Getting his tattoo took less than 20 minutes. Regret set in within hours.

“What does it mean?” I asked.

“I don’t know,” my honest offspring responded.

It had taken less than 20 minutes and cost my son nothing: a Trojan Horse gift from a friend who happened to be a tattoo artist. Regret had set in within hours: the kind of burning remorse that, depending on which survey you read, affects between 23 and 78 percent of people who let other people draw “permanent” designs on their skin.

“I genuinely feel like I’ve ruined my life forever now, like I’ll never truly be happy unless they’re gone,” reads a typical comment on a recent Reddit forum titled “Severe mental health issues from tattoo regret.” Other writers speak of feeling “genuinely suicidal” or “insane with anxiety.”

There’s no quick or easy fix for tattoo angst. My son faces at least several sessions of laser treatment, at a cost of more than $1,000, none of which his parents intend to pay. The pandemic has further taxed his patience, postponing future appointments.

Tattoo regret, as we two have since learned, feeds a booming industry that earlier this year was on track to reach $4.8 billion by 2023. That’s mostly because tattoos themselves have been so popular. A 2015 Harris Poll found that nearly half of millennials and more than one-third of Gen Xers had at least one tattoo, compared to 13 percent of baby boomers.

Nonetheless, tattoo shame is as old as the Old Testament, in which Leviticus 19:28 says, “Ye shall not make any cuttings in your flesh for the dead, nor print any marks upon you.” Tattoos indeed violate Jewish law, although contrary to popular belief, they may not disqualify you from being buried in a Jewish cemetery.

People regret their tattoos for many reasons. The artwork may no longer feel meaningful. That colorful rainbow may have faded and stretched. Tattoos can also thwart career progress. In 2013, the U.S. Army banned anyone enlisting with tattoos on the neck, hands or face.

Once you’ve decided that gang emblem or butterfly no longer fits your lifestyle, you have a lot of choices, from inexpensive DIY creams, which doctors warn can irritate the skin, to high-tech and high-cost outpatient laser treatments.

My son knew he wanted to see a professional, but as I helped with his research, we faced new and baffling questions. Assuming he chose a laser treatment, how to choose between conflicting reviews of the PicoWay or PicoSure, which operate on picoseconds (trillionths of a second) or the older, nanosecond varieties with names like Ruby, Alexandrite and Nd: YAG? Or what about skipping the lasers and trying dermabrasion, with a small skin-grinding tool, or excision with a scalpel, under a local, regional, or general anesthesia?

Given that these latter methods risked serious pain and scarring, we ended up gathering referrals to dermatologists specializing in tattoo removal with lasers — and immediately faced sticker shock. The receptionist for one highly touted physician coolly told me she charged $375 just for a consultation.

After more referrals and calls, I found a San Francisco doctor who charged $195 for the consultation but, unlike the first, applied it to the treatments, each of which would cost $300 and of course wouldn’t be covered by insurance. Still, by then it looked like a deal. At our first appointment, he told my son to expect to come in at least three more times for treatments with his PicoWay laser.

That was good news — relatively. Doctors figure out how many treatments you might need by consulting the Kirby-Desai scale, on which the number grows to the degree that you have darker skin, a more colorful tattoo, or a tattoo in an area of poorer circulation, such as hands or feet.

Internet sites such as WebMD suggest a dermatologist is a safer bet than a dedicated tattoo-removal shop operator. Yet I wondered if there might not be exceptions after talking to Chris Slavin, the contagiously confident owner of Zapatat in Arlington. Va.

“I’m not a dermatologist, I’m a geek,” said Slavin, a former senior living properties executive, who argued that Zapatat has performed far more treatments than most dermatologists and that experience makes a big difference. Before the pandemic, his nine-year-old business was treating 50 tattooed people a week, which he estimated was more than most dermatologists see in a year. He shut down March 15, but has been taking bookings for June.

At my son’s first appointment with the dermatologist, the doctor numbed his skin with an anesthetic cream and ice and talked us through the procedure as he traced the little heart and hands with the laser.

Tattoos are made of thousands of particles of ink embedded just below the skin. The ink sticks around because those particles are too big to be flushed away by the immune system, as would occur with other foreign bodies. But lasers can heat and shatter the particles into smaller, more digestible bits. The treatment isn’t painless — my son said it felt like being snapped by rubber bands.

Watching through my safety goggles, I was initially thrilled to see what looked like ink popping off my son’s skin, although immediately afterward the tattoo seemed unchanged. The doctor said it would take weeks before we’d notice any fading. Weeks later, the change was minimal.

Slavin, at Zapatat, argued that he could have saved my son money and time with an accelerated technique, using an older Nd:YAG laser, which can provide four treatments (at $99 each) in one session without damaging the skin. “There’s a big hoopla over the picosecond lasers, but we outperform them hands-down,” he asserted.

Scientific research has yet to clarify which kind of laser is best. A study last year in the journal Photochemistry and Photobiology said there was an urgent need for more clinical trials of the picosecond lasers to compare their safety and effectiveness with more time-tested equipment.

The tattoo-removal industry keeps evolving. Some dermatologists say a new silicone patch used with laser treatments can speed subsequent fading. Others report that a commercially available hydrogel dressing helps reduce pigmentation loss in darker-skinned patients. A Houston-based medical device firm called Soliton claims it has developed breakthrough “acoustic wave” technology, approved by the Food and Drug Administration, that can greatly reduce office visits for tattoo removal and get rid of your cellulite to boot.

It all seems hopeful, but my advice about tattoos remains unchanged from before my son and I embarked on this journey. Think twice before getting one — or at least make sure it’s something you can live with for a long, long time.

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