PFD Solution for Tattoo Removal
Perfluorodecalin (PFD) solution is used as a transparent patch applied directly to the skin during Q-switched or picosecond laser tattoo removal to enable multiple laser passes in a single treatment session by rapidly clearing the opaque white micro-bubble layer that normally forms after each laser pulse. 1, 2
Mechanism of Action
PFD functions as an optical clearing agent that dissipates the white epidermal whitening (cavitation bubbles) produced when Q-switched or picosecond lasers fragment tattoo pigment particles 1, 2. This whitening normally prevents additional laser passes during the same session because it blocks laser penetration to deeper pigment 2.
Treatment Protocol
Application Technique
- Apply the transparent PFD-infused silicone patch directly over the tattoo before laser treatment 1, 2
- The patch allows the laser to be fired directly through it, maintaining optical clarity throughout the procedure 1
- The PFD provides index-matching and epidermal protection properties that allow significantly higher fluences than conventional through-air treatment 1
Treatment Parameters
- Multiple passes: The PFD patch enables 3-4 laser passes (average 3.7 passes) within a 5-minute treatment session, compared to only 1.4 passes with conventional laser-alone treatment 2
- Treatment intervals: Maintain standard 4-6 week intervals between sessions 1, 2
- Fluence: Use highest tolerated fluence, which can be higher than conventional treatment due to the epidermal protection provided by PFD 1
Compatible Laser Systems
- Q-switched Alexandrite (755 nm) 1, 2
- Q-switched Nd:YAG (1064 nm) 3
- Picosecond lasers (532 nm, 755 nm, 785 nm, 1064 nm) 3, 4
Safety Profile
Skin Type Compatibility
- Fitzpatrick I-III: Proven safe and effective 1, 2
- Fitzpatrick IV-VI: Retrospective data from 14 patients demonstrates safety with no adverse effects reported 3
Adverse Events
- Lower rates of transient edema (36.7% vs 63.3% with laser alone) 2
- Lower rates of erythema (33.3% vs 70.0% with laser alone) 2
- No dyschromia (hypo- or hyperpigmentation) observed at 1-month follow-up 2
- All adverse events were transient and resolved quickly 2
- Patients consistently report less edema, erythema, and epidermal crusting with PFD use 4
Tattoo Color Compatibility
The PFD patch has been used safely on tattoos containing blue, black, red, green, purple, and pink ink 3.
Clinical Outcomes
Efficacy
- In 11 of 17 subjects (65%), tattoos treated with the PFD patch showed more rapid clearance than conventional treatment 1
- In no case did the control side fade faster than the PFD patch side 1
- Patient preference: 100% of subjects (30/30) preferred to continue treatment with the PFD patch when surveyed at 1-month follow-up 2
Comparative Effectiveness
One comparative study of 15 different laser combinations found that picosecond 1064 nm plus picosecond 755 nm plus fractionated CO2 laser without the PFD patch showed superior results after two sessions 5. This suggests that while PFD enables multiple passes, certain advanced laser combinations may achieve better results through alternative mechanisms.
Important Caveats
Standard Laser Safety Still Applies
- Proper training in Q-switched and picosecond laser use remains essential 6, 7
- Significant burns can occur with improper technique, leading to scarring 6
- Toxicologic risks exist from cleavage products formed during laser-assisted removal 6, 7
Patient Counseling Requirements
- Tattoo removal remains expensive ($49-300 per square inch per treatment) 6
- Complete removal requires multiple sessions (documented cases requiring up to 47 treatments for large multicolored tattoos) 6, 7
- Removal is difficult, expensive, and only partially effective in many cases 6
- Patients with keloid formation history should be advised of scarring risks 6
Not a Standalone Treatment
PFD is an adjunct to laser therapy, not a replacement 1, 2. The laser remains the primary therapeutic modality; PFD simply optimizes the treatment session by enabling multiple passes 2.