Photo by Annie Spratt on Unsplash.

Tom Gotowka

In January 2023, Ledge Light Health District (LLHD) will enact regulations for the oversight of the tattoo and piercing establishments and their respective practitioners and operators in the nine communities in LLHD’s SE CT service area. 

Background:

Connecticut had passed legislation requiring some oversight several years ago, but an organized monitoring and inspection system had never really been implemented.

This absence of oversight surprised me, because Connecticut already reviews barbers, cosmeticians, estheticians, hairdressers, and nail technicians; none of whom intentionally pierce the skin or introduce foreign materials into the body.

Connecticut DPH did eventually make such oversight the responsibility of the individual health districts; and per the above, LLHD drafted regulations and office inspection protocols that were reviewed and approved by their Board of Directors. Local body art practitioners had input and were supportive of the efforts.

This essay reviews the need fulfilled by LLHD and broadly considers the body art genre, which not only includes tattooing and piercing, but also branding, and permanent cosmetics. I sometimes use the term “practitioner” in this essay, as equivalent to tattoo “artist” or “technician”.

Note that since 2015, Connecticut has required written consent of a parent or legal guardian for tattoos and piercings for those under age 18. Piercings of the ear lobes are exempt from the requirement for parental consent. 

Body Art by the Numbers:

In my “youth”, tattoos had been the hallmark of the troubled and/or rebellious individual; — somebody with “attitude”; and definitely not someone you should be hanging out with. For example, in 1950s’ Milwaukee, Arthur Fonzarelli (“the Fonz”), with his motorcycle, black leather jacket, and rebel attitude would have had tattoos. Richie Cunningham, would not.

But fortunately for every individual who has “gotten ink” since the days of my “youth”, that negative stigma has faded; and body art now appears to be generally accepted as a form of self-expression.  

A 2019 survey indicates that about 30 percent of Americans have at least one tattoo, compared to only 21 percent in 2012. Forty percent of people 18 to 34 years old, and 35 percent of those 35 to 54 years old have at least one tattoo; and it is estimated that more than 60 percent of adults in the United States have had a body piercing (the estimate includes pierced ear lobes).

Results were not stratified by any measure of attitude.

Photo by Allef Vinicius on Unsplash.

Common Procedures:

Tattoos are created by injecting ink into a person’s dermis, (i.e., the middle and thickest layer of skin. The practitioner usually uses a machine that makes many small holes in the skin and inserts ink into the holes.

For cosmetic procedures like microblading, pigment is scratched into the skin to resemble eyebrow hair. The microblade is a manual, handheld tool with tiny needles at the tip that create the shape of a small blade. 

Training and Licensure:

In order to qualify for a Connecticut tattoo license, the applicant must

• have completed 2,000 hours of practical training and experience under the direct supervision and instruction of a licensed tattoo practitioner
• have successfully completed, within the prior three years, a course on prevention of disease transmission and blood-borne pathogens that comply with OSHA  standards
• hold current certification in basic first aid by the American Red Cross or the American Heart Association.

Individuals that only provide body piercings are not required to be licensed. 

However, establishments that provide piercings outside of the ear lobe/will be inspected. Licensing of the individual practitioner is granted by Connecticut DPH, while LLHD has responsibility for inspecting and licensing the facility/establishment and the breadth of services provided therein.

Some Colorful History:

Sailors in the merchant marine had their initials tattooed onto their skin in the 1700s. These tattoos were then recorded in their personal “Seamen’s Protection Certificates”, which were used as identification and to fend off impressment, which was a form of illegal conscription employed by the Royal Navy during the 18th and early 19th centuries as a means of crewing warships. 

A modification of Thomas Edison’s electric pen, invented in 1875 and designed for duplicating and printing documents, is still used today for tattooing.

The New York World newspaper, a pioneer in yellow journalism, which published independently until 1930, when it merged into the “New York World-Telegram,” reported that by 1900, more women than men in New York City sported tattoos. 

In 1961, it became illegal to provide someone a tattoo in New York City. The city claimed that there was an outbreak of hepatitis B, while many suspected that it was done in an attempt to clean up the less than savory areas of the city in advance of the 1964 World’s Fair. However, the ban remained in effect for 36 years and was finally lifted in 1997.

Of course, the ban had created a busy underground market for tattoos. 

Several religious denominations have decreed that tattoos are a sin to obtain and a sin to display. Father Jerry Herda of the Archdiocese of Milwaukee wrote in the “Catholic Herald” in 2012 that “a tattoo in and of itself is not a sin; but “there are times when getting a tattoo can be sinful.”

He went on to illustrate with the examples of an individual, who gets a tattoo, that is vulgar or offensive to others; and a minor child, who gets a tattoo in opposition to his parents’ wishes, which would be a violation of the fourth commandment. Father Herda’s second example is pertinent to some of the discussion below. 

The Risks:

Although tattooing and piercing can be performed safely, they both carry risks. These risks include allergic reactions, skin infections at the site, and the spread of infectious diseases and bloodborne pathogens, all of which underscore the importance of providing the procedure in a clean environment and under sterile conditions.

Notably, infections can also occur when the ink is contaminated.  

The Role of the FDA:

The FDA considers the inks used in intradermal tattoos, including permanent makeup, as cosmetics, but the pigments used in the inks are color additives that require pre-marketing approval. There are a variety of pigments and dilutants used in tattooing.

Although a number of color additives are approved for use in cosmetics, not all are approved for injection into the skin; and using an unapproved color additive in a tattoo ink makes the ink “adulterated” and possibly harmful.

When the FDA identifies a safety problem associated with a cosmetic, including a tattoo ink, the agency investigates and takes appropriate action to prevent illness or injury.

For example, in 2017 and 2019, the FDA issued safety alerts advising consumers, practitioners and retailers to avoid using or selling certain contaminated tattoo inks. Further, the FDA initiated actions in 2011, 2012, 2014, and 2017 that resulted in the voluntary recall and, in some cases, market withdrawal, of tattoo inks and needles due to reports of infection and confirmed microbial contamination.  

LLHD Inspections:

Onsite reviews may be completed annually or in follow-up of a complaint or some corrective action. However, due to the nature of body art and a respect for privacy, inspections will be scheduled, which differs from other regulated establishments, where inspections are unannounced.

Routine reviews could include verification of credentials, review of the sources of inks and additives, record keeping, and the sterilization procedures required to control cross-contamination of instruments and equipment. Note that the industry has progressed to more single-use materials stored in “steri-packs”. 

Closer to Home:

Two-thirds of our daughters and neither of our sons have tattoos; and none, as far as I can tell, have piercings.

Our youngest daughter, “D”, a computer systems professional has a tattoo of an artist’s interpretation of the Fibonacci Sequence.

Our middle daughter, “K”, a teacher, has a small fish tattoo that is only visible on the beach. The fish is an artist’s rendering of the logo of a sports equipment company. “K” has a son, aged 6, and two daughters, aged 3 years and younger. Remember, in the future, “What goes around, comes around”.  

Some Thoughts:

Perhaps this is all just a contemporary continuation of the “Aesthetic Movement” of the late 19th century, — “Art for Art’s Sake”, which prized the aesthetic value of literature, music and the arts over any didactic, moral, or socio-political function.

Based on a quick search, there does not appear to be a tattoo establishment currently operating in Old Lyme, but Old Saybrook seems to be awash with ink; as are several other Southeast Connecticut communities.

Sources:

CT Department of Public Health (2022). Practitioner Licensing & Investigations Section; Tattoo Technician.
National Environmental Health Association. (2021). Model Body Art Code.
American Broadcasting Company. Happy Days 1974-1984.
Herda, J. Archdiocese of Milwaukee: Catholic Herald. Ask Father Jerry: Is getting a tattoo a sin? (09/20/2012).
Le Blanc, P, Hollinger, K, et al. Tattoo ink–related infections: awareness, diagnosis, reporting, and prevention. NEJM 367(11),985-987
Nalewicki, J. Tattooing was Illegal in New York City until 1997. Smithsonian Magazine. (02/28/2017).
Food and Drug Administration. Tattoos, Temporary Tattoos & Permanent Makeup. 03/01/2022).

Editor’s Note: This is the opinion of Thomas D. Gotowka.

 About the author: Tom Gotowka is a resident of Old Lyme, whose entire adult career has been in healthcare. He will sit on the Navy side at the Army/Navy football game. He always sit on the crimson side at any Harvard/Yale contest. He enjoys reading historic speeches and considers himself a scholar of the period from FDR through JFK. A child of AM Radio, he probably knows the lyrics of every rock and roll or folk song published since 1960. He hopes these experiences give readers a sense of what he believes “qualify” him to write this column.