallen off.

Generally the healing time, provided that the area is not infected, occurs within a maximum of 10 days and it is marked by the scabs falling off on their own accord.