Removal techniques -- always more expensive than having tattoos applied in the first place -- range from excisional surgery and dermabrasion to the newer lasers. And while patients may no longer have a tattoo after these procedures, they almost always emerge with some kind of scar or mark, say physicians at the University of North Carolina at Chapel Hill.

Add those reasons to the ever-present threat of infection, and Dr. Robert Tomsick, associate professor of dermatology at the UNC-CH School of Medicine, makes a case for thinking twice before going under the needle.

"What you're doing is breaking the skin and introducing pigmented material into the area," Tomsick said. "Even though the needle only goes in a little way, anytime you break the skin, you have a risk of bacterial or viral infection. I think it [getting a tattoo] is generally a risky thing to do."

Tomsick said he's especially concerned about methods amateur tattoo "artists" use to introduce pigment into skin. "I've even heard of people using wooden sticks and forcing in the pigment," he said. "Once pigment is in, even if there's no infection, there's always the chance of contact allergies, dermatitis and allergic reactions that can cause skin to get red, swollen, crusty and itchy."

Such reactions, which occur more often with red and white pigment than with blue and black tattoos, generally continue until the pigment is removed, Tomsick said. He also cautions dark-skinned people that they are at risk of getting keloid scars -- raised scars that keep growing -- from tattoos.

"These begin with pain and tenderness and can get to be so big that they can interfere with movement on certain body parts," he said.

Laser ablation is the newest and best for tattoo removal, but the process requires expensive equipment, including multiple lasers -- each specially tuned for the various pigment types to be removed, the physician said. Because of high equipment and maintenance costs, he and his colleagues at UNC-CH have not pursued this work. "Nonetheless, for the patient who wishes the most 'elegant' and least scarring tattoo removal, laser is the way to go."

Dr. Lynn Damitz, assistant professor of plastic surgery, said her department is looking at the possibility of purchasing laser equipment necessary for tattoo removal. "Lasers designed for this purpose have gotten much better at tattoo removal," she said. However, tattoo removal lasers are not yet standard at most hospitals. Such surgery takes multiple sessions, with each costing from $250 to $400.

"It's very expensive, and most of the patients I've talked to say it's more painful than getting the tattoo was," Damitz said.

Tomsick described the most common types of removal: Tattoos can be cut away with an excision that goes through the full thickness of the skin. All the skin is pulled off and then pulled together again. Excision on small tattoos can make the area less conspicuous, but "a scar will always be there when you take scalpel to skin," he said.

Dermabrasion involves a hand-held tool that literally sands off the tattoo along with the skin, he added. The procedure can remove most of a tattoo, but residual pigment often is left behind, along with a scar.

Damitz offered a word of advice for those who are determined to get a tattoo: "Go to someone reputable, a professional whose health record you've investigated. And if you think you might change your mind about your tattoo, don't get a red or yellow one. They're the hardest to remove."

Note: If no author is given, the source is cited instead.

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