Let 'Em Run.

More and more folks are loosening up a bit and letting their artists take the reigns on design. Granted, you need someone who's trustable with your idea (and your skin)- but if you've got that sort of relationship with your tattooer, the best approach is having a good rough idea of what you want, where you want it, and letting them run with it. If they're good, they'll be able to come up with something that fits within their range of style that you will be happy with for a long time. Here are some examples of  some small to medium sized tattoos where I was allowed artistic freedom, within the confines of the customers' ideas: