Process of tattooing

Permanent makeup or semi-permanent makeup tattoos are cosmetic tattoos that are meant to alter pigmentation in the facial features. Some types of permanent makeup are used for medical conditions, such as to cover up scars or vitiligo,[6] while other types are simply for aesthetic reasons like tattooing eyeliner, lip color or eyebrows. The pigment is inserted into the surface of the skin in patterns to be able to cover the desired areas.

Permanent makeup is typically done with some form of tattoo machine. There are machines now that are needle-less which should result in less painful procedures. These needle-free devices are considered safer and more sterile to use than traditional tattoo machines. They are designed to create a more comforting experience during the application process and eliminate the possibility of spreading disease like HIV, hepatitis and other healthcare issues.[7] The needle-less device is also capable of inserting the pigment deeper into the skin than machines that use needles.

There are several different ways to get rid of these tattoos, the most common being laser removals. It is suggested that different color pigments should be removed with different lasers in order to reduce the risk of scarring and ink retention. The needle-free machines also have the capability of removing or lightening the pigment from the skin as well by adding in a removal solution into the skin.[7]

Permanent makeup or micropigmentation is much like any tattoo and can have side effects over time. Infections, fading, scarring, inflammation, and allergic reactions are just a few of the side effects that have been reported from patients who received permanent makeup procedures.[8]

Tattoos have also made an entrance into the medical field. Nipple-areola tattoos are a form of medical tattoos that can be done for those who lost their nipple during a mastectomy and had breast reconstruction surgery. The tattoo artist tries to recreate the same pigment and shape as the original nipple and areola, although it may not always result in an exact replica as the patient’s old nipple. The tattoo may not be the exact or desired shade of the nipple that the patient originally had because the artist may make the tattoo a bit darker in order for the tattoo to lighten up over time, ultimately resulting in the correct shade.[9] The machine that is used during the procedure will also affect the color that the tattoo has and how the pigment will react with the skin.[10]

Not all nipple-areola tattoos are successful. There is a chance that the tattoo could get infected just as any tattoo can. In a study from 1988—1993 of 103 patients who received nipple-areola tattoos, 5 patients reported getting an infection, 1 patient reported getting a rash, one reported getting slough, and 19 patients had to have their tattoo touched up due to the pigment diminishing from the tattoo through the healing process.[10]

Nipple-areola tattoos tend to be one of the final steps to breast reconstruction surgery. In the study of those who received the tattoos, 86% said that they would get the procedure done again if they needed to.[10]

A variety of inks at a station in a tattoo shop. The small paper cups on the counter are used for mixing inks.

Early tattoo inks were obtained directly from nature and were extremely limited in pigment variety. In ancient Hawaii, for example, kukui nut ash was blended with coconut oil to produce an ebony ink.[2] Today, an almost unlimited number of colors and shades of tattoo ink are mass-produced and sold to parlors worldwide. Tattoo artists commonly mix these inks to create their own unique pigments.

A wide range of dyes and pigments can be used in tattoos, from inorganic materials like titanium dioxide and iron oxides to carbon black, azo dyes, and acridine, quinoline, phthalocyanine and naphthol derivatives, dyes made from ash, and other mixtures. Iron oxide pigments are used in greater extent in cosmetic tattooing.

Modern tattooing inks are carbon-based pigments that have uses outside of commercial tattoo applications.

Concern has been expressed[11] over the interaction between magnetic resonance imaging (MRI) procedures and tattoo pigments, some of which contain trace metals. The magnetic fields produced by MRI machines interact with these metals, including nonferrous metal particles, and while rare, are capable of causing first-degree or second-degree burns[12] or distortions in the image. The type and density of the ink as well as shape of the tattoo may increase the risk, particularly if the shape approximates an RF pick-up loop.[13] The television show MythBusters tested the hypothesis, and found a slight interaction between commonly used tattoo inks and MRI. The interaction was stronger with inks containing high levels of iron oxide.[14]

Tattoo artist drawing a design on a client before permanent tattooing. Disposable gloves are used in modern tattooing for hygiene.

The properly equipped tattoo studio will use biohazard containers for objects that have come into contact with blood or bodily fluids, sharps containers for old needles, and an autoclave for sterilizing tools. Certain jurisdictions also require studios by law to have a sink in the work area supplied with both hot and cold water.

Proper hygiene requires a body modification artist to wash his or her hands before starting to prepare a client for the stencil, between clients, and at any other time when cross contamination can occur. The use of single use gloves is also mandatory and disposed after each stage of tattooing. The same gloves should not be used to clean the tattoo station, tattoo the client, and clean the tattoo.

In some states and countries it is illegal to tattoo a minor even with parental consent, and (except in the case of medical tattoos) it is forbidden to tattoo impaired persons, people with contraindicated skin conditions, those who are pregnant or nursing, those incapable of consent due to mental incapacity, or those under the influence of alcohol or other drugs.

Before the tattooing begins the client is asked to approve the final position of the applied stencil. After approval is given the artist will open new, sterile needle packages in front of the client, and always use new, sterile, or sterile disposable instruments and supplies, and fresh ink for each session (loaded into disposable ink caps which are discarded after each client). Also, all areas which may be touched with contaminated gloves will be wrapped in clear plastic to prevent cross-contamination. Equipment that cannot be autoclaved (such as counter tops, machines, and furniture) will be wiped with an approved disinfectant.[15]

Membership in professional organizations or certificates of appreciation/achievement generally help artists to be aware of the latest trends. Most tattooists do not belong to any association.

While specific requirements to become a tattooist vary between jurisdictions, many mandate only formal training in blood borne pathogens and cross contamination. The local department of health regulates tattoo studios in many jurisdictions. For example, according to the health departments in Oregon and Hawaii, tattoo artists in these states are required to take and pass a test ascertaining their knowledge of health and safety precautions as well as the current state regulations. Performing a tattoo in Oregon without a proper and current license or in an unlicensed facility is a felony offense. Tattooing was legalized in New York City in 1997,[16] in Massachusetts in 2000[17] and Oklahoma between 2002 and 2006.

Tattoo specific salves have become widespread in recent years.

Tattoo artists and people with tattoos vary widely in their preferred methods of caring for new tattoos. Some artists recommend keeping a new tattoo wrapped for the first 24 hours while others suggest removing temporary bandaging after two hours or less to allow the skin to breathe. Many tattooists advise against allowing too much contact with hot tub, pool water or soaking in a tub for the first two weeks to prevent the tattoo ink from washing out. In contrast other artists suggest that a new tattoo be bathed in very hot water early.

General consensus for care advises against removing the flakes or scab that may form on a new tattoo, and avoiding exposing a new tattoo to the sun for extended periods for at least three weeks; both of these can contribute to fading of the image. It is agreed that a new tattoo needs to be kept clean. Various products may be recommended for application to the skin, ranging from those intended for the treatment of cuts, burns and scrapes, to panthenol, cocoa butter, A&D, hemp, lanolin, or salves.[18] Oil based ointments are almost always recommended for use on very thin layers due to their inability to evaporate and therefore over-hydrate the already perforated skin. Recent scientific studies have demonstrated that wounds that are kept moist heal faster than wounds healing under dry conditions.[19] In recent years specific commercial products have been developed for tattoo aftercare. Although opinions about these products vary, soap and warm water work well to keep a tattoo clean and free from infection.[20] It is advised that fragrance-free soaps and soaps that contain alcohol not be used to clean the tattoo to avoid burning or drying out the tattoo too quickly. Try to avoid loofahs and unwashed clothes which both can contain bacteria that could get into the tattoo and cause an infection. The best way to dry your tattoo is to use a paper towel as regular towels may also contain bacteria, even if they are just washed. [21]

The amount of ink that remains in the skin throughout the healing process determines how the final tattoo will look. If a tattoo becomes infected or the flakes fall off too soon (e.g., if it absorbs too much water and sloughs off early or is picked or scraped off) then the ink will not be properly fixed in the skin and the final image will be negatively affected. [22]