Tattoos and body piercing

Description
Tattoos are produced by injecting ink into the second layer of skin. They're commonly applied to the arms, legs or torso. Permanent makeup, also known as cosmetic tattooing or micropigmentation, can be applied to the face or other parts of the body. Body piercing is the attachment of jewelry to the body by piercing the skin. A metal stud is threaded through the skin or body tissue and must be left in place while the hole forms. Areas commonly pierced include the ear, eyebrow, genitalia, lip, navel, nose and tongue.

Purpose
Tattooing and body piercing have been performed for centuries by many cultures. They've been used as symbols of courage, nobility and virility, as well as for spiritual rituals. Today, tattooing and body piercing are mainly forms of self-expression. Both practices are growing in popularity among today's youth.

Preparation
Before tattooing or body piercing, make sure your tetanus immunization is up to date. Check with your doctor to see if you need a booster shot. Also make sure you've completed your hepatitis B vaccination series. Before the procedure, ask to see the equipment used to sterilize instruments. According to U.S. Food and Drug Administration (FDA) regulations, an autoclave should be used to heat sterilize any instruments shared between people. Prepackaged sterilized needles are to be used only once -- never reused.
Tattooing
Tattoos may be done by a tattoo artist in a studio, by self-application or by an untrained amateur, often a friend. Permanent makeup, also known as cosmetic tattooing or micropigmentation, is often applied by plastic surgeons or trained personnel in beauty salons.

In a studio, make sure you're asked to sign a written consent form before the tattooing begins. Ask your tattoo artist to show you a membership certificate for the Alliance of Professional Tattooists (APT), a nonprofit organization dedicated to the education of tattooists in proper infection-control practices. This certificate is an indication that your artist is well trained in the proper infection-control aspects of tattooing. Also, make sure the needles used during tattooing are not put directly into the bottle of ink and any leftover tattoo dye is discarded.

Your skin will be inspected to make sure there are no cuts or abrasions on the area to be tattooed. Then, the area will be shaved and cleaned with an antiseptic. The tattoo artwork will be stenciled or drawn on your skin with a pen. Anesthesia is not used.

Body piercing
Make sure the piercer uses jewelry made of a noncorrosive metal, such as surgical stainless steel, solid 14-karat gold or titanium. As with tattooing, your skin will be inspected to make sure there are no cuts or abrasions on the area. Then, the skin will be cleaned with an antiseptic. Anesthesia is not used.


Procedure
Tattooing
The tattoo artist should wash his or her hands before beginning and wear surgical (preferably nonlatex) gloves throughout the entire procedure. Permanent tattoos are applied using a small electric machine with a needle bar that holds multiple needles. The tip of the needle is dipped in ink. Then, the needles move up and down into the skin, depositing the ink. The needles penetrate a couple of millimeters into both the outer layer of skin (epidermis) and the second layer of skin (dermis). There will be some bloody discharge from the skin. The amount of pain depends on the particular tattoo site and your individual pain tolerance. A small tattoo takes about 45 minutes to complete. A large tattoo can take several hours or perhaps even several visits.

Body piercing
The person performing the piercing should wash his or her hands before beginning and wear surgical (preferably nonlatex) gloves throughout the entire procedure. Most body areas are pierced using a 12- or 16-gauge needle. The jewelry used is connected to a needle and threaded through a hole formed by the needle. Pressure is applied until bleeding has stopped. The tongue is pierced using a 14-gauge or larger barbell. This large barbell is kept in place for a few days until the swelling has gone down and is then replaced with a smaller one.

Piercing guns, once the mainstay of ear piercing, should no longer be used for any kind of body piercing. Theses guns cannot be adequately sterilized, making them a possible carrier for disease transmission.


Postprocedure care
Tattooing
After the procedure, the tattooed area is washed and covered with an antiseptic ointment and bandage. After two to 12 hours, remove the bandage by wetting it down in the shower and gently pulling it away from the skin. Clean the area daily with soap and water and apply an antibiotic ointment to the area for up to five days. Then, use a mild hand cream until healing is complete, usually within 10 days. The skin around the tattoo is usually inflamed for the first few days, and the tattooed skin will crust over and peel within seven days. Avoid swimming, hot baths and hot tubs for the first few weeks to prevent color loss. Also, avoid direct sunlight for four weeks to prevent sunburn and pigment changes. To prevent the colors from fading, always wear sunscreen on your tattoo.

Body piercing
A newly pierced site requires careful care to prevent infection. You'll usually be instructed to cleanse the pierced site twice a day with an antibacterial soap for the first couple of weeks. Try to prevent any crust from forming on your pierced skin or the jewelry. After each cleansing, apply an antiseptic ointment. Avoid contact with anyone else's body fluid until healing is complete.

If you've had your tongue pierced, rinse your mouth out with mouthwash twice a day. Avoid mouthwashes that contain undiluted alcohol, however, because they can dry out your mouth. Avoid smoking and spicy foods until your tongue is completely healed.

Wait to remove your jewelry until instructed by your piercer. Removing the jewelry too soon after the piercing may make it difficult to reinsert later. Never handle or play with your new jewelry -- this can lead to irritation or infection of the site.

If the pierced area becomes infected, don't remove the jewelry. This could lead to an abscess (a collection of pus). Instead, clean the skin more often, such as three to four times a day. If the infection worsens or doesn't improve, consult your doctor.


Risks
The risk of infection is a concern for both tattooing and body piercing. Blood-borne illnesses may spread during either procedure if the needles are not properly sterilized or if prepackaged one-time use needles are reused. There are numerous documented cases of hepatitis B transmission via tattooing. Cases of bacterial tetanus, tuberculosis, syphilis and even leprosy have also been documented. There are currently no documented cases of HIV transmission due to tattooing or piercing, but any time the instruments used are contaminated with blood or not thoroughly sterilized, the potential for HIV and other disease transmission exists.
Additional risks of tattooing include:

adverse or allergic reactions to dyes
tetanus due to contamination of puncture sites
swelling, redness or a wart-like appearance when the tattoo is exposed to sunlight
swelling or burning of the tattooed areas during magnetic resonance imaging (MRI, an imaging study based on the bodyormation (a solid or fluid-filled pouch)
bluish discoloration of the skin surrounding the pierced site
irritation (Waistbands can easily irritate navel piercing, for example.)
delayed healing (Navel piercing can take up to a year to heal, for example.)
for nose piercing, imbedding of jewelry in nasal tissue
for ear piercing, ear lobe deformities or imbedding of jewelry within ear tissues, especially the earlobe
for penile piercing, local tissue destruction
for female nipple piercing, scarring and constriction of breast milk ducts, which may interfere with current or future breastfeeding (Avoid piercing the areola -- the round, pigmented area of the breast surrounding the nipple.)
Tongue piercing poses special risks, including:

a high infection rate due to the high bacteria count normally found in the mouth
airway obstruction
increased salivary flow
injury to gums and/or tooth loss
broken teeth due to biting down on the stud
damage to cheek tissue
speech impediments
numbness and/or loss of taste
hemorrhage due to injury to major blood vessels in the tongue
changes in chewing
obstruction of dental and skull X-ray films

Considerations
Both tattoos and body piercing should be considered permanent. Never have these procedures done on the spur of the moment or when your judgment may be impaired, such as while you're drinking alcohol. It's a good idea to keep a record of the dyes used in your tattoo, including the lot number of each pigment. This can be a tremendous help to your doctor if you ever decide to remove your tattoo. Keep in mind that you cannot donate blood for one year after body piercing or receiving a tattoo or permanent makeup.
The FDA regulates inks for use in cosmetics, but it has not approved their use for tattooing or permanent makeup. The FDA has no control over the practice of tattooing -- it's left to state and local laws. Some states have strict regulations, prohibit it for anyone under age 18 or prohibit it altogether, while others have no regulations at all. A few states have regulations regarding body piercing. Check with your state, county or local health department for details.

Infant body piercing
Piercing the earlobes of infants is a common practice in many cultures. In addition to the information provided above, keep in mind that an infant may be more likely to play with the jewelry, increasing the chance for irritation, infection and jewelry removal. Once removed, the jewelry may cause choking or other types of injury. Plus, infants are not as able to fight infection as older children or adults, and they will not be fully immunized against hepatitis B or tetanus. If you're considering body piercing your infant, discuss the risks with your child's doctor.

Tattoo removal
It may be possible to remove a tattoo with laser surgery. The laser breaks the ink pigments up into very small pieces that are eliminated into the air or by the body. It may take up to six laser sessions until the tattoo is completely gone. Some colors are harder to remove than others, and certain types of lasers work better on certain colors. Laser treatment has replaced most of the other methods of tattoo removal, including surgical excision, dermabrasion, salabrasion (using salt to soak away the dyes) and scarification (creating scars to hide the tattoo).

A new technique for tattoo removal involves the use of a tattoo removal infrared coagulator (TRIC). This instrument creates more heat than a laser and works by "melting" away color. This type of treatment is similar to laser surgery, but ite skin remain once the tattoo is removed. Again, remember to consider tattooing a permanent procedure. Wait to have a tattoo until youtattoos provide an alternative to traditional tattoos. They're applied to the skin with moistened cotton and fade after a few days. The color additives in temporary tattoos have been approved by the FDA for cosmetic use on the skin. However, reports of allergic reactions to temporary tattoos have been documented.

Magnetic jewelry can masquerade as pierced jewelry. It's safer, cheaper and can be removed at any time. This alternative can't be used on the tongue, however, and wearing a stud in each nostril can counteract the magnetic forces.


Pregnancy-specific information
Body piercing and tattooing both increase your risk for infection. Consult with your doctor if you're considering having either done during pregnancy.

Senior-specific information
As you get older, your immune system may not be as strong as it once was. In addition, chances are you may have one or more medical conditions. Due to the risk of infection, consult with your doctor before getting a tattoo or body piercing.