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Tattoo or Not To

and Other Piercing Questions

“Not if you want to live in this house!”
“But it’s my body!”

This dialog from Danielle Loftus’ memory reflects common adolescent-parent skirmishes over control. These days that tug-of-war has moved from clothes and hair to tattoos and body piercings.

Loftus, 22, resides in West Philly, works at a preschool and caters. She obtained a belly button ring at age 16. For her 18th birthday, this “straight-A kind of kid” got a tattoo on her lower back. It’s a star with wings, partly designed by a friend.
She likes tattoos because “I’m intrigued by them. It’s interesting to have stuff you want on yourself forever. They show style, personality. I don’t like plain, boring.”

A Cultural Norm

A glossy catalog from Macy’s this March featured a male model, a large tattoo across his upper chest and shoulder, in three different scenes. Up to 35 percent of American youth aged 11-25 have “body art,” according to several scientific studies cited by Lisa Tuchman, MD, a pediatrician specializing in adolescent medicine at Children’s Hospital of Philadelphia.

Tattoo Risks

The U.S. Food and drug administration lists these potential complications that can result from tattooing:

Infection. Unsterile tattooing equipment and needles can transmit infectious diseases, such as hepatitis. The risk of infection is the reason the American Association of Blood Banks requires a one-year wait between getting a tattoo and donating blood.

Removal problems. Despite advances in laser technology, removing a tattoo is a painstaking process, usually involving several treatments and considerable expense. Complete removal without scarring may be impossible.

Allergic reactions. Although FDA has received reports of numerous adverse reactions associated with certain shades of ink in permanent makeup, marketed by a particular manufacturer, reports of allergic reactions to tattoo pigments have been rare. However, when they happen they may be particularly troublesome because the pigments can be hard to remove. Occasionally, people may develop an allergic reaction to tattoos they have had for years.

Granulomas. These are nodules that may form around material that the body perceives as foreign, such as particles of tattoo pigment.

Keloid formation. A person who is prone to developing keloids — scars that grow beyond normal boundaries — is are at risk of keloid formation from a tattoo. Keloids may form any time skin becomes injured or traumatized. Keloids occur more frequently as a consequence of tattoo removal.

MRI complications. There have been reports of people with tattoos or permanent makeup who experienced swelling or burning in the affected areas when they underwent magnetic resonance imaging (MRI). This seems to occur only rarely and apparently without lasting effects.

Learn more about tattoos from the U.S. Food and Drug Administration.

“It’s such a cultural norm,” she says, referring to thousands of years of history in which many cultures have engaged in tattooing and body piercing. “You’d be surprised at who gets tattoos,” notes Terry Manning, owner and chief tattoo artist of Wildcard Studios in Wilmington, DE. “Forty percent of my tattoos are for lawyers, doctors, even kindergarten teachers.”

On the other hand, as our grandmothers lectured, “Just because everybody else is doing something, doesn’t mean we should do it too!” Even Manning — who got his first tattoo at age 16 — doesn’t work on minors. Asked what he’d say to his own children if they wanted tattoos, he raises his voice, “No way! Not permanent stuff like that!”

What’s the Appeal?

“You have such a pretty face. Why do that?” Margit Myers’ grandmother challenged her desire since the age of 15 for a septum ring. Myers patiently waited until she was 18, when she could get the piercing legally without permission. At 25, Myers coordinates education programs for Pennsylvania Service-Learning Alliance in Philadelphia and says when she’s 65, she’ll still love her dainty silver ring and enjoy showing it off to her grandchildren. “It’s fun. It’s a form of decoration, like clothes and other jewelry.” Myers says she has a retainer to hide the ring when circumstances warrant.

Dave Miller, 24, is an Arizona State University graduate living in Philadelphia, working for an events booking company. He, like his friend Loftus, is “straight edge,” meaning they abstain from drugs, alcohol and tobacco. He designed some of his tattoos himself as playful reminders of that personal commitment.

An employee of Philadelphia Eddie’s 621, Nick Sloan recalls getting his first tattoo six days after his grandfather passed away. “I was 17, so my parents had to sign for me in Delaware County. I picked a funny old German cartoon, and they agreed that was a great way to remember him.”

Parent-Kid Dialogue

Body art is usually just a social or cosmetic statement, Tuchman notes. Parents should “Keep open lines of communication, and start the dialogue with kids early: who they are, who they’re becoming, what they believe in. Explore why they want what they want, and what meaning it has for them. Get a better understanding of them and their motivations. ”

Young people go through different developmental stages, with different abilities to plan and think abstractly about consequences, Tuchman emphasizes. Middle adolescent years carry particular risks of impulsivity, self-identity and group pressures.

Tuchman says to “recognize and support teens’ enthusiasm to express social views” but to also suggest other ways they can express their perspective and find their place in the world. These can include forms of expression with few permanent consequences, such as attending a rally, writing a letter to Congress or involvement in community activities.

Myers believes that females with tattoos risk being stereotyped as looser, tougher and spunkier than their non-tattooed counterparts. She senses that older generations associate body art with “hooligans and rowdiness.”

What Regulations?

States and municipalities vary dramatically in their regulation of body art.

Pennsylvania has no statewide rules on this field. Body art is left to counties and municipalities to regulate and enforce.

In Delaware, “There is no age restriction on a person getting a piercing or a tattoo,” says Heidi Truschel-Light of the Delaware Heath and Social Services. However, for body piercings (other than ears) and tattoos on persons age 18 or under, body artists are required to have parent or guardian’s written signature, and that adult must remain present during the procedure.

New Jersey requires the presence, written consent and identification of a parent or legal guardian for tattooing youth under 18, and forbids genital piercings of all children under 17 regardless of parental involvement.

In 2002, Philadelphia adopted a code that requires certification of establishments and operators and stipulates minimum rules for sanitation, records, and age and cognitive function.

The Downside

Among serious health concerns raised by experts are blood-borne diseases such as HIV and hepatitis caused by unsanitary needles, and the possibility of infection developing at the wound.  A small number of young adults are drawn to body piercings and tattoos because of what some repeat customers call “pain addiction.”

Philadelphia Eddie’s co-owner Troy Timpel says artists should be clean, gloved, have appropriate sterilizing and waste disposal procedures, avoid cross-contamination, and rely on single-use, sterile equipment packages that they open in front of the client.

Tattoo dyes are not approved by the FDA for injection into the skin, and many contain metals such as aluminum and mercury. Timpel refers families to safety guidelines published by the Alliance of Professional Tattooists.  He also recommends looking carefully at the artist’s portfolio before making any decision.

He cautions clients about the placement of tattoos as well. “I suggest younger people stay away from their hand and necks — any place they can’t cover up, that might have an effect on their future career possibilities.”

One young woman interviewed for this article says she regrets a tattoo on her upper arm because it shows when she dresses for formal occasions and when she wears sundresses. Experts also steer clients against tattooing the name of a girl- or boyfriend or a favorite band. Think: permanent.

Serious tattoos can require serious financial investments as well. Manning charges about $150 per hour, and one tattoo can require five lengthy appointments in one month. Sloan says a quality leg tattoo could cost $7,000. He warns, “Don’t rush into it. Don’t get it done at somebody’s house. It’s like buying a car, or a shirt you can’t take off. Make sure you know what you’re doing.”

Ann L. Rappoport, PhD is an educational consultant and contributing writer to MetroKids.

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