Getting a tattoo is a common practice nowadays, with an estimated 45 million Americans having at least one tattoo. With tattooing becoming more mainstream, questions arise on whether it should be considered a surgical procedure. In this article, we’ll examine if tattooing meets the criteria to be classified as a surgical operation.
What is a Tattoo?
A tattoo is a form of body modification where ink is inserted into the dermis layer of the skin. This is done using a handheld device with needles that puncture the skin and deposit ink droplets. The ink spreads in the dermis and becomes permanent, only fading over time. Tattoo artists use various tattoo machines and needles to create different effects and styles of tattoos.
The origins of tattooing go back thousands of years to ancient civilizations that used it for spiritual and decorative purposes. Modern electric tattoo machines made the process faster and enabled the art form to grow in popularity in Western culture starting in the 1900s.
What Makes a Procedure Surgical?
For a procedure to be considered a surgery, it must meet certain criteria determined by medical authorities. Some key requirements are:
- Involves cutting or wounding of body tissues
- Performed for diagnostic or therapeutic purposes
- Carried out in a sterile environment
- Requires anesthesia to numb and sedate the patient
- Needs post-operative care and wound management
Surgeries also carry risks of complications like infections, bleeding, and adverse reactions to anesthesia. They are invasive procedures that penetrate and alter the tissues.
Does Tattooing Involve Surgery?
When examining the tattoo process, it does share some similarities with surgical procedures. However, there are also distinct differences that set it apart from a surgery.
Similarities to Surgery
- Invasive procedure – Tattoo needles puncture the skin and penetrate the dermis layer
- Bleeding – Getting a tattoo causes blood and plasma fluid to escape from the punctured capillaries
- Pain and trauma – Having a large or complex tattoo can be quite painful and traumatic for the body
- Aftercare – Tattoos require care while healing such as cleaning, applying ointment, and bandaging
Differences from Surgery
- No anesthesia – Tattooing is done without any anesthesia or sedation medication
- No vital organs – It only affects the skin, not internal organs or anatomy
- No diagnostic purpose – Tattoos are decorative, not done to diagnose medical conditions
- No sterile setting – It is typically not performed in an operating room or sterile environment
- No life support – Does not require equipment for respiration, circulation support, etc.
- No prescriptions – Does not involve prescribed medications or pharmaceuticals
Regulation of Tattooing
In the United States, tattooing is regulated on a state-by-state basis. Most states treat it as a cosmetic service and have rules about sanitation and hygiene standards at tattoo parlors.
Tattooing does not require medical licensing and is not governed by healthcare agencies. The artists learn their skills through apprenticeship programs, not formal medical education. Some states prohibit certain groups like minors from getting tattoos without parental consent.
However, a few states such as New Hampshire and South Carolina categorize tattooing as a regulated medical procedure. This subjects them to stricter regulations on bloodborne pathogens training and following sterile techniques.
Medical Settings for Tattoos
There are some medical situations where tattooing is performed by healthcare professionals in clinical settings:
- Medical tattoos – Tattoos to replicate areolas after breast surgery or create scalp hair effects for hair loss conditions.
- Tattoo removal – Laser tattoo removal procedures done by dermatologists and plastic surgeons.
- Microblading – Semi-permanent tattooing on the eyebrows done at specialized clinics.
- Permanent makeup – Tattooing on the eyeliner, lips, beauty marks, etc. at cosmetic studios.
In these cases, doctors or clinical aestheticians perform the tattooing under stricter sanitary requirements and often with some form of local anesthesia. The setting may also resemble a medical clinic or doctor’s office for patient comfort and care.
Risks and Complications
Since tattooing involves penetrating the skin, there are some health risks associated with it:
- Infections – Unsterile equipment can cause bacterial, fungal and viral skin infections.
- Allergic reactions – Pigments, especially colored dyes, may trigger allergies and skin reactions.
- Granulomas – Immune reactions to pigments can form painful bumps on tattoos.
- MRSA – Antibiotic-resistant staph infections may occur if proper hygiene is not maintained.
- Keloid scarring – Scars may form around the tattoo site and grow abnormally raised.
- Bloodborne diseases – Reused needles pose a risk of transmitting illnesses like hepatitis or HIV.
These complications are relatively uncommon if proper precautions are taken. Following aftercare instructions also minimizes risks of infections or excessive scarring. Overall, tattooing has become much safer thanks to single-use needles and modern pigments.
Is Anesthesia Used?
Tattooing is generally performed without any pain relief medication or anesthesia. The sensation of the vibrating needle penetrating the skin is part of the tattoo experience.
Only topical numbing creams may be applied beforehand to reduce some discomfort. Oral pain pills are also sometimes used to make the tattooing more tolerable.
In medical tattooing settings, local anesthetic injections are often administered to numb the area being tattooed. This provides maximum comfort for delicate areas like the face or after breast reconstruction surgery.
Does Insurance Cover Tattoos?
For the most part, standard health insurance plans do not cover the cost of decorative tattoos obtained at tattoo parlors. Similar to cosmetic treatments like teeth whitening or Botox, tattoos are considered elective body enhancements.
However, certain medical tattoos may be partially covered by insurance when deemed medically necessary. These include:
- Post-mastectomy nipple/areola tattoos
- Scar camouflage tattoos from serious burns
- Scalp micro-pigmentation for hair loss conditions
It’s best to consult your insurer to check if medical tattooing is included under reconstructive surgery benefits after an illness or injury. Some plans may reimburse a portion of the tattoo cost in those specific situations.
Do Tattoo Artists Have Medical Training?
In most cases, tattoo artists do not have formal medical training or credentials. They learn tattooing as an apprentice under an experienced mentor over months to years.
Many states require tattoo artists to complete a Bloodborne Pathogens/Infection Control Training course for health and safety knowledge. However, their skills are centered on the artistic and cosmetic aspects of tattooing rather than medical care.
Tattoo artists may benefit from courses on anatomy, skin physiology, first aid, and recognizing infections. But currently there are no legal requirements for medical education prior to tattooing.
Should Medical Doctors Perform Tattoos?
Due to the skin trauma involved, some medical experts argue that only doctors should perform tattooing. Proponents believe it may lower health risks.
However, the majority of tattoos are not medical procedures but cosmetic enhancements. Trained tattoo artists have the artistic talents and experience preferred for creating decorative tattoos.
There are benefits to having doctors involved in certain medical tattoo situations. But regulating all tattoo parlors to require licensed physicians would likely not be feasible or necessary for all tattoos.
Conclusion
While there are some similarities to medical procedures, standard tattooing would not be considered a form of surgery by most authorities. It does not meet key criteria of being diagnostic, requiring anesthesia, or involving vital organ systems.
Tattooing is viewed as an elective cosmetic service and regulated under safe body art guidelines. However, medical tattooing in clinical settings shares more parallels with surgical procedures and may even utilize anesthesia.
Ultimately, the answer depends on the context and purpose of the tattoo. But for the average decorative tattoo obtained at a tattoo parlor, it does not qualify as actual surgery.