Tattoos

Tattooing the skin has been done throughout history and remains a popular form of body decoration today.

If you are considering getting a tattoo, it is important to have a good think about it before going ahead. Always choose a tattooist whose business is registered with their local council to minimise the risks of complications.

People may get tattoos for many reasons, including:

• cultural traditions
• to show membership of a group
• as an expression of individuality
• to mark a significant event, such as the death of a loved one or the birth of a child.

Types of tattoos

The two types of tattoos are:

• Traditional or ‘decorative’ tattoos are made by repeatedly puncturing the skin with a needle saturated with coloured ink to make a specific design.
• Cosmetic tattoos are also known as pigment implantation or permanent make-up. ‘Permanent’ colour pigment implants are applied around the eyes, on the eyebrows or to the lips. These implants generally last for two to six years, depending on your skin type. They are usually applied by a beautician.

Getting a tattoo can change your body image for life. Some things to consider include:

• Tattoos are permanent. It may be the look you want now, but how will you feel about it when you are older?
• Tattooing can be a painful process. Depending on the complexity and size of the design, it can also take quite a while (days or weeks) to complete.
• Tattoos can be expensive– the costs will vary depending on the size, design, number of colours used and the time taken.
• How will your family and friends feel about your tattoo and how will it affect your relationships?
• Having a visible tattoo may be an issue for particular workplaces and could affect your employment opportunities.
• Unwanted tattoos can cause psychological problems, especially if they are easily visible.

If you decide to get a tattoo and it is your first, it may be helpful to get a small design. A small design will be easier to complete, and is a less extreme ‘trial piece’ for determining whether you like having a permanent tattoo. It is important that you carefully consider the reasons for getting a tattoo, and the way it may impact on your life, before going through with it.

Laws relating to tattooing in Australia

Laws relating to tattooing are different in each state or territory. In some parts of Australia (including Victoria), it is illegal to perform a tattoo on a person under 18 years of age, unless it is for medical purposes.

It is also now illegal in Victoria for the practices that are considered to be ‘like’ tattooing – scarification, tongue splitting, branding and beading – to be performed on anyone under 18 years of age.

Complications of tattooing

Choosing a registered, experienced tattooist can help reduce the risk of complications. However, getting a tattoo can still put you at risk of:

• infections, such blood-borne viruses
• allergic reactions
• thick scars.

If the tattoo extends over a mole, it may make it more difficult to identify any changes in colour or size or any other changes that occur to the mole. While a tattoo will not increase the chance of a mole becoming cancerous, it is important to be aware that a tattoo may obscure any changes that might occur.

Another possible reaction is that you may become distressed after the procedure, due to regret at getting the tattoo. This has been identified as one of the major problems involved with tattoos.

Choosing a tattooist

Choose an experienced tattooist whose business is registered with their local council. A certificate of registration should be made available for you to see. Make sure the tattoo premises you choose looks clean and professional.

Check that the tattooist uses single-use and sterile equipment for each client, or thoroughly cleans and disinfects their equipment before use, by putting it through a steriliser. If a premises looks dodgy, trust your judgement and keep away.

Don’t be afraid to ask questions about the tattooist’s experience and procedures. If they do not answer your questions, or you are not satisfied or comfortable with them, do not feel pressured – take your business elsewhere.

To comply with health regulations:

• The premises must be kept clean and hygienic.
• Instruments and needles must be sterile at the time of use.
• The operator should not have exposed cuts or wounds, and their clothes must be clean.
• The proprietor or operator must provide you with health information before any procedure is done.

The ideal tattoo premises should have:

• good ventilation and lighting
• a separate area set aside for the cleaning, disinfection and sterilisation of instruments
• benches, floors, shelving and furniture that can easily be kept clean – items that may need to be touched (such as spray and ink bottles) should be covered with single-use plastic bags so that only the nozzles are exposed
• a hand washbasin.

Procedure for tattooing

During the procedure, the tattooist should:

• wash their hands at the beginning and end of the procedure, and whenever they take a break during the procedure – for example, when answering the phone – using soap, and patting dry hands
• clean and disinfect your skin thoroughly before and after the procedure
• wear single-use gloves on both hands throughout the procedure
• use sterilised equipment and explain to you how they sterilise the equipment
• change the needle assembly or handpiece after use with another client
• tattoo an outline of the design on the skin
• use cleaning solution and wipes to remove excess pigment and blood from the tattoo site
• cover the area of your skin that is being tattooed with a dry dressing if you need to take a break during the procedure
• clean the area when the tattoo is completed, apply antiseptic cream to the treated area and cover with a dressing
• talk to you about how to care for the tattoo to prevent infection, and provide you with this information in writing so you can take it home
• never smoke, drink or eat while conducting the procedure.

Ask your tattooist what you can expect after the procedure. It is normal to experience some initial bleeding, irritation and tenderness in the area.

Tattooing equipment must be sterilised

The tattooist should be able to explain to you how the equipment is sterilised and, ideally, should have a steriliser on the premises.

To make sure equipment is correctly sterilised and to avoid infection:

• All needles and instruments must be thoroughly cleaned and sterilised before they are used.
• Reusable instruments should only be used if the shop has its own steriliser, or has a system in place for off-site sterilisation. Once sterilised, they must be replaced if they are accidentally touched or contaminated in any other way. Sterility must be maintained at all times.
• It is even safer if operators use pre-sterilised, single-use needles and instruments. These must be disposed of into a sharps container, out of reach of children.

If the equipment is sterilised somewhere else, the operator should be able to provide you with evidence of this.

Preventing cross-contamination when tattooing

Gloves must not be reused. If the operator is distracted during the tattooing procedure (for example, to answer the phone), they must first remove their gloves and wash their hands. Before returning to the procedure, they must rewash their hands and put on new gloves.

After a tattooing procedure

After tattooing your body, the operator should:

• wash your skin with warm water and soap, and single use wipes
• remove their gloves, wash and pat dry their hands, then re-glove using new gloves
• apply antiseptic cream from a single-use container to the treated area of skin and cover the site with a sterile dressing.

Avoiding infection after getting a tattoo

As a tattoo is an open wound, it is important that you take precautions to help avoid the chance of infection, including:

• Follow the advice given by the tattooist regarding aftercare and how best to prevent infection.
• Make sure your skin is free from cuts, abrasions or infection at the proposed site of the tattoo. If you have a skin infection, you should only have a tattoo performed once the infection is completely healed and the skin has returned to normal.
• Two to three hours after being tattooed, wash the area with soap and pat dry with a clean towel.
• After washing, using new gloves, lightly apply some ointment to the area that has been provided or recommended by the tattooist or a health professional, such as a pharmacist. Repeat this process as necessary when you feel the skin is drying out.
• Do not touch the tattooed skin area and do not pick at any scabs that may form.
• Avoid wearing tight or dirty clothing, or exposing the tattoo to direct sunlight.
• Avoid soaking your tattoo in water such as in a bath, swimming pool or the sea.

If the tattooed area becomes very red, swollen or tender to touch, it may be infected. An infected tattoo can be treated with antibiotics.

Consult your doctor immediately and notify the tattooist if:

• your skin becomes very irritated, itchy, red or sore
• the site doesn’t heal
• you experience pain or swelling
• there is continual bleeding or discharge from the site
• you have any other concerns about the procedure.

Why tattoos are permanent

Tattoos appear under a microscope as tiny granules of colour (pigment). These granules are located in a skin cell known as a macrophage. Macrophages normally remove foreign objects (for example, bacteria) from the body. The pigment in the tattoo ‘freezes’ the macrophage cell so that it can’t do its job. As a result, the pigment remains in the skin and the tattoo becomes permanent.

Where to get help

• Your doctor
• A tattooist whose business is registered with their local council
• Local council
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)