title: Analysis of incidence of bulla formation after tattoo treatment using the combination of the picosecond Alexandrite laser and fractionated CO2 ablation.
abstract: BACKGROUND
  The picosecond Alexandrite laser has shown increased efficacy in tattoo removal in comparison to Q-switched lasers. However, bulla formation is a well-known and expected side effect of this novel treatment and causes patient discomfort.
  
  
  OBJECTIVE
  To analyze the incidence of bulla formation after tattoo treatment using the combination of the picosecond Alexandrite laser and fractionated CO2 ablation.
  
  
  METHODS
  This is a retrospective chart review to determine the incidence of bulla formation after laser tattoo removal in 95 patients who were treated with either with the picosecond Alexandrite laser alone or in combination with fractional CO2 ablation.
  
  
  RESULTS
  Twenty-six patients (32%) treated with the picosecond laser alone experienced blistering, whereas none of the patients treated with the combination of the picosecond laser and fractionated CO2 ablation experienced blistering. The difference in incidence of bulla formation between the 2 groups was found to be statistically significant (p < .05).
  
  
  CONCLUSIONS
  This study shows a significant decrease in bulla formation associated with tattoo treatment when fractionated CO2 ablation is added to the picosecond Alexandrite laser, which is consistent with observations from a previous case series. This is important because decreasing extensive blistering likely results in increased patient satisfaction and willingness to return for future treatments.
authors.affiliation: *Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois; †Goldman, Butterwick, Fitzpatrick, Groff & Fabi: Cosmetic Laser Dermatology, San Diego, California.
authors.forename: Sonoa
authors.initials: S
authors.lastname: Au
authors.forename: Ana M
authors.initials: AM
authors.lastname: Liolios
authors.forename: Mitchel P
authors.initials: MP
authors.lastname: Goldman
mesh_terms: D001768:Blister / Q000209:etiology* / Q000517:prevention & control*; D003131:Combined Modality Therapy; D006801:Humans; D054020:Lasers, Gas / Q000009:adverse effects* / Q000627:therapeutic use*; D053844:Lasers, Solid-State / Q000009:adverse effects* / Q000627:therapeutic use*; D012189:Retrospective Studies; D013653:Tattooing