Did you know that, according to research conducted by the Pew Research Center in August 2023, almost one-third of Americans now have at least one tattoo, and one-fifth have more than one?

Tattoos were once considered a body modification predominantly for men, particularly sailors. However, the trend has changed drastically in recent times. According to this recent study, 38% of American women now have at least one tattoo, while only 27% of men do. The percentage of women with tattoos is higher among younger women, with 56% of American women aged 18 to 29 having at least one tattoo and 53% of women aged 30 to 49 also having tattoos. The number of adults aged 50 to 64 having tattoos is relatively lower, with only 25% having tattoos and 65 and older at 13%. Among different races and ethnicities, Black Americans have the highest percentage of tattooed individuals, with 39%, followed by Hispanic with 35%, White with 32%, and Asian Americans with only 14%.

As tattoos have become more popular and commonplace, they have gained greater social acceptance. One result is that dermatologists are asked increasingly how to care for tattooed skin, how to maintain a tattoo’s appearance as its “canvas” ages, and how to successfully remove a tattoo that is no longer wanted.

Here’s what you should know:

1. Choose a mole-free area of your body when considering a new tattoo. You don’t want to make detecting the earliest signs of skin cancer more difficult because even melanoma—the deadliest form of skin cancer—is highly treatable if caught early enough.
2. Tattooed skin needs moisturizer and SPF. You’ll want to avoid petroleum-based products, which can cause the ink to fade, and opt for water- or plant-based moisturizers, such as coconut, shea, hemp, or jojoba oil. UV light can also fade some tattoo inks, so protect your tattoo—and the rest of your skin—by applying a broad-spectrum, water-resistant sunscreen with a Sun Protection Factor (SPF) of 30 or more. Apply the sunscreen 15 minutes before you go outside and reapply at least every two hours.
3. Avoid tanning beds and sunlamps. These devices can fade the ink in tattoos and increase your risk of skin cancer. For some people, the UV light may react with the ink and cause a painful reaction.
4. See your dermatologist if you have a skin reaction or if your tattooed skin is changing in any way. Even years later, your skin may have a bad reaction to the ink in a tattoo. A change could also be a sign of skin disease. Your dermatologist can diagnose what’s happening and treat it.
5. Your tattoo will age with your skin. Wrinkles, crepey skin, and hyperpigmentation will inevitably change your tattoo’s appearance, as they will your non-tattooed skin. In addition, the ink in your tattoo will fade over time. (Interestingly, tattoo artists say that a large design will hold up better than a small one because any blurring of the lines with age will muddle the detail in a smaller tattoo.) To prolong the life of your tattoo—AND of the rest of your skin!—practice good skincare by incorporating the Four Pillars of Modern Wellness:
   • EAT your water! (To keep your skin hydrated and build strong cell membranes.)
   • MOVE your body! (Exercise builds muscle, which holds more water than fat; counteracts the wasting that can accompany aging; and relieves stess.)
   • AWAKEN your mind. (To minimize the effects of Cultural Stress.)
   • NOURISH your skin! (Skincare is healthcare. It’s your body’s largest organ!)

If you want to remove a tattoo

There are many reasons you may want to remove a tattoo: your feelings or aesthetic tastes may have changed; the tattoo itself may not be aging well; a new profession or relationship may have stricter rules regarding tattoos, including the one you have. One study found that 78% of tatted people regret at least one of them. Whatever the reason, the best technology for removing an unwanted tattoo is the new generation of lasers.

When lasers were first introduced for tattoo removal in the 1960s, they often caused tissue destruction and scarring. However, according to a PubMed article, lasers with “Q technology” are capable of more effective ink removal with less “collateral” damage. The specific type of laser used for best results will depend on:

• How long you’ve had the tattoo.
• How deeply the ink penetrates your skin.
• Your normal skin color. (Darker skin types may experience hypopigmentation following laser tattoo removal, so should be treated cautiously.)
• The colors in your tattoo. (Colors that respond best to laser removal are black, brown, dark blue, and green, while the most difficult colors to remove are red, orange, yellow, and light blue.)
• Where the tattoo appears on your body.
• Your health.
• The medicines you take.
• If you’ve ever had a raised scar.

Removing a tattoo with a laser usually requires multiple sessions, based on the size, colors involved, and other factors. Also, in many cases, the tattoo will not be completely “erased.” Instead, it will be substantially lightened so that it is less noticeable.

It generally takes about 7 to 10 sessions to remove a tattoo with laser treatment and costs $423/session. In addition, you may have to wait 6 to 8 weeks between sessions for best results.

What about creams, dermabrasion, and surgery?

According to an article in Rolling Stone, titled “RS Recommends: Get Rid of Tattoos At Home With These Tattoo Removal Creams, “tattoo removal creams don’t actually remove tattoos. Instead, the tattoo removal creams can fade and re-color the skin around the tattoo to make the artwork less visible. If you want genuine removal, you’ll need to shell out for (and suffer through) laser or surgical tattoo removal.”

So, now that we have that misconception cleared up, here’s the scoop on dermabrasion and surgery:

Dermabrasion involves using a sanding device to remove the top layers of tattooed skin, encouraging the tattoo to fade. The effectiveness of dermabrasion varies widely from person to person, making it a less popular option, especially for people with very sensitive skin or a skin condition like eczema. If you take blood thinners, you may also be more prone to bleeding, bruising, and changes in your skin color following the procedure, which is especially true for people with darker skin. During a typical dermabrasion session, the clinician will administer a local anesthetic to reduce any pain. The length of the procedure varies, depending on the size and color of your tattoo, but it may take an hour or more. Full recovery can take several weeks, although pinkness or discoloration may require 8 to 12 weeks to fade.

Surgical removal involves making a surgical incision (under local anesthesia) to remove the tattoo and stitching the edges of the incision back together. It’s the most invasive method, often less expensive than laser removal, but will always leave a scar. As a consequence, it’s usually only done on smaller tattoos.

The healing process takes several weeks. Your surgeon will probably prescribe an antibiotic ointment, recommend that you keep the site clean and out of the sun, and follow any other aftercare instructions.

As a dermatologist, I always prefer my patients’ natural skin. However, if you’re one of the millions of people who have chosen a tattoo, I hope you’ll take as good care of it as you would your natural skin!