What would you say if your kid asked to get a tattoo? (“Kid” meaning 18 or older, the legal age for ink in the US.) Most people have an immediate gut response- either a HARD NO (“we don’t do that”) or a WHY NOT (because it’s an artistic expression or rite of passage.) As a family doctor, I see the spectrum of tattoo outcomes: a lot of pride and joy, but also regret*, infections, and ink allergies. What do I advise?

Ultimately, the medical risks of tattoos are acceptably low for most people (see details below), and in fact, most people don’t stop at one- so know up front that this body art is often addictive! Over 70 percent have more than one, and over 20 percent have more than five.

REGRETS* may surprise you. Yes, many people regret impulsive tattoos obtained in their teens or early twenties (think Spring Break, birthdays and initiations), and the most common regret is tattooing the name of a significant other…who later becomes less “significant”.

Did you know that many professions (federal agents, military, law enforcement, airlines, corporate, legal and financial professionals, among others) still prohibit visible ink in the workplace? Dermatologists see many people in their 30’s or later coming in for tattoo removal from their fingers, hands, wrists and neck when they change careers.  I want to point out, though, that many regrets are not about disliking a tattoo, but rather wishing the ink was positioned differently, located on another body part, or better quality.

CONSIDER: If you get ink on your back or neck, YOU will never see it- except in photos. If you want a tattoo on your wrist or arm, is it a personal affirmation that you want to easily read every time you glance down, or do want it positioned so people looking at you read it? Did you go with the flash tattoo special to see if you’d tolerate the pain? Many people start with a small, “stock” tattoo but move on to full sleeves and/or original artwork, and then later regret they put their first tattoo in “prime real estate” on their body. Location, location, location!

“Know up front that this body art is often addictive!”

My STRONG suggestion is to start with a temporary tattoo. Get the design (colors don’t matter as much) done in pure henna or consider a DIY printable temporary tattoo. (Avoid black henna, which can sensitize you to PPD, the main ingredient in nearly all hair dyes.) The idea is to actually LIVE with the temporary design for days, or preferably weeks, to work out any tweaks in content, position and esthetics.

CAUTION: If you’re going with a foreign language, especially with Chinese characters, get at least two different native speakers to read it to be sure the translation is correct.

INFECTIONS are surprisingly RARE- self-reported between 1-6%, and typically mild staph bacterial infections from self-contamination after scratching with unclean fingernails. In my own clinical practice, where a definite majority sport tattoos, I see only a handful of these per year. The literature reports severe infections that result in hospitalization or death at less than 0.1%. Many parents worry about blood-borne infections like HIV and hepatitis B, but with fresh ink, new needles and sterile technique in reputable, licensed tattoo studios, this risk should be minimal. Note that ink is considered a cosmetic product, not a drug, so it has much less FDA regulation. Pro tip: your tattoo artist should always open the new needles and ink from their factory packaging in front of you.

INFLAMMATION is expected to some degree for all fresh tattoos, but this is typically transient and resolves with diligent aftercare cleansing with antibacterial soap and water. Since inflammation involves swelling, redness and often oozing, it can be very difficult to know if your reaction includes an infection. Any fever, chills, nausea, body aches or increasing pain should send you directly to a physician.

ALLERGIC REACTIONS are not common, but usually show up as itchy red bumps, swelling or even blisters, and are often triggered by sun exposure. Red and yellow inks are the most common culprits, and the allergy may show up at any time, possibly weeks to years after getting your tattoo.

SCARRING can occur from an overly reactive immune systems  or complications of an infection. If you get keloid scars (the raised, thick scars typically larger than the original injury), know that you are at higher risk of scarring from tattoos.

TATTOO REMOVAL is expensive, lengthy, and similarly painful to getting tattoos. Simple black ink designs on light skin have the best success rate. The take-home message is to plan on your ink remaining permanently, so take time deciding on the front end and choose wisely!

BOTTOM LINE:  Don’t wait till AFTER the first tattoo to have a discussion about ink!