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Tattoos: Are They Safe?

What you need to know about the health risks of tattoos, finding a safe tattoo parlor, and the process of tattoo removal.

Kate Beschen spent years contemplating a tattoo. So when the 37-year-old Philadelphia-based doula finally went for her ink last year, she thought she had covered all the bases. "I had my son and daughter drawn as superheroes on my upper arm," Beschen says. "I decided this was an image I'd be proud to have for the rest of my life."

But there was one angle Beschen didn't anticipate: her daughter's reaction. "My 15-year-old is making comments about wanting a tattoo," she says. "Now I'm not so sure how I feel about the process -- I want her to be safe, and I don't want her to regret it."

Tattoos: No Safety Regulations

Are tattoos safe? The FDA regulates the inks in tattoos, but the actual practice of tattooing is regulated by local jurisdictions, such as cities and counties. That means there is no standardized certification for those doing the tattooing or an overall governing body supervising the health and safety of tattoo parlors.

"When you are injecting a substance into the skin, you risk infection," says Elizabeth Tanzi, MD, co-director of the Washington Institute of Dermatologic Laser Surgery in Washington, D.C., and assistant professor of dermatology at Johns Hopkins University. "Although small, the risks include hepatitis, staph, or warts."

Other Tattoo Risks

There are other possible health risks: A gun equipped with needles punctures the top layer of the skin to deposit ink in the dermis, the deep layer of the skin. Unsterilized tools such as the needles or gun, and ink that has been contaminated, can lead to infection. As the surface skin heals, the pigment remains trapped below.

Pain is always a factor. Depending on the part of the body you're tattooing, the experience can feel like a pin scratch or like being carved by nails. And because the skin is punctured, bleeding is involved, which can put you at risk for blood-borne illnesses such as hepatitis B.

The ingredients in the ink also can pose a problem, in the form of allergic reaction, Tanzi warns. "An allergy to the ink is uncommon, but can lead to inflammation and scarring," she says. Ask if the inks contain nickel or mercury -- the most likely allergens -- so you can avoid these. The ingredients in tattoo ink can vary depending on the color, but they often contain metals and other organic compounds in a liquid base like purified water.

The most likely downside for anyone getting a tattoo is regret. "Tattoos are very difficult to remove," Tanzi says. "You can lighten them, but complete removal is a challenge. You have to accept the fact that the skin will never look the same."

Regret is what worries Beschen about her daughter's interest in ink. "I think of myself as a teenager, and I know I would not be happy with any permanent decision I made then," she says. "I just hope the fact that I have a tattoo will make it seem less cool when she's older."

Making Sure Your Tattoo Parlor Is Safe

Want a tattoo? Follow these safety checks from Tanzi.

  • Treat a tattoo as you would any other medical procedure. “You want a tattoo parlor to be at least as clean as a dentist or dermatologist’s office,” Tanzi says.
  • Ask to see the tools the artist will use. The needles should be new, sterilized, and wrapped -- no exceptions. The ink should be in small pots meant for single-use and anything that touches your skin should not be reused. And the artist should wear gloves.
  • Make sure the work area is free of any possible contamination from items like purses and cell phones.

Getting Your Tattoo Removed

You might think that if you tire of your tattoo, you can just get it taken off, but the process of tattoo removal is actually expensive, time consuming, and painful. Depending on the size of the tattoo and other factors, you may need to undergo anywhere from five to 20 sessions for a satisfactory removal -- and each session costs hundreds of dollars.

The process of tattoo removal involves a laser that targets the pigment and dissolves it so the body can absorb it. Some tattoos can never be removed completely because the ink has been placed too deep in the skin and the laser treatment can't reach it. Other complications include hypopigmentation (white spots where the tattoo used to be) and fibrosis (thickening of the skin in the tattoo site). Because of the risks (burns and scarring) involved and the skill required, you should see a dermatologist or other medical professional to have the work done.

Black is the easiest shade to remove, while green, blue, yellow and purple can be the most stubborn. Older tattoos will fade more easily than newer ones. And the darker your skin pigment, the more difficult it will be to erase your ink. Where the art is on your body can also affect removal: The further away the tattoo is from your heart, the harder it is to treat.

A new ink called Freedom2Ink has recently earned FDA approval and may make tattoos less permanent. The ink is micro-encapsulated so that when laser energy hits the pigment, it is destroyed quickly. Removal with this type of ink will require fewer visits, possibly as few as one or two, making them easier to erase.

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