A tattoo is a temporary or permanent drawing on the body, depending on the methods and means used. In the past, tattoos were used to mark social status, kinship, and maturity in various nations. Now they are an aesthetic means of self-expression, an adornment of the body with a symbolic meaning. But if this decorative solution eventually becomes boring, what if the values it represented change? Unfortunately, this is just one of the drawbacks of tattoos.
On the origin and depth
The localisation of body paintings varies, often as a result of cultural factors. For example, temporary henna tattoos, popular in India, are usually applied to the hands, wrists, forearms, and feet. However, the most common locations for permanent drawings are the shoulders, upper arm, forearm, wrist, back, lower legs and chest.
Tattoos are divided into decorative tattoos, whether done in a professional or non-professional parlour; cosmetic tattoos, also known as permanent make-up; traumatic tattoos, which are the result of an accident, an explosion, or any other mishap that has caused the pigmented particles to become trapped in the affected skin; and medical tattoos. Professional decorative tattoos are done using a special device called a tattoo gun, which is used to inject pigment into the skin with a needle. The colours used in tattoo parlours are derived from organic inks mixed with heavy metals. The drawings, created with high-density coloured materials, reach deeper layers of the skin. Non-professional tattoos are done on the upper layers of the skin, as the pigment enters the skin using wires or needles. Amateur tattoos are usually black and made with charcoal ink, making them easier to remove.
The tattoo is applied by injecting the pigment into the middle layer of the skin — the dermis. The process damages the junction between the epidermis (the top layer of the skin) and the dermis, causing the pigment to spread within and between cells. After 2-3 months, the pigment remains concentrated in the scar tissue formed in the dermis as the skin layers recover.
Unfortunately, various complications can arise from body drawings, which in some cases can occur regardless of the professionalism of the artist. For example, an allergic reaction, scarring, dissatisfaction with the tattoo over time, etc. “When thinking about tattoos, it's important to consider the risks involved. Infection can develop due to the damaged skin barrier. Microorganisms inside the skin cause inflammation, which is characterised by pain, redness, and swelling. Severe infections are also possible, as evidenced by high fever and other more pronounced symptoms,” says dermatovenerologist Prof Dr Matilda Bylaitė‑Bučinskienė, sharing her professional insights. “Failure to comply with hygiene requirements can lead to hepatitis and HIV infections.”
The dermatovenereologist notes that contact allergies are possible in some cases, but there are no regulated tests for tattoo ink allergy. Allergic reactions, although rare (most often to red ink), are unpredictable. The ink used for body art contains a wide variety of chemicals, some of which are carcinogenic. However, according to Prof M. Bylaitė‑Bučinskienė, there is currently no established link between tattoos and oncological diseases. The doctor also adds that ink can be perceived by the body as a foreign body, triggering immune reactions that can lead to the formation of various bumps or scars. An MRI scan may cause burning and swelling sensations at the tattoo site, and the presence of metals in the ink may result in visual artefacts.
An (un)temporary indulgence
Statistics show that 30% of people regret getting a tattoo, while 10-20% seek to remove it. Medical experts say that the tattoo removal procedure is painful, there is an inherent risk of complications, and it is not always possible to completely remove the tattoo.
A recent study in Denmark identified various reasons for tattoo removal, which can be grouped into several categories. These include social exclusion (stigmatisation, visibility, problems at work as a result of the tattoo), changes in the drawing (poor quality or fading of the tattoo, pigment bleeding into the surrounding tissues), personal factors (the tattoos got stale, maturity, loss of symbolic relevance), health problems (allergic reactions, scarring, sensitivity to the sun).
“There are various methods of removing tattoos, but laser removal is the safest. The main target of the laser for removing tattoos is their pigment. One of the lasers used is the Q-switched YAG, which generates the different wavelengths needed to destroy a particular colour. This laser produces infrared light waves of 1064 nm for black, 532 nm for red, 585 nm and 650 nm for blue and green pigment removal”, explains dermatologist M. Bylaitė‑Bučinskienė. “During the treatment, the laser produces a photo-acoustic vibration and releases energy, which is converted into heat in the skin. These factors cause the pigment to break down into smaller particles, which are removed through the epidermis, other skin cells (macrophages — cells that remove foreign bodies) and drained with the lymph.”
According to the dermatovenereologist, laser removal of tattoos is a painful procedure. The manipulation site is anaesthetised with a local anaesthetic, but the pain often persists. In most cases, the removal procedure needs to be repeated several times, on average between 4 and 15 times. An interval of 4-6 weeks between them is recommended. When removing tattoos, a certain laser pulse speed is set. The treated area swells or turns yellow, redness and swelling develop, small bruises appear after a few minutes, and scabs and bruises may appear in the more distant period. These are normal skin changes that are unavoidable for a good quality removal of tattoos. Complications include unbearable pain, syncope, hyperpigmentation, hypopigmentation, bleeding, and other changes.
The most beautiful drawing — an erased one
The results of body art removal depend on several factors (see table), which the doctor must discuss with the patient before the first and subsequent procedures. Not all tattoos can be removed, and a good result is not always guaranteed. Only a third of people have their tattoos completely removed, but around 85% of patients are satisfied with the final results. The table shows that old, faded, monochrome tattoos have better results. Lighter skin tones are less likely to develop hypopigmentation or hyperpigmentation. It is important to know that the green pigment is the most difficult to remove.
For better results and a shorter tattoo removal period, it is important to consult a dermatologist with experience in laser body art removal. Before the procedure, it is important to discuss the expectations of the person and the questions that arise. Complications of laser tattoo removal are also unavoidable: excruciating pain, scarring, hyperpigmentation, inadequate pigment removal, hypopigmentation, infection, blistering, bleeding, exacerbation of blisters, exacerbation of other illnesses (psoriasis, atopic dermatitis), bleeding, paradoxical darkening of the tattoo, prolonged healing time, episodes of syncope/hypoglycaemia, change in the texture of the skin, and compartment syndrome. So, when you decide to decorate your body with a beautiful, meaningful drawing, you should ask yourself several times: will the most beautiful drawing be erased?..
Table: Factors influencing tattoo removal time and results.
The most prominent invisible tattoos
We will find a plethora of celebrities famous for the dynamics of body art. One of the most famous examples of tattoo removal and transformation is actor Johnny Depp. For example, the tattoo bearing the name of his beloved Winona Ryder, “Winona Forever”, became the playful “Wino Forever” after the divorce, after a subtle erasure of several letters. Actress and philanthropist Angelina Jolie took a similar creative approach with a tattoo of the name of her ex-husband Billy Bob Thornton. Instead, a drawing of the coordinates of the birthplaces of her family members appeared on her left hand.
A number of celebrities have live-streamed the painful tattoo removal process. For example, Kelly Osbourne, who emotionally addressed her fans live on air: “Who else knows how bad this hurts??? It’s 1000000000000 times worse then getting the tattoo!!!“
However, it is clear that the emotional connection to a symbolic drawing, beliefs or aesthetic changes are more important to famous personalities than the pain of tattoo removal and the discomfort of the healing process.