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Half the people who get tattoos will want them removed someday. However, removing a tattoo is not as easy as getting one. An expert explains some of the factors to consider before having skin art removed.

These days, getting a tattoo is safer, easier and more popular than ever. Most people who get a tattoo expect their skin art to be a lifelong decoration, but for many, the time comes when they consider having it removed. They quickly discover that getting rid of a tattoo is generally much more difficult and more costly than getting one.

Dr. Julie Woodward, an oculoplastic surgeon at Duke University Medical Center with a special interest in cosmetic laser surgery, said more people with tattoos means more 'tattoo regrets.'

"As the demand for tattoos has gone up, so has the demand for tattoo removal," said Woodward. "There are approximately 10 million people in the U.S. who have at least one tattoo, and we estimate about half those people will want them removed at some point."

Woodward said most tattoo removal techniques now use laser technology. The laser delivers a short energy pulse that shatters the pigment into fine pieces. Every time a laser is applied, a certain amount of ink will shatter and macrophage cells come in and carry away the debris. Each time you have a laser treatment, there is slightly less ink remaining.

"The laser has no idea what any kind of tattoo ink is, it only knows what any kind of pigment is," she explains. "So a patient with very pale skin is a much better candidate for tattoo removal than an African American or an Asian or Hispanic. Because these groups have more pigment in their skin, the pigment in the basal layer of the epithelium will absorb the laser energy, heat up and cause hypopigmentation, or lighter areas. So an African American could potentially have white marks where the laser was. We always do test spots on tattoos just to make sure there's no problem."

Woodward said the removal procedure involves some pain and office visits over a period of several months. "I think most people have done some research before they make the doctor's appointment and realize they're in it for the long haul. Occasionally we have a patient who's surprised they can't get it taken off in one visit.

"Actually the removal of the tattoo hurts quite a bit more than having it done in the first place. Usually we give numbing creams that don't deaden all the pain, but do take the edge off. For people who have large tattoos, each pulse of the laser is about a four-millimeter spot, so it can add up to a fair amount of pain."

Woodward identifies some other factors to consider about tattoo removal:

Difficulty of removal depends on the size of the tattoo and the colors of ink. Blue and black inks are easiest to take off; other colors, especially bright greens and reds, are far more challenging. "Even if a tattoo cannot be completely removed," said Woodward, "it can often be partially removed to the point where it looks like a bruise and then covered with makeup."

Having a tattoo taken off may change the texture of the skin. The skin in that location may be somewhat thicker and whiter. Woodward said most patients are perfectly fine with this change: "They're just happy to have the ink off."

While rare, there are health risks associated with getting a tattoo. Dirty needles can transmit hepatitis and HIV. Some individuals can have a severe allergy to certain inks and can suffer chronically irritated skin until the tattoo is removed. And some inks have metallic pigments that can heat up and cause irritation to the skin during an MRI scan. "I've heard of some radiologists who refuse to do MRIs on patients with large tattoos," said Woodward.

The patient needs a treatment about every four to six weeks. The number of treatments can usually be predicted by the type of ink and size of the tattoo. Blue-black tattoos can typically be removed in four to six months.

Professional tattoos deposit more ink in the dermis than homemade tattoos and require more treatments to remove.

Tattoos can be removed from all areas of the body. "I've removed quite a few tattoos for patients who have had cosmetic tattoos on their eyelids and eyebrows," notes Woodward. "They come out very nicely without disturbing the lashes."

The cost of removal depends on the size of the tattoos and how much time the laser is in use. Small tattoos take about five minutes to treat, and the cost currently ranges between $300 - $500 per session. Tattoo removal is not covered by medical insurance. "The laser we have at Duke is a $150,000 machine," adds Woodward. "If patients don't understand why it's so expensive to have a tattoo removed, that's why."

The number-one reason for tattoo removal? Woodward said it's to erase a former sweetheart's name or an embarrassing symbol.

"The most important thing for patients to understand is that if they have a blue-black tattoo, chances are they're going to have a nice result. They're going to be able to get the tattoo off and have Johnny or Frankie or that swastika or marijuana leaf removed. We help a lot of brides wear their wedding dresses without having to worry about an old boyfriend's name showing."