There are ways to remove tattoos, but the process can be highly costly and is not always effective. In some cases, "removal" will only dull a tattoo and certain colors cannot be removed at all. Eve Center instructor Florence Shalit says that what people usually do is get a new tattoo over the one they no longer wish to have. Of the methods available, laser removal is the most widely praised. Chemicals and creams are alternative options, but do not have a reputation for being reliable, according to Karen L. Hudson, an advocate for acceptance of and safety in body art. Dr. Emil Litvak, one of the partners at Keshet Laser Clinic in Kiriat Ono, says the most effective tattoo removal device offered in Israel is the Fotona's Q Switched ND YAG double frequency 1064 nm laser combined with KTP 532 nm laser, which came out approximately five years ago. Fotona recently introduced a new instrument that is better than the Q Switched lasers, but it is very expensive and currently not available in Israel, according to Litvak. The Q Switch laser emits very short pulses that go straight to the tattoo's color without damaging the epidermis (outer layer of skin cells). It does not leave scars. However, this method of tattoo removal can lead to hyper-pigmentation or hypo-pigmentation in the area, which may disappear after six months, and can also lead to immediate swelling, redness, burning and appearance of blood vessels on the skin, which tend to disappear within 24 hours. Other instruments can be used for tattoo removal but were not designed specifically for it, like laser hair removal instruments and long pulse lasers, which can cause scarring. At Keshet Laser Clinic, tattoo removal costs NIS 500 per treatment, and the number of treatments required depends on various factors, including the size of the tattoo, number of colors, whether or not the tattoo includes "problematic" shades (like green and pale blue) and the age of the tattoo. "Some tattoos disappear after two treatments, others after 12," said Litvak, who also explained that patients must wait one to two months between treatments. US studies show that most tattoos are done on people aged 16 to 20, notes Litvak. As people mature and especially when they get married and have children, some have their tattoos removed. But there are also those who get tattoos and months or even weeks later already decide to get them removed. In addition, according to Rabbi Yonason Wiener, many secular Jews who get tattoos remove them if they become more religiously observant, although they are not obliged to do so.