SACRAMENTO, Calif. - Let's say you are living in the moment, feeling giddy -- a little tipsy, maybe -- and you decide to go for it. You decide to get that tattoo.
Dr. Suzanne Kilmer has a warning for you: Think twice before acting. Not only do you face five times the risk of contracting hepatitis C, chances are you'll change your mind about whether you like your tattoo before you reach middle age.
Kilmer, 55, a clinical professor at University of California, Davis, has seen tattoo-regret galore.
"Most people come in and say, 'It was something I did while I was young, and I've outgrown it,' " Kilmer said.
The founder of the Laser & Skin Surgery Center of Northern California, she's removed upward of 20,000 of the inky images.
That's no small accomplishment, and Kilmer is no ordinary dermatologist. She's a world-renowned, pre-eminent expert in the field of laser tattoo removal and laser skin care.
To this day, Harvard University mentors who first worked with Kilmer as a fellow in the 1990s describe her as a pioneer in tattoo removal -- and a force who has helped chart the future of the field.
"She actually had a hand in the very early development of lasers for tattoo removal," said Dr. R. Rox Anderson, professor of dermatology at Harvard.
Kilmer also is known for creating a world-class laser center that does groundbreaking research for U.S. Food and Drug Administration clinical trials and as the only woman to have headed the American Society for Lasers in Surgery and Medicine.
But in the realm of tattoo removal, Kilmer's work has opened up possibilities for better and faster results -- key in a nation filled with people obsessed with etching on their outermost organ.
Removal is difficult, lengthy and painful. Think hot bacon grease spattered on the skin. Think the sting of a stretched rubber band smacking you from up close. Imagine paying $150 to $1,000 for the multiple appointments to obliterate a tattoo.
People "have no idea how hard it is to get it off," Kilmer said of tattoo dye.
Among those who find themselves at her east Sacramento clinic are job seekers, career professionals and parents of young kids who seek to erase stigma, Kilmer said. There are former gang members and people with what's termed "traumatic tattoos" identifying them, for example, as former prisoners of war.
Brittany Costarella, 38, was in the laser chair one recent day, trying to rid her midriff of a winged, haloed red heart. It wasn't her first time there.
"Oh, my gosh, if people knew how painful it is to get it off," Costarella said. "It feels like piercing hot oil. Not a hot oil droplet, but deep heat under the skin."
Lasers deliver hot, powerful pulses through the upper skin to a deeper layer where a tattoo artist has embedded pigment.
When the laser beam hits a particle of ink, its force fractures the pigment. Immune system cells then move in to clean up the mayhem, which the body's lymphatic system clears away.
Some tattoos leave "ghosts" behind that simply will never disappear even after several rounds of the laser beam.
Melissa Leal, 30, a doctoral student in Native American studies at UC Davis, was undergoing her ninth removal appointment one sunny April afternoon.
As Leal's hand was zapped, she looked away, grimaced and practiced deep breathing.
"What she's feeling is the heat breaking up the ink dye," Kilmer said. "Usually, if it hurts, it means it's working."
About a dozen laser technology professionals crowded a hallway while awaiting the West Coast's first demonstration of a new, state-of-the-art picosecond machine.
That one-of-a-kind device delivers laser pulses at the rate of one-trillionth of a second, as opposed to a nanosecond machine, the industry standard, which pulses at the slower one-billionth of a second.
The new machine in the corner of the room was built by a colleague at Kilmer's request. A previous picosecond model she'd tested at Lawrence Livermore Laboratories 20 years ago was the improbable size of a small barn.
"It took (18 years) to figure out the science of sizing it down," Kilmer said.
Even under Kilmer's supervision, tattoo removal can be a challenge. For each tattoo, each patient is diagnosed, charted, treated, educated and observed by Kilmer with the utmost attention to skin type and pigment of tattoo ink.
Several patients and colleagues said that one of the qualities they appreciated most in Kilmer was her carefully conservative approach to laser skin care.
Richard Cumings, 35, recalled that two decades earlier, she had removed for free a gang tattoo from his cheek when he was a juvenile in custody for robbery.
Since then, he's worked hard at making better choices, he said.
"I changed my life," Cumings said. "I broke the cycle. That's what I needed to do."