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An Online Wellness Magazine produced by The University of Texas Health Science Center at Houston (UTHealth)

Think Before You Ink

Be smart (and safe) when deciding to get a tattoo

Need proof tattoos, or “tats,” are anything but taboo? 

Though fashion may be the most ephemeral of arts, jeweler Pamela Love bestowed a permanent party favor on her guests at last season’s runway collections: tattoos. 

Ink has so seeped into our culture that getting stamped has become a rite of passage for the young and the famous—especially females. Last year, tattooed women outnumbered marked men, 59 to 41 percent, according to Lightspeed Research.  

“Angelina Jolie wannabes think tattoos make you cool and risqué,” says Ronald P. Rapini, MD, Josey Professor and Chair of the Department of Dermatology at The University of Texas Health Science Center at Houston (UTHealth) Medical School. “Part of the mystique is when you get something few will see.” 

Capitalizing on the popularity of tattoos are recent TV shows such as Oxygen’s “Best Ink,” TLC's “LA Ink,” A&E’s “Tattoo Highway,” Spike TV's “Ink Master”—and even PBS’ “Skin Stories.” Further fueling the fad has been the frequent display of tattoos on social media sites Twitter and Instagram from oft-inked celebrities such as Justin Bieber, Miley Cyrus and Lady Gaga. 

But tattoos go way back. The very first were traced to 5,200 BC, intended to relieve joint pain and ward off evil spirits, reports the Smithsonian Institution. Over the centuries, ink served as an emblem of the elite, camouflage of the scarred or, in recent decades, war paint on those who saw themselves as outsiders. Few rebels with a cause—be they convicts, circus freaks, gangsters, bikers or soldiers—may realize they shared ink with Britain’s King George V, who reigned from 1910 to 1936. 

Warning: A tattoo is (somewhat) forever

Just as varied can be a tattoo’s subject matter, from mottos to marigolds and Marilyn Monroe to “Mother.” 

Getting tattooed is like being pricked by a threadless sewing machine that deposits ink—painfully. Not that everyone remembers, Rapini says. “So many will say, ‘I was drunk and it didn’t hurt that bad.’” 

Professional parlors tend to needle deeper into the dermis, creating darker and sharper images. “Homemade tattoos are made with cigarette ash, car paint—anything they can find,” says Rapini. “They don’t go as deep, in part because they hurt.”  

Yet many fail to think before they ink, says David J. Wainwright, MD, professor in the Division of Plastic and Reconstructive Surgery at UTHealth Medical School. “It’s not something you can change, like your clothes. It’s there pretty much for life.” 

An ink-stained person’s regret can far exceed the dieter’s “moment on the lips, lifetime on the hips”—especially if he or she decides to prove love is forever by etching his or her mate’s name on skin. Just ask Jolie (former owner of a “Billy Bob” tattoo in honor of ex-husband Billy Bob Thornton), Johnny Depp (who has since changed “Winona,” as in Ryder, to “Wino Forever”) or one of Rapini’s patients, who regrettably branded “Property of Emil” on her chest. 

“You never know. Relationships change,” says Rapini. 

Over time, body ink fades and borders smudge. Nonprofessional tattoos distort within six months to a year, while a professional’s ink may endure several years, Wainwright says. “With age, skin does stretch and sag—especially on the abdomen and breasts—so the original tattoo may not retain its former glory.” 

“But the worst place to be tattooed is on the face,” adds Rapini. “Who’s going to hire you?” 

Consider, too, any time you break the surface, you risk infection. Until it heals, skin must be kept clean and covered with antibiotic ointment and a non-adherent bandage (if the surface is large), Rapini says. Risk of the dangerous and often chronic liver disease hepatitis B from used needles is rare, especially if you go to a licensed professional. 

One percent of people with tattoos get an allergic reaction, most commonly to red dye, which may leave permanent bumps or scales. “The only way to remove it is surgically,” says Wainwright. 

Also, you may wish you had brought along a decent grammarian or a foreign language translator to your appointment, Rapini warns. “The parlor can say the tattoo means something and you find it means something different—or it’s misspelled.” "Nashville" star Hayden Panettiere boasts a torso tat that reads “To Live Without Regrets” in Italian. Since it was inked with a misspelling, the phrase now contradicts itself. 

Removal: slow, painful and pricey

With tattoos, people are increasingly confessing buyer’s remorse, and TV has turned to drat-that-tat programming such as Spike TV’s "Tattoo Nightmares" and TLC’s "America’s Worst Tattoos." 

“It’s a slow process to remove a tattoo,” says Rapini. The most common method is laser, in which high-intensity light beams are directed at pigment to explode it into tiny particles that white blood cells carry away. While lasers rarely leave scars, they may leave a flat whitish or brownish area, Rapini says. For the best results, go to a board-certified dermatologist or plastic surgeon. 

What may have taken 15 minutes to create can take three to 15 equally labor-intensive, painful and pricey sessions to erase. Insurance does not cover the $100 to $300 monthly visits. “It adds up,” says Rapini, “The lucky few can get an image removed in three treatments at monthly intervals.” 

Indeed, heavily-inked actor Mark Wahlberg has had 30 sessions so far— not the five-to-seven visits he was expecting—just to obliterate a Sylvester the Cat tattoo on his leg. 

“I’ve taken my two older kids to the procedure so they can see how painful it is and what I have to go through,” Wahlberg said in a recent interview. “It’s like getting burned with hot bacon grease…Hopefully that will deter them.” 

People with obscene tattoos also can have surgeons change a letter, if needed. “It leaves a small scar, but it’s faster than laser. We can cut and stitch part or all of a tattoo to form another letter, say an L instead of an F,” says Rapini. 

While removals may have risen 20 percent locally in the past four years, “people usually put up with [their regretted tattoos],” says Wainwright.

Of course there's another way to get inked without regrets: apply a stick-on or get a henna tattoo. “Henna tattoos are safe, except for rare allergic reactions,” says Rapini. “They’re fun – and they’re temporary!”