By Merry Sue Baum
Unbutton your shirt. Don't be afraid, my needles are as clean as a doctor's fingers," the ancient woman says as she begins tattooing in Ray Bradbury's classic tale, "The Illustrated Man."
Bradbury's narrative is fiction, but contracting infectious diseases from unsterile needles is very real. An article in Clinical Infectious Diseases (April 1994) states that tattooing carries medical risks, including the transmission of hepatitis B, tetanus, cutaneous TB, and possibly HIV/AIDS. Tattooing has increased dramatically during the last decade, and so has the number of tattooists. Not all of them can make the same claim as Bradbury's old woman.
Tattooing is not regulated by state law in New Jersey, licensing is not required and tattooists take no exams. They learn by serving an apprenticeship. The industry is, however, under the jurisdiction of local municipalities, says Tony Monaco, a health projects coordinator at the state department of health. Each community has its own ordinances, so before getting a tattoo, he suggests, it's wise to check with local health officials. Find out if the shop is inspected regularly, if an autoclave is used to sterilize equipment (that's the only foolproof method of killing micro-organisms), if needles and ink wells are disposable and if the pigments being used are FDA-approved, food-grade colors.
Thomi Hawk, owner/operator of K & B Tattooing in Hightstown, says he welcomes questions from potential customers: "I'll give anyone a complete tour of my shop, and explain the procedure and our sterilization techniques. Any responsible tattooist who is doing things safely and has nothing to hide will be happy to do the same."
Hawk runs a tight ship. A large sign on the shop door warns that no one under 18 will be tattooed without parental permission and alcoholic beverages are prohibited. He says, he adamantly refuses to tattoo anyone who he suspects is intoxicated, high on drugs or ill. The local board of health inspects the shop regularly, and he gets medical updates on infectious diseases from his family - his wife is a dental hygienist and his father-in-law is a dentist.
Hawk also belongs to the Alliance of Professional Tattooists (APT), a nonprofit organization that requires members to attend an annual seminar on legislation, technology, and diseases and infection control. "I want to protect my customers as well as my staff and myself," he says. "I have a 3-month-old daughter. I don't want to bring anything home to her."
A tattooist for 20 some years, Hawk says he's probably "illustrated" thousands of people, including members of several Princeton sports teams. He did the crew team a few years back and has done a number of swimmers, including Olympic gold-medal-winner Nelson Debile. He also tattooed an entire fraternity at Rider University - a task which earned him an honorary membership.
Hawk's oldest customer was an 80-year-old woman who had wanted a tattoo all her life. His youngest was a 13-year-old whose parents asked him to try and make her homemade tattoo a bit more appealing. He's done everything from simple names that cost about $20 to intricate, full-back, mural tattoos that cost thousands. As far as he knows, Hawk says, none of his customers has ever gotten an infection. He has seen a few adverse reactions to the inks, especially red. "But the newer pigments are hypoallergenic so we're seeing less and less of that."
The procedure is fairly simple. The area to be tattooed is shaved and cleaned with tincture of green soap and alcohol. A stencil of the desired image - which has been drawn on special thermal paper - is pressed onto the skin and the image transferred. Next, a coating of an ointment like A&D® is put over the area so any extra ink won't seep into the pores and the tattooist's hand can slide freely.
The pigments are poured from bottles into small, disposable ink wells, and the tattoo gun draws up the desired color into a tube-like barrel inside. (It works like an old fashioned fountain pen.) The needle rapidly pierces the skin, injecting the pigment.
First the outline is covered and then, working in small circles from the lightest color to the darkest, the practitioner fills in the rest of the design. Hawk says he uses from one to seven needles per person, depending on the design's complexity. After another coat of ointment, a sterile bandage is put in place - it can be removed in an hour - and customers leave with written instructions on how to care for their new tattoos.
"Having it done feels like an annoyance - a constant scratching," explains Hawk, who has had his arms, chest, back and legs tattooed. "Some areas of the body are more sensitive than others, but if it's done correctly, it shouldn't hurt all that much. And if customers keep their tattoos clean until they heal, there shouldn't be complications."
Roger Brodkin, MD, clinical professor of medicine at UMDNJ-New Jersey Medical School, concurs: "There are risks, but if it's done under sterile conditions and with disposable equipment and pigments, it's relatively safe."
He warns, however, that tattooing yourself is very dangerous. "The chance of infection increases dramatically," he notes.
Besides the risks, Brodkin points out the difficulty in having them removed: "There's no such thing as getting a tattoo removed in one shot. It's far more involved than that. And there are emotional problems too. People are often angry that they got a tattoo and disappointed that it can't be completely removed and their skin restored to normal. At best, there will be a shadow or ghost where there once was a tattoo."
The most common methods of removal are dermabrasion, or sanding the skin, tattooing skin-colored pigment over the existing tattoo, laser removal and excision. Brodkin says the technique used depends on the person's skin type, size and color of the tattoo, and whether it was put on by a professional or a do-it-yourselfer.
Professionally done tattoos, he says, are usually removed with lasers. A different laser is needed for each color, so removing a large, multi-colored tattoo can mean numerous visits to the doctor and a great deal of expense. Even small tattoos require more than one session. And, he adds, "If you give up in the middle, you'll wish you'd never started. You'll have a tattoo that's a mess."
Brodkin says dermabrasion is a painful procedure that leaves scars and may result in an infection. Sailors of old, he notes, performed a similar procedure known as salabrasion. They rubbed coarse salt over the tattoo causing a deep brush burn. After it healed, they would repeat the process until the tattoo was gone. "Dermabrasion is a lot more sophisticated than that, but it is still quite painful, and the area that's been abraded is tender for a very long time."
He says excision, too, is painful and sometimes leaves disfiguring scars. Tattooing pigment or freckles over the tattoo usually doesn't work well either.
Brodkin advises people to think long and hard before getting a tattoo. "Life changes," he says. "I've known preachers who are embarrassed by the hula girls on their arms. And what is done can never be completely undone, with repentance or lasers."
Everything Old Is New Again
It may be the latest fashion craze, but body piercing and tattooing are anything but new. Archaeologists have found Egyptian and Macedonian jewelry for pierced ears dating back to 2000 BC, and it's believed pirates and sailors who had crossed the equator once wore one hoop earring - two if they had crossed at least twice. Piercing the navel was denied commoners in ancient Egypt, as it was a sign of royalty, and Roman centurions wore nipple rings to symbolize virility and courage, and as an accessory to hold their capes.
Ancient rites of passage that included ceremonial piercings were held around the world. It was a proud day for an Arab youth when a ring inserted through his scrotum provided visual evidence that he had become a man. Sioux Indians who aspired to the rank of warrior were required to hang in the summer sun, for 10 to 20 minutes, suspended from piercings in the chest.
As for tattooing, it's believed the caveman tattooed himself by pricking the skin with a sharp stone or piece of bone and rubbing natural dyes into the wound. Egyptians tattooed permanent makeup on their faces and mysterious patterns of dots and dashes on their bodies. American Indians sometimes tattooed themselves before going to war.
Tattooing as we know it today originated in the South Pacific. Captain Cook brought the art form to Europe in the late 1770s, and it soon made its way across the sea. The word itself comes from the Tahitian, "tatu," meaning "to mark." It refers to the sound made by a wooden or bone mallet tapping on the end of a stick during the tattooing process.
And just in case you thought women of the 1800s were too delicate to withstand the rigors of tattooing, Lady Randolph Churchill, the prime minister's mother, started the fad of dainty tattoos among fashionable women of her day. She had a coiled snake around one wrist. When tattoos went out of vogue at the turn of the century, she concealed it by wearing a heavy bracelet.