We All Make Mistakes - Now You Don't Have To Live With Them Forever!
If you are having second thoughts about your tattoos, you’re not alone. Every week we see clients, from every walk of life, who are having second thoughts about their tattoos.
If what once seemed like a good idea no longer fits your changing image and you wish you could fade it or just make it go away, we are here to assist you.
ln the not too distant past, the only ways to get rid of unwanted tattoos were through invasive surgical procedures. Surgeons would either remove the entire offensive area & graft skin from another part of the body, which invariably resulted in multiple scars, or they would use a metal sanding disc to 'dermabrade' or sand your skin right down to the basal layers. These treatments were often quite painful after the fact, with long drawn out healing processes & your skin would invariably not look real again.
At Age Less MEDI Spa's we have searched internationally for the best, safest, most effective, advanced tattoo removal systems & unique methods, to effectively fade or remove your unwanted tattoos. Our customized tattoo removal technologies, here in Victoria BC, can combine state of the art, latest generation, Q-Switched Nd Yag Lasers, using Chiller Cart technology for maximum comfort as well as with a targeted Cryogenic System, &/or a Digital/Gel method similar to tattoo implantation but without the discomfort, to significantly lighten or completely remove your tattoo over a series of sessions.
For the last 10 years we at Age Less MEDI Spas here in Victoria, BC have offered you advanced Tattoo removal technologies in the relaxing atmosphere of private Spas rooms to effectively fade or remove of your unwanted tattoos. Our Certified Clinicians have years of experience in Para Medical Skin Revision the Skin Rejuvenation fields so as to be able to provide you with the best possible care. Several variables will determine which of the three or which combinations of the three modalities we offer might be best to fade or remove your tattoo. Factors such as which type of pigments were used - iron oxide, vegetable dye pigment, India ink or other? How deep it was implanted? If it was professionally implanted or applied by an amateur? How many colours & what colours were used? If it is a tattoo which has been applied over another older tattoo? How old is the tattoo and where the body your tattoo is located.
It is important to note that no facility or clinician can guarantee the complete removal of any tattoo, or guarantee that the skin on the treated site may not experience textural or pigmentary changes which can exist short term or be longer lasting.
In order to provide you with a customized solution for your laser tattoo removal here in Victoria BC, we offer you a selection of tattoo removal methods. A personalized consultation is always required to ascertain the best ways to tackle any tattoo regrets. Patch tests may also be performed.
It is important to be aware that the effective fading and or removal of a tattoo requires a certain amount of time & monetary commitment, as they need to be performed every 6– 12 weeks over a period of months for maximum results. Due to this fact, we offer you advantageous Package Pricing Specials as well as affordable Financing options (OAC) to allow you to invest in yourself sooner rather than later. For your convinience we are open later hours and Saturdays.
Our relaxing spa atmosphere, extra TLC and exclusive latest generation tattoo removal methods allow for your treatments to be surprizingly comfortable. In fact the typical comments are that they are definitely more comfortable than the original tattoo application.
Laser Tattoo Removal with 'Latest Generation' Q-Switched Nd Yag Laser
Laser tattoo removal using the 1064 Q Switched Yag Laser works more quickly on darker pigments, such as black, dark blues and deep greens, as the laser light is attracted to and absorbed faster by the deeper colours of the ink pigments. The 532 Q Switched Yag targets the red and orange shades effectively. Other lighter or brighter coloured pigments usually require more treatments. Most clients experience mild swelling, and temporary moderate brusing with the possiblity of a few very tiny blood speckles, and in healthy individuals usually normalize over 10 -14 days. Some of the pigment is released through surface skin shedding while the majority of the pigment fractures into microscopic particles to be absorbed by the lymphatic system for natural elimination.
How many sessions will I need?
Every tattoo and every person differs, as such count on a minimum of 8 sessions appropriately spaced. While we have had a few individuals whose tattoos have disappeared in less than 6 sessions, it is not a typical occurence and as such should not be expected by most. Some more complex tattoos may require 15 plus sessions, however the pricing at Age Less MEDI Spas which has not gone up in the last 10 years, reduces as the amount of area to be treated reduces.
Kirby-Desai Scale Helps Victoria Laser Tattoo Removal Facility Estimate Clients Treatment Time and Results
Laser tattoo removal is an intriguing process to most individuals, and like a tattoo, each procedure is individualized based on the person and the ink they’d like to remove. Because laser tattoo removal is a light based technology, there are important factors to consider when trying to quantify the results on any particular person’s tattoo. While most tattoos can be removed successfully, the number of treatments required to eliminate a tattoo completely vary as well as the type of laser used. It’s also important to note that some tattoo pigments may not be able to be removed 100%.
The Kirby-Desai Scale helps our Clinicians to better assess the most effective methods and closely estimate the possible number of sessions needed to fade or remove most tattoos.
The Kirby-Desai Scale focuses on 6 major elements to determine the effectiveness of tattoo removal: a person’s Fitzpatrick skin type, the tattoo’s location on the body, the tattoo pigment colour, the amount of ink in the tattoo (or size), the amount of scarring or tissue change, and whether the tattoo is layered. Each element is assigned a score from 1 to 5.
This scale is useful to the client as well. Being able to closely plan out the approximate number of tattoo removal sessions allows our clients to schedule the removal sessions within their agenda, budget for the appropriate number of procedures, and prepare themselves adequately for the process because they’ll know what they can expect from laser tattoo removal.
The actual number of treatments required for maximum improvement depends on the depth and colour of your tattoo pigment, as well as the type of pigment originally used. Most clients will see substantial, visible reduction in their tattoos after the second session. The improvement can be quite dramatic. You will be the ultimate judge of when you're satisfied with your results. Many of our clients are happy to have substantial fading as quite often their goal is to have new artwork applied over the original area.
Cryogenic Tattoo Removal
Cryogenic tattoo removal in Victoria BC utilizes an European Technology using a targeted probe that is effective on virtually any colour pigment because it is not influenced by the colours of your tattoo. It works through a targeted freezing mechanism creating a temporary yet substantial surface blister - stimulating the production of collagen, and causing surface skin to shed along with a layer of unwanted pigment. It is also a very successful method for removing badly placed permanent makeup, or permanent makeup which has changed into the wrong colour. As with any other tattoo removal method possible skin discolourations and textural changes although typically minor can occur.
Digita/Gel Tattoo Removal
Relatively new to North America yet widely and successfully used in hundreds of European Clinics for over 6 years, this method is similar to that of the initial tattoo application. After the application of an effective numbing cream, a specialized digital machine along with an inert gel pigment is utilized to mechanically remove your tattoo. This specialized technique implants the inert, specifically formulated & proven antiseptic product, into the area of the pigment. This anti-microbial product then binds to the coloured pigment (ink), encapsulating (causing a protective, hardened scab over the treated area) the unwanted pigment & drawing the ink out over a period of 14 - 20 days. As the inks are absorbed, the 'scab' turns progressively darker. This method can only be performed by clinicians with Para Medical Skin Revison and Permanent Makeup Certification and as such may cost more up front than other methods. Digital/Gel removal needs to be done in smaller incremental sections, however; it usually requires fewer sessions to achieve the maximum results, and as such can be a real time & money saver.
It is important to note that with any method of tattoo removal, some textural changes and discolourations can ensue. Proper aftercare is important and will be discussed in detail at your complimentary consultation.
Contact us at 250 472-0400 today for more information, and to schedule your FREE Consultation.
Further Reading
Tattoo Removal With Laser
Tattoo removal is most commonly performed using lasers that react with the ink in the tattoo and break it down. The broken-down ink is then absorbed by the body, mimicking the natural fading that time or sun exposure would create. All tattoo pigments have specific light absorption spectra. A tattoo laser must be capable of emitting adequate energy within the given absorption spectrum of the pigment to provide an effective treatment. Certain tattoo pigments, such as yellows, greens and fluorescent inks are more challenging to treat than darker blacks and blues. These pigments are more challenging to treat because they have absorption spectra that fall outside or on the edge of the emission spectra available in the tattoo removal laser.
Widely considered the gold standard treatment modality to remove a tattoo, laser tattoo removal requires repeat visits. The newer Q-switched lasers are said by the National Institutes of Health to result in scarring only rarely and are usually used only after a topical anesthetic has been applied. Areas with thin skin will be more likely to scar than thicker-skinned areas. There are several types of Q-switched lasers, and each is effective at removing a different range of the colour spectrum. Lasers developed after 2006 provide multiple wavelengths and can successfully treat a much broader range of tattoo pigments than previous Q-switched lasers.
Mechanism of laser action
Experimental observations of the effects of short-pulsed lasers on tattoos were first reported in the late 1960s.[6] In 1979 an argon laser was used for tattoo removal in 28 patients, with limited success. In 1978 a carbon dioxide was also used, but generally caused scarring after treatments[4] It was not until the late 1980s that Q-switched lasers became commercially practical. One of the first published articles describing laser tattoo removal was authored by a group at Massachusetts General Hospital in 1990.[7]
Tattoos consist of thousands of particles of tattoo pigment suspended in the skin.[8] While normal human growth and healing processes will remove small foreign particles from the skin, tattoo pigment particles are permanent because they are too big to be removed. Laser treatment causes tattoo pigment particles to heat up and fragment into smaller pieces. These smaller pieces are then removed by normal body processes.
Laser tattoo removal is a successful application of the theory of selective photothermolysis (SPTL).[9] For laser tattoo removal, SPTL for the selective destruction of tattoo pigments depends on four factors:
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The color of the light must penetrate sufficiently deep into the skin to reach the tattoo pigment.
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The color of the laser light must be more highly absorbed by the tattoo pigment than the surrounding skin. Different tattoo pigments therefore require different laser colors. For example, red light is highly absorbed by green tattoo pigments.
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The time duration (pulse duration) of the laser energy must be very short, so that the tattoo pigment is heated to fragmentation temperature before its heat can dissipate to the surrounding skin. Otherwise, heating of the surrounding tissue can cause burns or scars. For laser tattoo removal, this duration should be on the order of nanoseconds.
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Sufficient energy must be delivered during each laser pulse to heat the pigment to fragmentation. If the energy is too low, pigment will not fragment and no removal will take place.
Q-switched lasers are the only commercially available devices that can meet these requirements.[10]
Although they occur infrequently, mucosal tattoos can be successfully treated with q-switched lasers as well.[11]
Laser parameters that affect results
Several colors of laser light (measured as wavelengths of laser energy) are used for tattoo removal, from visible light to near-infrared radiation. Different lasers are better for different tattoo colors. Consequently, multi-color tattoo removal almost always requires the use of two or more laser wavelengths. Tattoo removal lasers are usually identified by the lasing medium used to create the wavelength (measured in nanometers (nm)):
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Q-switched Frequency-doubled Nd:Yag: 532 nm. This laser creates a green light which is highly absorbed by red and orange targets. Useful primarily for red and orange tattoo pigments, this wavelength is also highly absorbed by melanin (the chemical which gives skin color or tan) which makes the laser wavelength effective for age spot or sun spot removal.
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Q-switched Ruby: 694 nm. This laser creates a red light which is highly absorbed by green and dark tattoo pigments. Because it is more highly absorbed by melanin this laser may produce undesirable side effects such as pigmentary changes for patients of all but white skin.[12]
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Q-switched Alexandrite: 755 nm. Similar to the Ruby laser, the Alexandrite creates a red light which is highly absorbed by green and dark tattoo pigments. However, the alexandrite laser color is slightly less absorbed by melanin, so this laser has a slightly lower incidence of unwanted pigmentary changes than a ruby laser.[13]
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Q-switched Nd:YAG: 1064 nm. This laser creates a near-infrared light (invisible to humans) which is poorly absorbed by melanin, making this the only laser suitable for darker skin. This laser wavelength is also absorbed by all dark tattoo pigments and is the safest wavelength to use on the tissue due to the low melanin absorption and low hemoglobin absorption. This is the wavelength of choice for tattoo removal in darker skin types.
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Dye modules are available for some lasers to convert 532 nm to 650 nm or 585 nm light which allows one laser system to safely and effectively treat multi-color tattoo inks.
Pulsewidth or pulse duration is a critical laser parameter. All q-switched lasers have appropriate pulse durations for tattoo removal. However, lasers with a shorter pulses have a safer and more efficient removal method because the peak power of the pulse is greater.
Spot size, or the width of the laser beam, affects treatment. Light is optically scattered in the skin, like automobile headlights in fog. Larger spot sizes slightly increase the effective penetration depth of the laser light, thus enabling more effective targeting of deeper tattoo pigments. Larger spot sizes also help make treatments faster.
Fluence or energy level is another important consideration. Fluence is measured in joules per square centimeter (J/cm²). Its important to get treated at high enough settings to fragment tattoo particles.
Repetition rate helps make treatments faster but is not associated with any treatment effect.
Number of laser tattoo removal treatment sessions needed
Complete laser tattoo removal requires multiple treatment sessions, typically spaced at least eight weeks apart. Treating more frequently than eight weeks increases the risk of adverse events and doesn't necessary increase the rate of ink resolution. Anecdotal reports of treatments sessions at 4 and 6 weeks lead to more scarring and dischromia and can be a source of liability for clinicians. At each session, some but not all of the tattoo pigment particles are effectively fragmented, and the body removes the smallest fragments over the course of several weeks. The result is that the tattoo is lightened over time. Remaining large particles of tattoo pigment are then targeted at subsequent treatment sessions, causing further lightening. The number of sessions and spacing between treatments depends on various parameters, including the area of the body treated and skin color. Tattoos located on the extremities, such as the ankle, generally take longest. As tattoos fade clinicians may recommend that patients wait many months between treatments to facilitate ink resolution and minimize unwanted side effects.
The amount of time required for the removal of a tattoo and the success of the removal varies with each individual. Factors influencing this include: skin type, location, color, amount of ink, scarring or tissue change, and layering. In the past health care providers would simply guess on the number of treatments a patient needed which was rather frustrating to patients. A predictive scale, the "Kirby-Desai Scale", was developed by Dr. Will Kirby and Dr. Alpesh Desai, dermatologists with specialization in tattoo removal techniques, to assess the potential success and number of treatments necessary for laser tattoo removal, provided the medical practitioner is using a quality-switched Nd:YAG (neodymium-doped yttrium aluminum garnet) laser incorporating selective photothermolysis with eight weeks between treatments.
The Kirby-Desai Scale assigns numerical values to six parameters: skin type, location, color, amount of ink, scarring or tissue change, and layering. Parameter scores are then added to yield a combined score that will show the estimated number of treatments needed for successful tattoo removal. Experts recommend that the Kirby-Desai scale be used by all laser practitioners prior to starting tattoo removal treatment to help determine the number of treatments required for tattoo removal and as a predictor of the success of the laser tattoo removal treatments.[14] Prior to 2009, clinicians had no scientific basis by which to estimate the number of treatments needed to remove a tattoo and the use of this scale is now standard practice in laser tattoo removal.
Factors contributing to the success of laser tattoo removal
Multiple factors contribute to the success of laser tattoo removal one of which is a patient's own immune system. A healthy patient will get the best results. Adequate hydration, eight hours of sleep a night, maintaining a healthy weight, eating a well balanced diet, exercise, and non-smoking may improve results. The Kirby-Desai scale parameters qualify the factors that can dictate tattoo removal success. Moreover, treatment on some patients with immune systems problems are contraindicated.[15]
Pain management during treatment
Laser tattoo removal can be uncomfortable but is very tolerable in most cases. The pain is often described to be similar to that of hot oil on the skin, or a 'slap' from an elastic band. Depending on the patient's pain threshold, and while some patients may forgo anesthesia altogether, most patients will require some form of local anesthesia. Pre-treatment might include the application of an anesthetic cream under occlusion for 45 to 90 minutes prior to the laser treatment session. In very rare cases, if complete anesthesia is necessary, it can be administered locally by injections of 1% to 2% lidocaine with epinephrine.
Anecdotal reports have noted that patients receiving anesthesia by local injection may require additional treatment as the injection causes mechanical edema, a spreading out of the tattoo ink, which in turn makes it more difficult for the laser light to act on specific ink particles. This may also increase the risk of scarring and/or additional treatment.[16]
Post-treatment considerations
Immediately after laser treatment, a slightly elevated, white discoloration with or without the presence of punctuate bleeding is often observed. This white color change is thought to be the result of rapid, heat-formed steam or gas, causing dermal and epidermal vacuolization. Pinpoint bleeding represents vascular injury from photoacoustic waves created by the laser's interaction with tattoo pigment. Minimal edema and erythema of adjacent normal skin usually resolve within 24 hours. Subsequently, a crust appears over the entire tattoo, which sloughs off at approximately 14 days post treatment. As noted above, some tattoo pigment may be found within this crust. Post-operative wound care consists of simple wound care and a non-occlusive dressing. Since the application of laser light is sterile there is no need for topical antibiotics. Moreover, topical antibiotic ointments can cause allergic reactions and should be avoided. Fading of the tattoo will be noted over the next eight weeks and re-treatment energy levels can be tailored depending on the clinical response observed.[17]
Side effects and complications
About half of the patients treated with Q-switched lasers for tattoo removal will show some transient changes in the normal skin pigmentation. These changes usually resolve in 6 to 12 months but may rarely be permanent.[18]
Hyperpigmentation is related to the patient's skin tone with skin types IV,V and VI more prone regardless of the wavelength used. Twice daily treatment with hydroquinones and broad-spectrum sunscreens usually resolves the hyperpigmentation within a few months, although, in some patients, resolution can be prolonged.[18]
Transient textural changes are occasionally noted but often resolve within a few months, however, permanent textural changes and scarring very rarely occur. If a patient is prone to pigmentary or textural changes, longer treatment intervals are recommended. Additionally, if a patient forms a blister or crust post treatment, it is imperative that they do not manipulate this secondary skin change. Early removal of a blister of crust increases the chances of developing a scar. Additionally, patients with a history of hypertrophic or keloidal scarring need to be warned of their increased risk of scarring.
Local allergic responses to many tattoo pigments have been reported, and allergic reactions to tattoo pigment after Q-switched laser treatment are also possible. Rarely, when yellow cadmium sulfide is used to "brighten" the red or yellow portion of a tattoo, a photoallergic reaction may occur. The reaction is also common with red ink, which may contain cinnabar (mercuric sulphide). Erythema, pruritus, and even inflamed nodules, verrucose papules, or granulomas may present. The reaction will be confined to the site of the red/yellow ink. Treatment consists of strict sunlight avoidance, sunscreen, interlesional steroid injections, or in some cases, surgical removal. Unlike the destructive modalities described, Q-switched lasers mobilize the ink and may generate a systemic allergic response. Oral antihistamines and anti-inflammatory steroids have been used to treat allergic reactions to tattoo ink.
Studies of various tattoo pigments have shown that a number of pigments (most containing iron oxide or titanium dioxide) change color when irradiated with Q-switched laser energy. Some tattoo colors including flesh tones, light red, white, peach and light brown containing pigments as well as some green and blue tattoo pigments, changed to black when irradiated with Q-switched laser pulses. The resulting gray-black color may require more treatments to remove. If tattoo darkening does occur, after 8 weeks the newly darkened tattoo can be treated as if it were black pigment.[19]
Very rarely, non Q-switched laser treatments, like CO2 or Argon lasers, which are very rarely offered these days, can rupture blood vessels and aerosolizes tissue requiring a plastic shield or a cone device to protect the laser operator from tissue and blood contact. Protective eye-wear may be worn if the laser operator choose to do so.
The use of Q-switched lasers could very rarely produce the development of large bulla. However, if patients follow post care directions to elevate, rest, and apply intermittent icing, it should minimize the chances of bulla and other adverse effects. In addition, health care practitioners should contemplate the use of a cooling device during the tattoo removal procedure. While the infrequent bulla development is a possible side effect of Q-switched laser tattoo removal, if treated appropriately and quickly by the health care practitioner, it is unlikely that long term consequences would ensue.[21]
Risks
Although laser treatment is gold standard method to remove a tattoo, unwanted side effects of laser tattoo removal include the possibility of discoloration of the skin such as hypopigmentation (white spots, more common in darker skin) and hyperpigmentation (dark spots) as well as textural changes. Very rarely, burns may result in scarring but this usually only occur when patients don't care for the treated area properly. Rarely, "paradoxical darkening" of a tattoo may occur, when a treated tattoo becomes darker instead of lighter. This seems to occur more often with flesh tones, pink, and cosmetic make-up tattoos.[22][23]
Some tattoo pigments contain metals that could theoretically break down into toxic chemicals in the body when exposed to light. This has not yet been reported in vivo but has been shown in the lab;. Laser removal of traumatic tattoos may similarly be complicated depending on the substance of the pigmenting material. In one reported instance, the use of a laser resulted in the ignition of embedded particles of firework debris.[24]
References
1. ^ The Harris Poll #15, February 12, 2008
2. ^ Harris Interactive Europe Poll
3. ^ Armstrong ML, et al., Motivation for contemporary tattoo removal: a shift in identity. Arch Dermatol. 2008 Jul;144(7):879–84.
4. ^ a b Kirby, William, Desai, Alpesh, Desai, Tejas, Kartona, Francisa, Tattoo Removal Techniques: Effective Tattoo Removal Treatments - Part 1, Skin and Aging, September 2005.
5. ^ Kirby, William; Desai, Alpesh; Desai, Tejas (2010). "Tattoo Removal: Wiping the Slate Clean". Skin and Aging 18.
6. ^ Goldman L. et al. Effect of the laser beam on skin. J Invest Dermatol. 1963;40: pp. 121–122
7. ^ Taylor C.R. et al., Treatment of tattoos by Q-switched ruby laser. A dose-response study. Arch Dermatol. 1990 Jul;126(7): pp. 893–9.
8. ^ Kilmer SL, Garden JM. Laser treatment of pigmented lesions and tattoos. Semin Cutan Med Surg. 2000 Dec;19(4):239.
9. ^ Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science. 1983 Apr 29;220(4596):524–7.
10. ^ Kilmer SL. Laser treatment of tattoos. Dermatol Clin. 1997 Jul;15(3):409–17.
11. ^ Kirby W, Chen C, Desai A, Desai T. Successful Treatment of Cosmetic Mucosal Tattoos Via Q-Switched Laser. Dermatologic Surgery, December 2011
12. ^ Kilmer SL, Anderson RR. Clinical use of the Q-switched ruby and the Q-switched Nd:YAG (1064 nm and 532 nm) lasers for treatment of tattoos. J Dermatol Surg Oncol. 1993 Apr;19(4):330–8.
13. ^ Alster TS. Q-switched alexandrite laser treatment (755 nm) of professional and amateur tattoos. J Am Acad Dermatol. 1995 Jul;33(1):69–73.
14. ^ Kirby,William, Desai,Alpesh, Desai,Tejas, Kartona,Francisa, Patel,Getta The Kirby-Desai Scale: A Proposed Scale to Assess Tattoo-removal Treatments, Journal of Clinical and Aesthetic Dermatology, March 2009, Volume 2, No. 3
15. ^ Kirby, William http://www.rethinkyourink.blogspot.com/, YOUR IMMUNE SYSTEM AND LASER TATTOO REMOVAL, October, 2008
16. ^ Kirby,William, Desai,Alpesh, Desai,Tejas, Kartona,Francisa, Tattoo Removal Techniques: Effective Tattoo Removal Treatments - Part 2, Skin and Aging, October, 2005
17. ^ Kirby,William, Desai,Alpesh, Desai,Tejas, Kartona,Francisa, Tattoo Removal Techniques: Effective Tattoo Removal Treatments - Part 2, Skin and Aging, October, 2005
18. ^ a b Kirby, William, Koriakos, Angie, Desai, Alpesh, Desai, Tejas, Undesired Pigmentary Alterations Associated with Q-Switched Laser Tattoo Removal, Skin and Aging, August 2010 http://www.drtattoff.com/images/articles/Undesired-Pigmentary-Alterations-Associated-with-Q-Switched-Laser-Tattoo-Removal-Skin-and-Aging-Aug-2010.pdf
19. ^ Kirby, William, Kaur, Ravneet Ruby, Desai, Alpesh, Paradoxical darkening and removal of pink tattoo ink - Journal of Cosmetic Dermatology, June, 2010 http://www.drtattoff.com/images/articles/Paradoxical-darkening-and-removal-of-pink-tattoo-ink-JOCD-Jun-2010.pdf
20. ^ Kirby, William, Desai, Alpesh, Desai, Tejas, Kartona, Francisa, Tattoo Removal Techniques: Effective Tattoo Removal Treatments - Part 1, Skin and Aging, September, 2005
21. ^ Kirby W, Kartono F, Desai A, Kaur R, Desai T, "Treatment of Large Bulla Formation after Tattoo Removal with a Q-Switched Laser", Journal of Clinical and Aesthetic Dermatology, January,2010 http://www.jcadonline.com/2210/treatment-of-large-bulla-formation-after-tattoo-removal-with-a-q-switched-laser/#more-2210
22. ^ S. Varma, et al. Tattoo ink darkening of a yellow tattoo after Q-switched laser treatment. Clinical and Experimental Dermatology. 2002: Volume 27 Issue 6, pp. 461–463
23. ^ Holzer A, et al. Adverse Effects of Q-Switched Laser Treatment of Tattoos. Dermatologic Surgery 2007: Volume 34 Issue 1, pp. 118–122
24. ^ Taylor Charles R., "Laser ignition of traumatically embedded firework debris," Lasers in Surgery and Medicine, 1998/22:157–158
Further reading
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Kirby W, Kartono F, Small R. (September 2011). "Chapter 30: Tattoo Removal with Lasers. Dermatologic and Cosmetic Procedures in Office Practice". Elsevier. pp: 367-376. ISBN 978-1-4377-0580-5
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Wysong P, "Tattoo Removal Comes Of Age - An Expert Interview With Dr. William Kirby and Dr. Rady Rahban" Medscape, August 16, 2011 http://www.medscape.com/viewarticle/747828
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Kirby W, Kartono F, Desai A, Kaur R, Desai T, Treatment of Large Bulla Formation after Tattoo Removal with a Q-Switched Laser,Journal of Clinical and Aesthetic Dermatology, January,2010 http://www.jcadonline.com/2210/treatment-of-large-bulla-formation-after-tattoo-removal-with-a-q-switched-laser/#more-2210
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Verhaeghe, Evelien (January 2010). "Chapter 7: Techniques and Devices Used for Tattoo Removal". In De Cuyper, Christa; Pérez-Cotapos S, Maria Luisa. Dermatologic Complications with Body Art. Heidelberg: Springer-Verlag. pp. 91–105. doi:10.1007/978-3-642-03292-9_7. ISBN 9783642032912.
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Goldberg, David J. (4 December 2007). "Chapter 3: Pigmented Lesions, Tattoos, and Disorders of Hypopigmentation". Laser Dermatology: Pearls and Problems. Malden, Massachusetts: Blackwell. pp. 71–113. doi:10.1002/9780470691991.ch3. ISBN 9781405134200.
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