or early twenties and were evenly distributed by gender. Among those seeking removals, more than half reported that they "suffered embarrassment." A new job, problems with clothes, and a significant life event were also commonly cited as motivations. Tattoos that were once a symbol of inclusion in a group, such as a gang, can make it difficult to gain employment. Tattoos that indicate a significant relationship, such as a spouse, girlfriend, or boyfriend, can become problematic if the relationship ends. Celebrities that have had these kinds of tattoos removed include Angelina Jolie, Eva Longoria, Marc Anthony, and Denise Richards. Removal by replacement Some people decide to cover an unwanted tattoo with a new tattoo. A skillful cover-up may completely hide the old tattoo, or it may partially hide the old tattoo, depending on the size, style, colors and techniques used on the old tattoo and the skill of the tattoo artist. Covering up a previous tattoo requires darker tones in the new tattoo to effectively hide the unwanted piece. Many tattoos are too dark to cover up. In those cases, patients may receive laser tattoo removal to lighten the existing ink to make themselves better candidates for a cover up tattoo. Laser removal Tattoo removal is most commonly performed using lasers that break down the ink particles in the tattoo into smaller particles. Dermal macrophages are part of the immune system, tasked with collecting and digesting cellular debris. In the case of tattoo pigments, macrophages collect ink pigments, but have difficulty breaking them down. Instead, they store the ink pigments. If a macrophage is damaged, it releases its captive ink, which is taken up by other macrophages. This can make it particularly difficult to remove tattoos. When treatments break down ink particles into smaller pieces, macrophages can more easily remove them. Tattoo pigments have specific light absorption spectra. A tattoo laser must be capable of emitting adequate energy within the given absorption spectrum of the pigment to provide an effective treatment. Certain tattoo pigments, such as yellows and fluorescent inks are more challenging to treat than darker blacks and blues, because they have absorption spectra that fall outside or on the edge of the emission spectra of the tattoo removal laser. Recent pastel-cultured inks contain high concentrations of titanium dioxide, which is highly reflective. Consequently, such inks are difficult to remove since they reflect a significant amount of the incident