If you’re thinking about getting a tattoo, be wise and make sure you know the best way to go about it. Your health -- as well as the design you choose -- is at stake.

What is a tattoo?
Tattoos are created when colored pigment is injected into small holes made in the dermis, a deep layer of the skin. Today most tattoos are applied with an electric tattoo machine, which has needles that rapidly puncture the skin with an up-and-down motion.

Is it safe?
Getting a tattoo is perfectly safe if you follow proper precautions. However, there are some serious health concerns. A new study has found that people with tattoos are nine times more likely to have liver-ailment hepatitis C as people without tattoos. People with several tattoos or large, complex or multicolored ones are most at risk, according to the study reported in the journal Medicine. Researchers say the infection can be passed through the reuse of needles or dye and poor sterilization practices and techniques, such as when a tattoo artist pricks the back of his hand with a needle to determine if it’s sharp enough.

The Centers for Disease Control and Prevention says the risk of getting hepatitis B and even HIV transmission does exist if instruments contaminated with blood are not sterilized or disinfected, or are used inappropriately between clients.

Musts to look for
Don’t take it for granted that a tattoo parlor is “clean,” even if it looks spotless. Ask how needles and inks are used.

• Needles and inks used on one person must never be used on another. Legitimate tattoo parlors will always use new needles.
• The artist should unwrap the needle in front of you. If he doesn’t, ask him to.
• Every ink used in your tattoo should be poured into a small cup specifically for your tattoo. Any leftover ink should be thrown away after your tattoo is finished.
• Tattoo artists should wear surgical gloves to help maintain a germ-free environment near your skin.

Does it hurt?
As the needles in the tattooing machine rapidly pierce your skin, yes … it will hurt. Some people describe the sensation more as a vibration than a deep pain. In general, the skin covering bony areas (collarbone, anklebone, wrist) will be more sensitive to pain than other areas. Some say the pain level depends on the needles used; that the sharp sensation from needles used for outlining a design are more difficult to endure than the needles used to shade the design. Taking Tylenol or another acetaminophen may help dull the pain. But don’t take aspirin or ibuprofen as they tend to inhibit blood clotting, making you more apt to bleed.

Choosing a design
Tattoo artists say that anything that can be drawn can be tattooed. Each will have his or her own style. Before deciding on a design, visit more than one tattoo shop and look at the work of different artists. (Ask to see photographs if you don’t see them posted.) Once you find someone whose style you love, discuss your ideas with the artist to make sure you both have the exact same image in mind.

Removing a tattoo
Only about half the people who get a tattoo decide to live with it their entire life.

Tattoos are meant to be permanent -- so they are not easy to remove. There are several ways to eradicate them, each requiring procedures from a medical doctor. There is no magic way to make tattoos go away. Each procedure takes time, is costly and may either leave a scar or some color in the skin.

The successful removal of your tattoo depends on several factors. “It depends on the depth of the tattoo, the type of ink used, who did the tattoo, the colors of your tattoo and where it’s located,” says Dr. Harold J. Brody, clinical professor of dermatology at Emory University in Atlanta, Georgia.

The deeper the tattoo, the more difficult it is to remove it, Brody says. Amateur tattoos are usually shallower than professional designs and come off more easily. Professionals also tend to use a greater variety of colors and create more intricate designs, making it even more difficult to remove their handiwork.

Removing tattoos through excision. If your tattoo is small enough, it can be removed with a scalpel in about 30 minutes. A plastic or dermatological surgeon will inject a local anesthetic to numb the area, cut around the tattoo and suture the edges together. If a larger tattoo is being excised, it must be removed in stages. If the wound is cared for properly, the resulting scar will be minimal. Cost: from between $200 and $1500.

Removing tattoos through dermabrasion. The skin where your tattoo is located is sprayed with a solution that freezes the area, then “sanded” with an abrasive rotary instrument, causing the skin to peel. You will mostly likely have some scarring from this procedure. The skin needs to be dressed with antibiotic ointment for several days after the procedure. As the skin heals, sun exposure should be minimized as it may slow the healing process. Cost: from between $300 and $2,000.

Removing tattoos with a laser. Today, lasers are the best way to remove tattoos. There is almost no chance for scarring, the skin recovers in a couple of days and newer lasers are able to eradicate more ink than ever. The one drawback is the expense: It can cost from $300 to $1,000 per treatment, and usually several are needed.

There are three types of lasers used to remove tattoo ink, all known as Q-switched: Ruby, Alexandrite and the Nd:YAG. Each works by producing a short, high-energy light that passes harmlessly through the skin and is absorbed by a specific tattoo pigment. The laser causes the ink to break up and be absorbed by your body. A dermatologist removing a multicolored tattoo typically needs all three lasers to do the job. Black tattoo ink is the easiest to remove because it absorbs all laser light; dark colors such as red and blue can also usually be wiped out by laser; green and yellow inks are the most difficult to remove.

What does it feel like?
Laser treatments are not painless -- people say it feels as if rubber bands were snapping against the skin or bacon grease were spattering it. But since each treatment only takes a matter of minutes, the discomfort isn’t intolerable for most. Doctors say you can take Tylenol to help dull the discomfort, but don’t take aspirin or Ibuprofen -- both can make you more susceptible to bruising. Your doctor may have a cream to numb the area being treated. Afterward, the skin may feel as if it’s been sunburned, and the wound will need to be covered with a dressing for 24 hours. In some cases a scab may form over the area.

How many treatments are required?
The number of sessions depends on the type of ink that was used and how deeply it was injected. The deeper the tattoo, the more difficult it will be to remove. Usually professional tattoos required 5 or 6 treatments. Amateur tattoos, which are usually not as deep, require 3 or 4 treatments. Three-week intervals between laser treatments are recommended to allow your body to absorb the fragmented pigments from each treatment.

Side effects. The tattoo may not be completely eradicated. A scab may form over the treated area. In a small percentage of people - roughly 5 percent -- a scar may result. If you don’t keep the area clean and dressed with antibacterial ointment, the area could become infected. Finally, your skin’s pigment cells may react badly to the laser treatments. After the treatment, you may have an area of darkened skin known as hyperpigmentation, or you may have an area of lightened skin, known as hypopigmentation.

Cost of laser treatment. Each laser treatment can cost between $300 and $500. The number of treatments you need depends on the size of the tattoo, the inks and colors used, the depth of the tattoo and where the tattoo is located on your body.

Where to go for laser removal. It’s important to find a medical doctor who specializes in laser surgery to remove a tattoo. If you can’t get a referral from your doctor, check out The American Academy of Dermatology, The American Society of Dermatologic Surgeons or The American Society of Plastic and Reconstructive Surgeons for a specialist in your area.