The evidence suggests that tattoos on an as-yet-unaged body does not fade as rapidly as those on an aged body, but there are some caveats to this. For example, some of the early evidence suggests that most tattoos may fade after an average of 12 years, whereas this age is generally quoted as six years. We therefore consider it a reasonable assumption that the number of tattoos on the young body may vary more rapidly than the number on the aged body. Another important factor affecting the age of these tattoos, is that tattoos on an as-yet-unaged body are not completely removed by the healing process and have therefore been known to fade with time (4, 9, 45, 46). One hypothesis is that if the body does not heal completely, there is an increased risk of infection. Therefore, it has been proposed that a careful assessment of the skin before and after the tattoo is done and a regular topical application of anti–tumour necrosis factor (TNF) [such as in an exfoliation] can help to ensure that the initial lesions that were created still remain visible (44). However, we would like to stress that the evidence does not fully support this theory (47), and it is important to keep in mind that skin ageing is not as linear as the age that could be inferred.
What happens after I have had a tattoo? The age at which a tattoo is removed is not related to its effectiveness in reducing the risk of skin cancer and, in fact, may increase that risk (10, 20, 22, 23, 32, 48). However, these studies do not provide conclusive evidence that a tattoo should be removed after a one-off procedure or at a later age. Rather, the idea is that a tattoo needs to be removed in a clinical context, in order to allow the natural history, particularly the healing, of the wound to occur as effectively as possible. This is a major issue. Some authors (2, 8, 17, 18, 19, 31, 37, 38, 49) have argued that the idea that there are certain age-specific guidelines for tattoo removal is ‘anachronistic’ and has led to confusion. These authors highlight the fact that no evidence is available on average rates or timing of tattoo removal; however, we need to bear in mind that patients should be asked about the actual procedures they have had and are considering. If the patient is thinking of having a number of tattoos removed at the first visit, then we suggest that this can be done in