WASHINGTON — Many young people of enlistment age have tattoos, and some percentage are required to remove body art that the military services deem inappropriate.

That sometimes can be a time-consuming, if not difficult, medical process.

Some tattoo inks are harder to remove than others, and it may be impossible to completely remove some body art.

“Yellows and greens are not as easy to remove as blues and blacks …The other thing to remember is that it may be impossible to completely remove all of the tattoo, and often times people are left with a shadowed or ghost-like image in the skin,” said Charles Greeson, MD, laser clinic director at Wilford Hall Ambulatory Surgical Center at Lackland Air Force Base, Texas.

While tattoo removal isn’t a priority for MTFs and patients have to pay out of pocket for the procedure, such knowledge may come in handy with the proliferation of servicemembers with skin ink. A Pew Research Center report released in 2010 found that nearly four-in-ten “Millennials,” those ages 18-29, have a tattoo. That report also stated that about half of those with tattoos in the U.S. have two to five tattoos and 18% have six or more.

Tattoos not uncommon

Each of the military services has guidelines on tattoos and, when the tattoos do not meet the guidelines, servicemembers may find themselves seeking tattoo removal. The Air Force’s dress code prohibits in or out of uniform “tattoos/brands/body markings anywhere on the body that are obscene, commonly associated with gangs, extremist and/or supremacist organizations, or that advocate sexual, racial, ethnic or religious discrimination.”

It also has a broader prohibition that is open to interpretation by commanding officers:  Tattoos/brands/body markings with unauthorized content that are prejudicial to good order and discipline or the content is of a nature that tends to bring discredit upon the Air Force are prohibited both in and out of uniform.”

Troops whose body art falls into those categories are required to initiate tattoo/brand/body marking removal/alteration. At the commander’s discretion, “members may be seen, on a space and resource available basis, in a Department of Defense medical treatment facility for voluntary tattoo/brand/body marking removal. When DoD resources are not available, members may have the tattoo/brand removed/altered at their own expense outside of DoD medical treatment facilities.”

“This is considered a cosmetic procedure according to AF regulations and is treated as such,” Col. Steven E. Ritter, MD, who is the Air Force Surgeon General Consultant for Dermatology, told U.S. Medicine a written statement. “Cosmetic procedures do not have priority over general dermatology conditions such as skin cancer, inflammatory skin conditions, infections, etc.”

In addition, anyone undergoing a cosmetic procedure, active duty, retiree or dependent, pays for the treatment at their own expense, according to prescribed billing guideline, he said. Even if a dependent or active-duty member is willing to pay for it, not all MTFs have the capability to remove tattoos.  “There are only a total of 16 MTFs (Stateside and Overseas) in the AFMS with dermatologists and few of these have the appropriate laser that can treat most common tattoos,” he said.