PHILADELPHIA – Given that it is human nature to live to regret, the permanence of tattoos is a problem.

Marriages break up, and the ex still abides on the divorced bicep. Gang members find religion. A forked-tongue lizard on the ankle sends the wrong message when competing for clerkships with a judge.

“Saturday Night Live” recently did a spoof ad for tattoo vanishing cream featuring a mother with a tattoo leering from the top of her jeans as she trotted her kids out to the school bus. In time-lapse photography, a “Pretty Lady” tattoo sagged into “Pretty Sad.”

Truth in fake advertising.

The mainstreaming of tattoos over the last decade has spawned a new generation of parents and professionals with regrets about their indelible markers. And technology is evolving to help them.

Nicole Fedeli, a school counselor in Voorhees, N.J., says that she was 21 when she had a dolphin tattooed on her ankle. Four years later she added a lizard on the top of her foot. “I thought they were cool at the time,” Fedeli says. Now 30, she says, “As you get older and go to nicer places, they just don’t look classy.”

Patients like Fedeli are increasingly common in the offices of laser surgeons.

“The interest in tattoo removal has increased … commensurate with the number of people with tattoos,” says Roy Geronemus, director of the Laser & Skin Surgery Center of New York and president of the American Society for Laser Medicine and Surgery.

Doctors report three main categories of patients who want their tattoos removed: Teenagers accompanied by upset parents “trying to rectify the mistake,” young professionals whose tattoos are not appropriate for their new image, and – the largest category – new parents. Especially mothers.

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Linda Schreiber, a seventh-grade science teacher from Haddon Heights, N.J., was a student at Rutgers University in 1994 when she had a sprawling illustration of the Giving Tree from Shel Silverstein’s classic children’s book tattooed across her lower back.

“The Giving Tree was my favorite book when I was a kid,” Schreiber explains. “For my 16th birthday, a friend bought a new copy of it for me.” When that friend died, Schreiber got the tattoo in memory of her.

She’d only had it a few years when she began to regret it.

“I thought when I have kids, I wouldn’t want them to see it … and it’s not professional.”

Until the 1990s, the only way to remove tattoos was to scrape the skin or slice it off. Scars were guaranteed. But then lasers were developed, using various light frequencies and colors to penetrate the skin, target specific pigments, and blast the dye into tiny pieces that the body absorbs.

Although a vast improvement over older techniques, the process is still no lark.

“Some pigments just don’t come out,” says Steven S. Greenbaum, director of the Skin and Laser Surgery Center of Pennsylvania in Philadelphia. Black and red are usually the easiest. Aquamarine and purple can be much harder. So can yellow, which, to make matters worse, may contain cadmium and create an allergic reaction in the sun. (Doctors are loath to use lasers on tattoos that have created allergic reactions.) White, which may be hidden in other colors, can oxidize and turn black when exposed to a laser.

No one should expect to walk out with a blank patch of skin after one session, says Greenbaum. “It can take many, many treatments and even then … we won’t always be able to get it all gone.”

The summer before he entered 10th grade, golf pro Chris Young and a band of his friends from Doylestown, Pa., all branded themselves with a symbol of their brotherhood.

“It was a group thing,” Young says, with unsparing remorse. “We were all idiots.” Young took a needle and thread dipped into India ink and jabbed himself about a thousand times to put the design – which resembles a yin-yang without the dots – on the inside of his arm.

“When you’re 14, you don’t realize how strong permanent is. I regretted it right away, but I couldn’t afford to do anything about it.”

Now 27, Young has had five laser treatments so far and keeps what’s left of his tattoo covered by a sweat band.

A relatively small plain, black, amateur tattoo usually comes off easily with minimum cost, a few sessions at $200 to $300 each. Young’s, however, will take about seven treatments. And a multihued professional tattoo may require many more visits, which must be spaced out over months or years and can cost thousands.

People with dark complexions may need to use bleaching creams in advance so that the light beams don’t get absorbed by the melanin in their skin. This minimizes the chances of the lasers hurting the skin’s surface.

In spring 2000, Schreiber had her first appointment with Eric Bernstein, a laser surgeon.

“I came for a few treatments,” Schreiber says. “But then I wanted to buy a house. Then I got married. Then I had a baby. So it’s been four years since the last time I was here.”

For this session, Schreiber lies face down on a table and lifts her shirt. Bernstein examines the partially faded tattoo and begins to inject lidocaine, a local anesthetic, under her skin. Since the tattoo is large, she requires at least 30 injections.

“It definitely hurts more than getting the tattoo,” Schreiber says.

A technician applies a slab of gel across Schreiber’s back to minimize blistering, then gives her goggles to protect her eyes.

The laser is a box about four feet high with a flexible wandlike device attached. Bernstein guides the tip methodically, shooting pulses of light over every inch of the tattoo. Each burst, lasting only billionths of a second, is accompanied by a soft clacking sound.

When he’s done, Bernstein tells her how to care for the blisters that may appear days later.

“To be successful, 50 percent is what I do and 50 percent is what the patients do,” Bernstein says. After treatment, they must apply balm, cover the wound, and keep the area completely shielded from the sun so the skin can heal.

Bernstein, 46, is a dermatologist with additional degrees in engineering and business. He holds several patents for laser techniques and devices. In his practice, he treats patients with disfiguring port-wine stains and birthmarks, as well as performing cosmetic laser surgery to remove veins, excess hair and wrinkles. For years now, he says, tattoo removal has been a steadily growing part of his work. (In 1998, Philadelphia Weekly dubbed him “Dr. Zap.”)

Lately, he says, technological advances have been more refinements than major breakthroughs. “What has changed is that everyone and their neighbor wants to get into laser.”

And that’s a concern.

Regulations vary from state to state. In Pennsylvania, for example, you don’t need to be a doctor to operate a laser. In New Jersey, you do – although you don’t necessarily have to be trained in dermatology. No matter what the laws, patients need to be cautious and ask a lot of questions before making a choice.

Although the Centers for Disease Control does not collect specific data on tattoo removal, laser surgeons say they are finding increasing anecdotal evidence of injuries from inexpert practitioners.

Laser machines, which typically cost between $60,000 and $100,000 each, must be carefully maintained. Different types may be required to treat different colors. Some centers rent machines, and have some lasers available only on certain days.

According to the physics of lasers, the longer wavelengths are more effective and less dangerous in removing tattoos. Bernstein says that he has seen damage when an inexperienced laser operator turns up the intensity trying to remove a stubborn color. Higher intensity generates more heat on the skin’s surface and can create burns and scars.

Yet another danger exists if a patient has had an allergic reaction to the dyes in a tattoo. Laser treatment to these tattoos has caused life-threatening anaphylactic reactions.

“Basically,” says Bernstein, “you tell them it isn’t worth the risk.”

Less than an hour after her appointment began, Schreiber’s tattoo is covered with bandages and she’s ready to leave. As she writes out a hefty check and makes her next appointment, she asks Bernstein, “Do you think we’ll get to the point where … “

“It will be gone?” he finishes her sentence.

“Yeah,” she says. “I know you can’t say exactly, but … “

“But I can’t say exactly,” he says.

If he’s unwilling to raise expectations too high, Bernstein says he’s continually amazed at how well most tattoos come off.

“The majority of patients wish it would come off faster, but the vast majority are extremely happy with the results.”


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