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Tattooing Process Could Lead to Permanent Scarring and Infection if Done Carelessly Industry Guidelines Should be Followed to Ensure Consumer Safety

  • 2023.10.16

Tattoos have become fashionable in Hong Kong and around the world, with many people using them for self-expression or as a token of remembrance for loved ones or even pets. On the other hand, cosmetic tattoos (also known as permanent make-up) such as eyebrow and eyeline microblading are convenient ways for busy urbanites to look sharp every day while saving time from make-up. The tattooing process uses equipment to pierce the surface of the skin to inject ink into the dermis layer. However, this might pose a series of health risks such as infection caused by poor hygiene of the tools, skin allergic reactions to tattoo ink, and heavy metals or chemical substances in the ink that may cause damage or harm to different organs or diseases in the long run. The Consumer Council reminds consumers to consider thoroughly and seek advice from healthcare professionals before deciding on getting a tattoo. 

Furthermore, there is currently no legislation in Hong Kong regulating the professional qualifications of tattoo artists or licensing of tattoo parlours. The Council urges the industry to exercise self-discipline in provision of a hygienic environment, appliances, and equipment in accordance with the Department of Health’s (DH) Recommended Guidelines on Infection Control for Skin Penetration Practice (Guidelines), and to comply with the Tattooing of Young Persons Ordinance, which prohibits tattooing of persons under the age of 18. Consumers who plan to get tattoos should patronise reputable tattoo parlours or beauty parlours that are well-equipped and have satisfactory hygiene conditions. They should also make sure that the tattoo artist maintains stringent cleansing and sterilisation procedures to avoid being exposed to unnecessary risks. 

Poor Hygiene and Improper Disinfection May Lead to Infections 

The process of tattooing usually employs an electric vibrating device which allows tattoo needles to pierce through the top layer of skin, inserting the ink into the dermis layer in order to leave permanent markings on the skin. There are two types of tattoos — traditional tattoos and cosmetic tattoos. Traditional tattoos (also known as “decorative tattoos”) are made by repeatedly piercing the skin with a needle dipped with coloured ink to form semi-permanent patterns on a specific area of the skin. Cosmetic tattoos (also known as “permanent make-up”), most commonly found as eyebrow tattoos, eyeline tattoos, or the recently popular eyebrow and lips “microblading”, involve injecting coloured pigments into the area around eyes, on eyebrows, or into lips, which generally last for 2 to 6 years. 

During the tattooing process, the top layer of the skin will be pierced by needles. If the needles are used repeatedly without proper sterilisation and cleaning beforehand, if the venue is not hygienic, or in case of improper treatment of the wound after tattooing, consumers may get bacterial or viral infections, leading to different infection symptoms such as red, purple, or dark brown blemishes, bulging or uneven tattooed areas, itchiness, pain, swelling, and rashes, etc. In case of serious infection, the patient may suffer from fevers, open sores, or even pus. After inflammation, there will be a higher chance that scars, keloid scars, or hypertrophic scars may form on the skin, increasing the risk of having permanent scars on the tattooed area. 

In addition, if the tattooing equipment is unclean or contaminated, the tattoo recipient may come into contact with other people’s blood during tattooing and get infected with bloodborne diseases such as hepatitis B and hepatitis C, or HIV, so the consequences can be extremely severe. 

Tattoo Inks Possibly Allergenic and Might Contain Heavy Metals and Potentially Carcinogenic Harmful Substances 

Tattoo inks usually contain pigments or dyes, solvents, pH regulator, preservatives, and other auxiliary substances, and some people may have allergic skin reactions to these chemicals. Studies have shown than red tattoo pigments are more likely to cause skin allergy. If symptoms such as itchiness, redness, swelling, and rashes appear, patients need to seek medical advice promptly. 

According to overseas studies, many tattoo inks contain heavy metals such as mercury, lead, copper, nickel, cadmium, and arsenic. The types and levels of heavy metals detected in different coloured inks vary. Most heavy metals will accumulate in the body, and excessive intake may cause damage to various organs. Black and dark brown tattoo inks are more likely to contain polycyclic aromatic hydrocarbons (PAHs), many of which are confirmed or potential carcinogens. Orange and red inks are more commonly detected with primary aromatic amines (PAA), which can alter the structure of the body’s DNA and cause cancer and other diseases. 

Large Tattoos May Affect Medical Diagnosis  

Removal of Tattoos Also Carries Risks 

Tattoo pigments deposited in the dermis after being injected into the skin may mask symptoms of skin diseases, or affect medical diagnosis and treatment. According to the Safety of Tattoos and Permanent Make-Up Technical Report published by the Council of Europe, tattoo pigments may affect the clarity of magnetic resonance imaging (MRI) and positron emission tomography (PET) images, and may even interfere healthcare professionals from accurately identifying melanoma in tattooed skin, delaying the diagnosis of potential risks of melanoma in that area of the skin. 

To change designs or remove tattoos, it is common to apply high-energy laser treatments. However, depending on the size of the tattoo, individual body pigmentation, and the intensity of laser deployed, consumers may have to undergo numerous treatments before the tattoo could be completely removed. Consumers should be particularly aware that the use of lasers may result in skin burns, permanent scars, and “hyperpigmentation” of the tattooed area. 

Tattooing of Persons Under the Age of 18 is Prohibited by Law 

The health risks associated with tattooing and permanent make-up should not be overlooked, yet there has been no legislation in Hong Kong regulating the professional qualification of tattoo artists, or requiring tattoo parlours to be licensed. The Guidelines developed by the DH cover basic infection control principles related to skin piercing operations such as tattooing, as well as providing information on environmental hygiene and handling of equipment, etc., but such measures are only voluntary. The Council urges the industry to take necessary precautions in accordance with the Guidelines and ensure that consumers are fully aware of the risks involved. In addition, under the Tattooing of Young Persons Ordinance, any person who tattoos a person under the age of 18 years commits an offence, unless a medical reason is provided by a medical practitioner. 

Consumers should patronise reputable tattoo parlours or beauty parlours so that there are appropriate measures to handle any undesirable conditions that may arise as a result of tattooing. Furthermore, consumers should pay heed to the following tips before deciding to get a tattoo and for subsequent maintenance to minimise risks: 

  • Tattoo artists should wear new protective gloves for each client, and disposable needles and equipment should be used. If repeated use is unavoidable, the equipment must be properly sterilised with alcohol or disinfectant; 
  • Avoid contact of the tattoos or permanent make-up with water for several hours after application. Bandages or plastic wrap used for protecting the tattoo should be kept in place for at least a few hours to minimise risks of bacterial infection or sun damage, and to prevent the wound from rubbing against clothing; 
  • Avoid showering with hot water as this may affect the healing process and may cause the ink to fade. The tattoo should not be exposed to intense sunlight or tanning lamps for a few weeks; 
  • Scabbing of tattoo wounds will usually start about 3 to 7 days after application, and extra care should be taken for treating the wound. As the area may become itchy, be careful not to scratch the skin, especially consumers with long nails or manicures; 
  • If consumers experience redness, itching, pain, secretion, pus, swelling, etc. any time after the tattoo is completed, please see a doctor immediately. 


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