VANCOUVER - The tattoo, once flaunted mostly by soldiers, sailors and ex-cons, has come into the mainstream thanks in part to TV shows such as "L.A. Ink," "Miami Ink" and the influence of celebrities.

But today's expression of individuality through body art can sometimes be tomorrow's unsightly embarrassment.

Like the guy who appeared at Dr. Jason Rivers' Vancouver clinic asking to have the corkscrew tattoo removed from his penis.

Judging from the growing number of people sporting ever more elaborate tattoos, dermatologist Rivers and his Ottawa colleague Dr. Sharyn Laughlin will likely get busier in the coming years.

"Some people don't realize that what's cool when you're 20 doesn't look so great when you're 75," says Rivers.

"The context of a tattoo in a young person versus somebody who's older is totally different."

A veteran Vancouver tattoo artist, who didn't want to be named, says there's a definite trend towards larger, more complex tattoos covering arms, backs and chests on both men and women.

It became almost cliche for young women to tattoo the lower back just above their butt cleavage.

"Personally, I love tattooing that spot and it's a beautiful area," he says.

"Then somebody came along and coined the term tramp stamp. Virtually overnight that spot's not popular anymore."

Instead, he says women are opting to have the side of their ribs done, which requires a little more commitment because it's more sensitive.

Besides pigeon-holing the wearer, tramp stamps have another adverse side effect, says Laughlin.

"The problem with those is when those little girls decide to have babies of their own, the anesthetist won't go through their tattoos to give them an epidural," she says.

Age also is not the tattoo's friend.

"If a woman gets a butterfly on her breast, there's a good chance in a few decades it's going to be a pterodactyl," the artist says.

Distorted tattoos are a common reason patients show up at Laughlin's and Rivers' clinics.

Other times it's buyer's remorse, like a teenage girl who came to Laughlin the day after she and a friend got matching hip tattoos to commemorate their high school graduation.

Luckily the artwork hadn't set and Laughlin was able to use an immune-enhancing cream to fade the tattoo.

But the girl's friend opted to cut out the tattoo herself rather than face her parents, Laughlin says.

More often, though, it's a change of lifestyle that prompts tattoo removal.

"They say they're not the same person they were at the time they put them on," says Rivers.

"I've had people, for example, who've moved up the corporate ladder and they've had tattoos on their shoulders. Now they're literally golfing with the boss and they can't roll up their sleeves."

Until the 1980s, getting a tattoo was a lifetime commitment. The only sure way to erase it was painful dermabrasion -- essentially sanding it off -- or surgically cutting the tattooed skin away.

The advent of tattoo laser removal in the last three decades has made it seem easier to reverse a regretted tattoo.

Pulsed Q-switched lasers blast the larger ink molecules apart so the immune system can get rid of them, says Laughlin, who sees an average 300 patients a year for tattoo removal.

"By smashing the ink up in tiny little fragments the body can deal with them and get them to go," she says. "Now they'll go to the lymph nodes and stay there forever but it doesn't scar."

But people still seem unaware it's a time-consuming, costly and somewhat painful process that doesn't guarantee success, says Dr. Melanie Grossman, a New York City dermatologist who pioneered the technique.

"What they don't understand is it's not always that simple," says Grossman. "Sometimes it's more difficult to remove them and sometimes they don't come off at all."

The effort needed for laser removal and its success depends on a lot of factors, including the depth of the tattoo under the skin, the type of ink and colours, as well as the location on the body. Tattoos in bony areas like ribs or ankles take more treatments.

Ironically, amateur tattoos -- your classic prison tat -- is easier to erase than professionally applied, multi-hewed artwork because it usually involves basic blue or black ink.

Laughlin says dermatologists are flying blind because even tattooists often don't know the ingredients of the inks they use.

Black, most blues, reds and greens are quite easy, says Laughlin.

"Once you get into the purples, the oranges and the browns, they really are very resistant," she says.

Grossman says she's had tattoos that disappeared after just one treatment but others that were still visible after 30 sessions.

Most often it takes five to 10 costly appointments, with several weeks in between, to fully erase a tattoo.

"And it hurts," Laughlin says. "It feels like a little snap of an elastic band. We can use numbing creams to make it less painful but there is recovery time. "

Costs vary. Rivers says a small- to medium-sized tattoo can cost $200 per session. Laughlin charges $5 for each pulse of her laser over a 6.5-millimetre area -- roughly the diameter of a pencil.

Dermatologists are leery of tattoos but if you must get one, they'd prefer you use a new type of ink called Freedom2 developed by a Harvard dermatologist and marketed by a company called Nuvilex.

Laughlin says it uses vegetable dyes encapsulated in an plastic polymer easily broken down by lasers.

"If people have regrets and what the tattoo removed the lasers that we use . . . will smash the little acrylic polymer and the ink will be released and gone," she says.

Tattooing carries other risks, such as allergic reactions and the use of contaminated needles and inks.

Grossman says she's also aware of tattoos with metallic ingredients in the inks interfering with magnetic-resonance imaging tests.

But most of all, they can mask skin cancers, especially if the tattoos use brown and black.

Grossman stumbled on a potentially fatal melanoma next to a tattoo she was removing.

"If they had put the tattoo on three inches over she might not have noticed it or I might not have noticed it."