Tattoo didn't frost during Picosure treatment, what should I do?

Question

I've had 5 sessions with Q-switched MedliteC6 laser my tattoo is all black ink. Tried a session with the PFD patch and Picosure laser During treatment the laser technician was frustrated because she did not see any frosting with the patch or without the patch. She only tested a small part of the tattoo and ended up not going through with the treatment. I wanted to try the PFD patch but now I'm not sure if it's an option. Is it ok that my skin didn't frost? It did turn red and swollen afterwards

J. Jason Wendel, MD, FACS · Answer

Thank you for your question in regards to tattoo removal. Using a PDF patch for tattoo removal treatments will prevent the effect of frosting. Although if the tattoo appeared red with edema, the treatment should be effective. To be sure what is best for you, see two or more board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment. I hope this helps.

Mark A. Blair, MD · Answer

Hello, thank you for your question.  The purpose of the PFD patch is to prevent frosting, (frosting is tiny gas bubbles under the skin that make it appear white right after firing laser on ink) The PFD patch is meant to resolve the frost so that multiple passes can be done during a single session.  This process is called R20 method.  The newer technology, the Pico-second technology, does not use the R20 method as it is not necessary, with the power of the Pico-second technology because the laser is already shattering the ink into even smaller particles.  After several sessions, as the ink fades, the energy is increased, if the ink and skin is still responding, the treatment should be effective even if it does not frost.  Hang in there!  Good Luck!

Richard Rosol, MD · Answer

After several treatments of a tattoo, it’s normal and expected to see no frosting. Frosting is not a measure of a treatment’s effectiveness in any way, a fact that I would expect any experienced practitioner to know intimately.
Also, there is no rationale for using the PFD patch with a Picosecond laser. In fact, proper use (according to the manufacturer) dictates use with a nanosecond laser solely for the purpose of retreating quickly, without waiting for frosting (if any) to clear. There exists no solid data justifying the perfluorodecalin patch at all, but that’s a subject for another Q&A. Short answer: Don’t spend the money, and beware of people who offer it.
I recommend, as always, finding a medically trained and licensed practitioner (eg MD, DO, RN) to continue your tattoo removal. That person is likelier to understand the physics, chemistry, anatomy, and physiology of the task at hand.
Good luck!

Philip A. Rettenmaier, DO · Answer

In my experience, you don’t always see “Frost” with the Pico second laser. It creates a photo acoustic shock wave that breaks up the ink particles so there isn’t always creation of steam, which is the “Frosting” you usually see with a Qswitched Laser. Since you did have localized swelling and redness the laser did its job.

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