A tattoo can be removed by physician - a dermatologist or a cosmetic surgeon - or a technician at a salon that specializes in the procedure.

The choice, however, may not be simple.

Doctors are wary of the new wave of salons, while salon owners insist they offer a more affordable alternative that is still safe.

"Removing a tattoo is a medical procedure," said Eric Bernstein, director of the Main Line Center for Laser Surgery in Ardmore. "It's more complicated than it looks, and the lasers can be very dangerous."

Blistering, infection, and allergic reactions are some of the complications that can arise, he said. If the treatments are too aggressive, there is also a risk of scarring.

"But done right, it can be absolutely awesome," Bernstein said. "It's like magic."

Anyone with a quarter of a million dollars can buy an advanced laser and set up a storefront business, said Nazanin Saedi, director of the Jefferson University Laser Surgery and Cosmetic Dermatology Center.

"The regulations for doing tattoo treatments in Pennsylvania are so loose that you don't need laser certification," Saedi said. "So you have no idea what background they have."

Carmen Vanderheiden, a former medical aesthetician with multiple tattoos, said that her Tataway salons are just as safe as any doctor's office and that her technicians are properly trained.

"A doctor's office can't do anything we can't," she said. "We make it affordable."

Here are a few tips to help decide on a provider who can erase that unwanted ink.

Ask about cost. Removing a tattoo is significantly more expensive than getting inked, and can take up to 10 treatments to be effective. Doctors may charge up to $400 per treatment. Salons may charge much less, but do not have medical staff on premises in the unlikely event of complications. No matter where the removal is done, price is determined by the size of the tattoo. Insurance plans do not usually cover removals.

Ask how many removals they have performed. The more experience, the better.

Ask about equipment. Not all lasers are appropriate for all skin types. A pico-second laser requires the fewest sessions. Darker skin requires a lower-energy device called the Q-switched Nd:Yag to prevent a loss of natural skin pigment that can result in reverse freckling.

Ask to see before and after pictures of previous clients. Are the tattoos gone? Look for scarring or changes in skin tone.

Ask for referrals. If your family doctor does not have a preferred dermatologist, call a tattoo shop. Their clients often are looking to cover old tattoos with something new. Good tattoo artists prefer to work over a faded design when applying fresh ink, and should know who does a good job.

Ask about free removals. Some providers offer free removal of so-called job-stoppers - tattoos on the face, neck, or hands - for ex-inmates, gang members, and survivors of human trafficking.