On his sixth visit to a state Tattoo Removal Clinic, Guzman lay face down on a padded exam table. A physician aimed a jet of chilled air at a giant tattoo on Guzman's back, drawing a slight wince on his face. Then with a laser, she traced the outline of the tattoo, gently coaxing the ink out from below the skin.

Guzman wants the 20 or so tattoos on his body to vanish. He gave up the life of a gangbanger long ago but only recently learned that the evidence of his past — such as the ink billboard on his forehead — could be erased. Guzman said he grew tired of trying to hide his tattoos with long-sleeved shirts, and with pancake makeup on his face.

"The culture here is that whoever has tattoos is a criminal," he explained.

Potential employers shut the door on anyone who is tatted up, fearing street gangs that relentlessly extort businesses. When tattooed riders get on buses, fellow passengers often change seats or get off altogether. Gangs have firebombed buses as part of widespread campaigns for extortion and turf.

"People panic when they see these guys," said Gladis Pacheco, a psychologist at the Tattoo Removal Clinic run by the National Council of Public Security. "In this country, it is just a primordial requirement to get rid of one's tattoos."

Tattoos have a mystique in North America and Europe. Those sporting them — from office clerks to actors and on to athletes — feel sexy or empowered. A survey early last decade found that 1 out of 7 U.S. adults have tattoos. Skin art has moved from skank to hip, from taboo to mainstream.

Not so in El Salvador. Tattoos are the province of the two big street gangs, the MS-13 and the 18th Street, and for much of the past two decades, young gangsters allowed the tattoos on their faces to serve as an angry warning to anyone who dared cross them.

That started to change eight years ago, with the first of a series of mano dura, or "hard hand," law enforcement crackdowns to break criminal gangs, whose ranks were swelling from a stream of thousands of Salvadoran gang members deported from the U.S. From July 2003 to June 2004, police arrested some 18,000 gang members, although only 5 percent were given prison terms, said Jeannette Aguilar, a gang expert at the Central American University here.

Following a subsequent crackdown, called super mano dura, gang leaders told members to restrict tattoos to less visible parts of their bodies.

"They aren't getting so many tattoos now," said Gersan Perez Mendez, a veteran commissioner of the National Civil Police. "They definitely don't put them on their hands and faces."

Even as gang members have become more cautious, they've also become a greater menace across the Northern Triangle of Central America — Guatemala, El Salvador and Honduras — with as many as 70,000 total members

The MS-13 and 18th Street gangs both got their start in Los Angeles decades ago, with the Mara Salvatrucha comprising Salvadorans who fled their nation's 1980-1992 civil war and the 18th Street starting with Mexicans but spreading to other Hispanics and even other races.

They remain a U.S. scourge. The FBI says MS-13 is active in at least 42 of the 50 U.S. states, with 6,000 to 10,000 members. It is particularly active in the West, Northeast and, increasingly, the Southeast U.S.

But it's in El Salvador where concern has soared over how the gangs have morphed into incipient transnational mafias with links to Mexican drug cartels.

"We already consider them part of organized crime," Defense Minister David Munguia Payes said in an interview. "If you're talking about drug trafficking, the gangs are there. Extortion? They are there. Hired killings? They are there, too. . . . We estimate that 90 percent of the homicides in the country are carried out in some way by the gangs."

Gang-led extortion has extracted a brutal toll, especially in the transport sector. Last year, 148 bus drivers, fare collectors and owners of the 7,000 buses that crisscross San Salvador each day were slain.

In one horrific incident last June, gang members sprayed a crowded bus with gunfire, then torched it, killing 17 people and intensifying the panic over gang violence.

Since then, more former gang members have come to the Tattoo Removal Clinic, on the second floor of a complex of government offices, hoping to literally come clean. Usually, they're gang veterans in their late 20s or 30s.

"To get into this program, you have to prove that you are not in gangs anymore," said Dr. Maydee Ramirez, a physician who operates one of the laser machines that causes tattoos to fade from the skin, then disappear without scarring. The treatment is free, paid for by the state. Length of treatment varies.

"It depends on the color of the ink. If it's black, it is easier to remove than colored ink. Also, how old the tattoo is and how big it is are also factors," she said.

So far, the clinic has treated 710 people, three quarters of them former gang members, she said. Some have come in with as many as 150 tattoos on their bodies.

"It can take eight to 12 sessions. You can see the difference after six sessions," she said. "The majority of them are very thankful to the program for allowing them back into society, to get rid of the stigma that keeps them from working."

Guzman, who got into gang life at age 15 and is now 26, said he slipped out of MS-13 after only a couple of years. But fellow gang members tracked him down and ordered him to commit new crimes, inflicting punishment when he failed.

"When they found me, they would beat me," he said.

Spotting his tattoos, rival 18th Street gangsters also would attack him.

Eventually, Guzman learned a trade, auto painting and detailing, and managed to eke out a living despite his gangster skin art. He works in the street in the San Marcos district of the capital. At home are his five-year-old daughter and his wife, who approves of his tattoo removal.

"She's happy with my new opportunities," Guzman said.

Leaving gang life is rarely accomplished, sometimes occurring through the pull of relatives or the tug of neighborhood evangelical preachers. Many of those who succeed are leaving the only life they've ever known.

"They are 35 or 40 years old, they have kids, and they want to leave this crazy life behind," said Luis Lechiguero, a member of a European Union delegation that helps finance programs to reduce gang activity.

But social pressure can be huge. Entire low-income districts of El Salvador's cities, such as Iberia in the capital, are controlled by gangs and live off proceeds of extortion and shakedowns in other urban areas.

"Mothers, wives and children participate in making the calls, picking up the money and researching targets," said Aguilar, the university expert.

The nation's 19 prisons, built for 8,500 inmates, overflow with 24,800 prisoners, a third of them gang members, said Aida Santos de Escobar, the head of the National Council of Public Security.

Gangs literally control the territory inside some prisons, and gang bosses use cellphones to organize crime campaigns, Aguilar said.

"They started issuing orders from inside the jails," she said.

Efforts to outlaw mere membership in a gang have failed. President Mauricio Funes, the head of a leftist government, signed the law despite a three-day gang-enforced transport strike in San Salvador in September aimed at halting its enactment.

Still, the law has proved toothless. Judges require an wide array of evidence, Attorney General Romeo Barahona said, such as that the gang had three or more members, controlled territory, held regular meetings and intended to commit crimes.

For former gangbangers like Guzman, removing tattoos is only one key step.

"Getting rid of tattoos alone isn't enough to get you back to normality," said Lechiguero. "You need a job, family and community support, and individual willpower."

Removing tattoos carries risks. Gangs forbid such an act without approval.

"If they find out you got rid of your tattoos, they will come after you," he said.