Tattooing is a process of creating a permanent or semipermanent body modification that transforms the skin. The word tattoo comes from the Tahitian tatau, which means “to mark something”; it is also hypothesized that the term comes from the sound the tatau sticks make when clicking together to mark the skin with ink. Tattooing is a process of puncturing the skin and depositing pigments, usually indelible ink, by a variety of methods beneath the skin to create a desired design or pattern. Tattoos range from “blackwork,” large areas of heavy black ink in designs, to fine details and elaborate color schemes including fluorescent inks.

Historic Tattoos

The earliest evidence of tattooing includes tattooing tools and tattooed mummies. At 10,000-year-old sites in Tan-zoumaitak, Algeria, tattooing instruments used for puncturing the skin were found with the female tattooed mummy of Tassili N’Ajje. In 1991, Otzi, a Stone Age male mummy, was found in the Otztal Alps, bordering Austria and Italy. This mummy had numerous tattoos, which were hypothesized as being used for medicinal cures, spiritual ceremonies, or indicating social status. Two well-preserved Egyptian mummies from 4160 B.C.E., a priestess and a temple dancer for the fertility goddess Hathor, bear random dot and dash tattoo patterns on the lower abdomen, thighs, arms, and chest. In 1993, a fifth-century B.C.E. Ukok priestess mummy, nicknamed the Siberian Ice Maiden, was found on the steppes of eastern Russia. She had several tattoos believed to have had medicinal, spiritual, and social significance. Most of the 4,000-year-old adult mummies from Xinjiang, China, had tattoos that related to their gender or social position.

A Japanese artist tattoos a pattern to a customer’s back, 1955.

A Japanese artist tattoos a pattern to a customer’s back, 1955. These elaborate and symbolic Japanese tattoos became a popular fashion during the late eighteenth to nineteenth century.

Classical authors have written about tattoos used by the Thracians, Greeks, Romans, ancient Germans, ancient Celts, and ancient Britons. Tattooing has been practiced in most parts of the world, although it is rare among people with darker skins, such as those of Africa, who more often practice scarification and cicatrisation. Scholars hypothesize that tattooing was a permanent version of the desired aesthetic of body painting. Motivations, meanings, and exact techniques relating to tattoos vary from culture to culture. Tattoos have emphasized social and political roles; indicated cultural values and created an identity for the individual; reinforced aesthetic ideals; encouraged sexual attraction; eroticized the body; served medicinal and healing roles; communicated group affiliation or membership, and emphasized ritual and spiritual roles and customs of a culture.

Polynesia. In 1787, a French expedition led by Jan Fran-coise de la Perouse landed on Samoa and reported the men’s thighs were heavily painted or tattooed, which gave the appearance of wearing pants. Samoan tattoos were applied with ink, tattoo combs, and hammer. Male tattoos had larger black areas than females, who had lighter, more filigreed lines.

Borneo. In the nineteenth century, Americans with tattoos were sailors and naval personnel, who wrote about their tattoo experiences in ships’ logs, letters, and journals. During World Wars I and II, some U.S. soldiers and sailors decorated their bodies with tattoos. Usually these tattoos were from a set of stereotypical symbols— courage, patriotism, and defiance of death—later referred to as “flash.” In the early 2000s, flash includes a wide variety of stock art used for tattoos.

Central America. In the nineteenth century most of Europe did not allow tattooing because the Catholic Church admonished it. However, tattooing flourished in England, due primarily to the tradition of tattooing in the British Navy. Many British sailors returned home with tattoos that commemorated their travels, and by the eighteenth century most British ports had at least one tattoo practitioner in residence.

In 1862, Prince Edward of “Wales had a Jerusalem cross tattooed on his arm to commemorate his visit to the Holy Land. Later, as King Edward VII, he acquired additional tattoos, and even instructed his sons, the Duke of Clarence and the Duke of York (King George V), to obtain tattoos to commemorate their visit to Japan.

In 1941, the Nazis registered all prisoners entering the Auschwitz concentration camp who were not ethnic Germans with a tattooed serial number. This tattoo was first placed on the left side of the chest; later, the location was moved to the inner forearm.

Contemporary Tattoos

During the latter part of the twentieth century, tattoos were primarily utilized by microcultures, such as motorcycle gangs, street gangs, and punks. In the twenty-first century, tattoos have gained popularity in Western culture and become commonplace and even fashion statements.

At the same time, some microcultures, such as the Modern Primitives, have sought alternative and perhaps more extreme tattooing methods and designs. Often these methods and designs have been borrowed from anthropological texts about ancient cultures and related tattooing practices. There are tattoo practitioners who specialize in “tribal tattoos” and “primitive technologies.” “Tribal tattoos” are typically heavy black ink and focus on designs that resemble Polynesian designs, ancient Celtic knotwork, or archaic languages. “Primitive technologies” include a wide variety of manual tattoo application methods, such as sharpened bones and ink; bone combs, hammer and ink; and tatau sticks and soot-based ink. These methods require lengthy tattooing sessions even for the smallest tattoos.

Electric Tattooing Practices

In 1891, the first electric tattooing implement was patented in the United States. In the early twenty-first century, many tattoos are applied in tattoo parlors using hand-held electric tattooing machines controlled by a foot pedal. These machines have a needle bar that holds from one to fourteen needles. The type or specific area of the tattoo design being worked on determines the number of needles. A single needle is used to make fine, delicate lines and shading. Additional needles are used for dense lines and filling with color. Even with the use of all fourteen needles, large or heavily detailed tattoos could take several months to complete.

Each needle extends a couple of millimeters beyond its own ink reservoir, which is loaded with a small amount of ink. Only one color is applied at a time. The tattoo practitioner holds the machine steady and guides the dyeloaded needles across the skin to create the desired pattern or design. A small motor moves the needles up and down to penetrate and deposit ink in the superficial (epidermis) and middle (dermis) layers of the skin.

Tattoo Health-Related Risks

Licensed tattoo establishments are required by law to take measures to ensure the health and safety of their clients. Since puncturing the skin and inserting the inks cause inflammation and bleeding, precautions are taken to prevent the possible spread of blood-borne infections, such as hepatitis B and C. Rooms used in the tattooing process are disinfected before and after each client. An autoclave, a regulated high-temperature steamer that kills blood-borne pathogens and bacterial agents, is used to sterilize the needle bar and reservoirs before each tattoo session. Sterile needles are removed from individual packaging in front of the client. The area of skin to be tattooed is shaved and disinfected by the tattoo practitioner. During the tattooing process, the skin is continually cleaned of excess ink and blood that seep from punctures with absorbent sanitary tissues.

Tattoo Removal

Tattoos have become part of fashion trends, resulting in the need for effective tattoo removal. Past methods of removing tattoos have often left scars. Tattoo removal with laser technology has become the most effective method used and has a minimal risk of scarring. Despite advances in laser technology, many tattoos cannot be completely removed, due to the unique nature of each tattoo. Successful tattoo removal depends on the tattoo’s age, size, color, and type, as well as the patient’s skin color and the depth of the pigment.

Semipermanent and Temporary Tattoos

Cosmetic tattoos are semipermanent makeup, such as eyeliner and lip color, tattooed on the face. These tattoos use plant-derived inks that are deposited in the superficial skin layer, resulting in a tattoo that lasts up to five years. Temporary tattoos come in a wide variety of designs and patterns. Unlike permanent and semipermanent tattoos, most temporary tattoos can be applied and removed by the wearer. These tattoos are burnished onto the skin and secured with an adhesive. Most temporary tattoos can be removed with soap and water or acetone, depending on the adhesive. Another type of temporary tattoo is henna or mehndi, which is a shrublike plant that grows in hot, dry climates, mostly in India, North African countries, and Middle Eastern countries. The leaves are dried, ground into a powder, and made into a paste, which is applied in desired designs to the skin. After several hours of drying, a reddish-brown stain temporarily tattoos the skin. This tattoo begins to fade as the skin exfoliates and renews itself.

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