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. Very rarely, non Q-switched laser treatments, like or Argon lasers, which are very rarely offered these days, can rupture blood vessels and aerosolize tissue requiring a plastic shield or a cone device to protect the laser operator from tissue and blood contact. Protective eyewear may be worn if the laser operator chooses to do so. With the mechanical or salabrasion method of tattoo removal, the incidence of scarring, pigmentary alteration (hyper- and hypopigmentation), and ink retention are extremely high. 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. Risks Although laser treatment is well known and often used to remove tattoos, 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 - these changes are usually not permanent when the Nd:YAG is used but it is much more likely with the use of the 755 nm Alexandrite, the 694 nm Ruby and the R20 method. Very rarely, burns may result in scarring, but this usually only occurs when patients do not properly care for the treated area. Occasionally, "paradoxical darkening" of a tattoo may occur when a treated tattoo becomes darker instead of lighter. This often occurs with white ink, flesh tones, pink, and cosmetic makeup tattoos. Some commercially available tattoo inks may contain organic pigments, also known as azo dyes. When these pigments are broken down via laser pyrolysis, the potential release of aromatic amine rings, a known carcinogen, into the body, could occur. This effect is theorized not to be