Tattoo parlors are doing a land-office business these days, and the customers are not drawn from a pool of street toughs as once was generally believed. "I just always wanted one since I saw a girl with a butterfly on her ankle," said 22-year-old Lynda Roberts of Pike Township, Ohio. "So on my 18th birthday, I just said 'I'm going to do it.

'" The red heart the size of a quarter just north of her ankle, she said, gave her the "tattoo bug."
"Now my girlfriends, except for one, all have them. One has the barbed wire around her arm.

But I have two more where you don't see them every day. Sometimes, I wish I didn't have the heart where I put it because it just doesn't go everywhere. But I have it, and it's not coming off.

" Economically, in Roberts' case, that is a sound decision. Removing tattoos is more difficult and exponentially more expensive than getting them. Ask Dr.

Steven S. Carp, a cosmetic surgeon who uses lasers to remove unwanted tattoos. That arm of his practice at Carp Cosmetic Surgery Center in Green, Ohio, is not booming - yet.

"I get more and more people requesting it. It goes in stages. There probably are more women coming in simply because of the stigma," he commented.

"I think the biggest impetus is getting into the workplace for women. If they put it on their ankle and they have to wear nylons, that could be a problem. "A lot of the guys I see do it (tattoo removal) because they are going into the military and if you have a big tattoo on your neck, they don't want that.

² Carp considers this tattoo boom period the precursor of a laser removal boom period in the next five, 10 or 15 years. Then, of course, today's lasers will be obsolete. But for the person who struggles with tattoo regret today, removal will take time and money.

Carp explained the procedure by comparing a tattoo to a stone. "The ink stays in the skin because the particles are too big for your tissue to remove. What the laser is doing is focusing a certain wave length to target a certain color.

It's like a sledgehammer breaking up that boulder," he continued. "Then the smaller pieces can be carried out through the body." The cost for laser removal is based on the size of the body art.

For example, a tattoo the size of a quarter will require a minimum of four laser treatments, at $150 to $200 per session. And the patient still may not be home free. "Typically, we don't expect to see a scar but there is that potential.

My experience has been that people who are getting tattoos can get an allergic reaction to the dye and develop scarring from the tattoo. When you treat it with laser, as you break it up, you may activate it again," Carp said. He also cautioned that laser treatment on dark skin may cause it to lighten.

Though he has not seen such cases in his practice, Carp said professional literature indicates older tattoos have the potential to darken when treated. Any advice for someone contemplating getting a tattoo? "I would tell them green is the worst color to get.

Don't get green. It is resistant to laser treatment because it has an unpredictable component. The ink may have been mixed and there may be blue in it," he offered.

"You might be able to get all the tattoo (off) except the green part." There is another concern arising as more and more young girls choose tattoos that traverse their spines. Some young women are getting an unexpected surprise along with the designs they commissioned for their backs.

When they visit their obstetrician, they could be told that some anesthesiologists will not perform an epidural during labor because of the ink covering the spine. The medical reasoning is simple. What could be more sensitive than the spine?

Dr. Roy Hall of RLH Anesthesia in North Canton, Ohio, said that, under most circumstances, he would not put a hollow bore needle through a tattoo. "Ink is not sterile.

When you insert an epidural needle (which must be large enough to thread a plastic catheter through), you can get coring which will take a biopsy of skin. It has been shown that skin cells can end up in the epidural space," he explained. "Now you are introducing ink which we don't know whether it's neurotoxic or containing an infectious agent.

"Theoretically," Hall continued, "a new tattoo would present a greater risk than an older tattoo. He has found scant literature on the topic. "The bottom line is no one knows what would happen.

Probably nothing would happen. Probably out there in the world, there are guys putting needles through tattoos. Evidence-based medicine would say its OK but that would be the equivalent to saying 'Why do I need a seat belt?

' Percentage-wise, the number of deaths per road hour is small. But the risk of not wearing a seatbelt is very high. That's why I'm not going to do it.

Do I believe the risk of that ink causing harm probably is low? Yes. But if it does, you're paralyzed or dead.

" Hall's policy is not written in stone, however. There are situations in which physicians must choose that which does the least harm and enhances the possibility of a good result. An example of special circumstances is the pregnant patient who has a tattoo covering her entire back.

She needs a cesarean section to deliver her baby. Available options for the surgery include an epidural, a spinal or general anesthesia. "General anesthesia is the least desirable in obstetrics.

That's the highest risk to the mother and the fetus because of a possible failed airway while inducing the anesthesia. If she needed a C-section, now I would put a needle in the back, yes, because the risk of airway failure is greater than the theoretic risk for contamination. I would choose to err on the side of the tattoo as opposed to losing the airway," he explained.

Hall recalls one pregnant patient who proudly displayed her tattoo, an oversized butterfly with wings covering her entire back. Luckily, the center of her back, where the epidural needle was to be injected, was clear of tattoo ink. Back in 1936, Life magazine estimated that only 10 million Americans or approximately 6 percent of the population had at least one tattoo.

A 2003 Harris Poll countered that 36 percent of those aged 25-29 have one or more tattoos. And, finally, the American Academy of Dermatology found in a 2006 study that 24 percent of Americans between 18 and 50 are tattooed; that's almost one in four. The survey also showed that about 36 percent of Americans age 18 to 29 have at least one tattoo.

And, backs rank the highest for tattoo placement.