A turn for the worse

Something that often surprises people is just how quickly a trapped infection can move from nonexistent to serious. These cheek piercings were about two months old and by all appearance doing just fine, when the wearer decided to switch the jewelry. In the process, they somehow managed to drag bacteria into the still-healing fistula, probably bacteria that was on their hands. Within the week the piercings were seriously swollen or infected, so they headed to their doctor, who insisted that the piercings be removed and put her on antibiotics. This photo was taken when she got home from the doctor.

cheek infection

Mistake number one: Changing the jewelry in a still healing piercing without proper attention to contamination control. Be aware that cheek piercings often take a long time to heal, and perhaps more importantly, piercings of all types will appear healed long before they actually are healed (and even young technically healed piercings may have very thin skin, making them highly susceptible to injury). Ideally a piercing that’s still healing shouldn’t have its jewelry changed, but if it must, the jewelry needs to be sterilized and gloves and other appropriate cross-contamination must be in place. Whenever possible this should be done at a piercing studio — most will autoclave and change jewelry for a small reasonable charge, or even do it for free when you buy the jewelry.

Mistake number two: When a piercing is infected with significant amounts of swelling and discharge, the presence of jewelry is both good and bad. It’s bad because a foreign substance in a wound can greatly increase the population of bacteria by giving them a “foothold”, but it’s good because it can keep the wound open and is often the only thing keeping the infection from becoming an abscess. The piercing allows the wound to drain, as the antibiotics (or alternative treatments) work to eliminate the infection — saline soaks and other treatments can also work to draw out the discharge, but can only do so if the wound is open. Even if antibiotics eliminate the infection, you can still have serious complications if a large pocket of pus is trapped under the skin. For this reason I feel it’s important to always have someone familiar with the treatment of troubled piercings involved in such complications — doctors are notorious for making problems with piercings worse due to their unfamiliarity with them, even today. Any reputable piercer is always happy to take the time to look at a piercing having difficulty (whether they did the piercing or not) and give you advice on how best to treat it (and that advice in this case likely would have been “go to the doctor, but don’t let them take out the piercing”). Better yet, piercers, unlike doctors, rarely charge for this service in my experience — although you should always tip them!!!

BME/Risks: Extreme Tattoo Ink Bleeding

It’s not unusual for some people to get a slight “halo” of color around their tattoos, as the ink moves out via capilliary action and permeates and stains subcutateous tissue. Sometimes this is because of a mistake make by the artist (for example, tattooing too deep), but because anatomy is so variable from person to person, even the best artists have it happen at times. Typically this halo extends not much more than 1/4″ and is subtle enough that most people won’t even notice it, but a friend just sent me this example which is one of the most extreme examples of tattoo ink bleeding out into surrounding tissue that I’ve seen to date.

In the pictures below, the left one (which also shows a rash that developed after the tattoo, which may or may not be related — I suspect not — and was treated successfully with Sibicort, a Chlorhexidine/Hydrocortisone cream) is two weeks after the tattoo was done, and the right one was taken four months afterward, showing what looks almost like a bruise all the way around the arm. Over a year and a half later and the discoloration still looks the same. The woman with the tattoo has very light, thin skin which is generally sensitive and prone to allergic responses. The ink that was used is the same ink the tattooist normally uses and hasn’t caused problems for other clients as far as anyone knows.

These pictures shows the extremes to which ink is capable of spreading. It should be noted that because of the likely depth and diffuse nature of the discolouration, it is unlikely that this can be treated short of simply tattooing over all affected skin. If any professionals have comments or feedback on this — theories on what caused it or how to minimize it, or whether this is just an unavoidable risk in a certain percentage of clients — I’d love to hear it.


The Eyeball Tattoo FAQ has been updated

I’ve updated the eyeball tattoo FAQ today with lots and lots of new information, including some discussion of risks information that backs up doctor’s warnings that eyeball tattoos could lead to blindness. After meeting someone whose ink migrated into the inside of the eye, into the vitreous humor, and then after a year of floating around in their vision attached itself to the optic nerve, I collected more information on both this issue (which is probably rare) and on intraocular press and ocular hypertension (which is probably common). Short version of the story is that eye tattoos increase the pressure in the eye, which is connected to glaucoma and blindness, and this risk seems to get worse in time, so it’s possible that we may see the “perfect nightmare” of eye tattooing thanks to people not waiting and everyone wanting to jump on the boat and get it done too before the longterm risks were established… imagine if in fifteen to twenty years the incidence of blindness in those with eyeball tattoos is way higher than it should be. Not one bit of fun there.

Anyway, the FAQ is updated and has a fun animation of Pauly Unstoppable added to it for the version 1.1 title. As always, all new information has been highlighted in a red font so you can quickly find it and only read the new stuff if you’re already familiar. Here’s the link: Eyeball Tattoo FAQ – http://news.bme.com/2012/10/18/the-eyeball-tattoo-faq/

Brief excerpts from the updates:

There has been at least one case where over-injected ink has migrated through the sclera and into the vitreous humor. In the case where this happened the eye didn’t seem to want to easily accept the ink, and what did go in seemed not to spread as normal. The other eye was tattooed in the same session without any complications, but three days after the procedure the person had what they described as the worst headache of their life including blurry vision and extreme light sensitivity. Intraocular pressure was increased, and for the next year the person saw black specks in their vision as these ink particle floaters tumbled through their vision. These particles appear to have now migrated to the optic nerve, which is their current location. The optometrist that examined the eye believes that glaucoma are likely and expects some degree of vision impairment or even blindness. It is also possible in this case for alternate complications to have arisen, and perhaps most importantly it is essential to understand that while experience and skill can mitigate this risk, it can not be eliminated and it can happen even to the most experienced artists (but is much, much more likely to happen to those who don’t have years of experience working on hundreds of eyes). Finally, I again want to emphasize that if anything abnormal is observed during the procedure it should be immediately aborted.

…complications from the tattoo may lead to blindness in the future due to damage to the tissues of the eye and/or optic nerve. Beyond acute injury leading to blindness, the most likely types of blindness related to eye tattooing are believed to develop slowly, perhaps over several decades. It is also likely that eye tattoos amplify preexisting conditions, for example a familial predisposition toward eye diseases such as glaucoma, and that it will be difficult to determine the degree to which the eye tattoo is responsible for the vision loss.

At some point soon the FAQ will need a rewrite because it’s getting a little jumbled and there may be some repetition as well…

I also wanted to show three tattoos that have been done recently, all by different artists, that I like visually quite a lot. From top to bottom they are Purple Haze eyes done by Russ Foxx (done with an utter minimum of ink, which all other things being equal increases the safety level), , next a pair of cyan eyes with a magenta iris outline (this type of design should be treated with the utmost of care due to its proximity to the corneal limbus and iris/lens muscles, as discussed in the FAQ) by Max Yampolskiy, and on the bottom, a set of psychedelic rainbow eyes by Chance Davis.

By the way, I assume this goes without saying but I need to make clear that just because I post a picture doesn’t mean that I endorse or recommend the procedure or the people involved… The risks on this procedure are still being discovered, and they may be quite significant. As much as I love the way these looks, it makes me beyond uncomfortable seeing how many people are getting it done, and how many new practitioners are not just diving into the procedure, but diving right into the deep end. Please treat this procedure with the utmost of care. It has more potential to severely damage someone’s live than just about anything else out there.

Second Generation Ear Pointing

At the start of October I posted about an ear pointing that Samppa Von Cyborg (voncyb.org) had done and included some fresh photos. I’m thrilled today to be able the healed result today, and it’s truly incredible. It’s not just an ear that’s been folded into a point at the top. It’s an ear that’s been completely rebuilt to give the illusion of having grown naturally into this form.

You may recall the ear pointing trainwreck posted about a month ago. It’s important to understand that the more complicated the procedure gets, the higher the risk of failure, both in terms of full-on failure, and aesthetic mistakes. This is very much the case with advanced ear pointing like this. I’ve been sitting on these pictures for a while, because I don’t have explicit permission to post them, so I’m cropping them more than I want to in order to hide the person’s identity (and really pointing fingers is not my goal), but they show an attempt to do this procedure leaving a customer with an ear that to me looks like the sort of thing a caveman might have after battling a sabretooth tiger. It’s definitely not as gnarly as some procedures-gone-wrong, but it falls far short of what a person should expect — for starters, in addition to the technical aspects of the procedure looking amateur, the aesthetics and angles are nonsensical, and the two ears don’t come close to matching.

I really want to urge clients to only go to people for work that they can show you multiple healed examples of in their portfolio. And practitioners, there is absolutely no excuse in today’s world for blindly copying procedures you’ve seen more experienced artists post online. Training is available. Take advantage of it. Take it slow. It’s better to be responsible practitioner than to be something akin to a jackass in a comment forum yelling “first”. You don’t want the weight of needlessly messing people up on your conscience. Just remember you’re playing with people’s lives. Do it for them, not for your ego.

Cartilage Surface Piercing

A friend forwarded me these pictures expressing concern after seeing them in someone else’s portfolio. I’m not going to out the person who did them (in part because it would involve shaming my family’s hometown), because I do agree this is not advisable. Anyone with a cartilage piercing knows how finicky even simple cartilage piercings can be to heal — how slow the process is, and how resistant the tissue can be to allowing a proper fistula to form. Surface piercing on the cartilage increases this risk exponentially, and is asking your body to do something it’s just not evolved to do. Simple rejection is the most likely, although it carries a strong risk of infection and permanent damage to the cartilage and ear structure. I’d urge a quick perusal of the BME wiki entries on Ear Collapse and Cartilage Swelling.

That said, I have seen cartilage surface piercings heal before, so I can’t tell you that it’s impossible. Just risky. For that reason, I would urge that if someone actually does want to insist on having such a piercing done, that they need to be extremely aware of what’s going on with the piercing — personally my feeling is that this is the sort of piercing that should only be done by those with a ton of experience, or better yet, someone who works in the industry so their coworkers can help them clean and keep a close eye on it. Of course I hope the wearers got lucky and these piercings actually healed, but more realistically, I just hope they made it through this experience with a minimum of damage.

Genital Beading in US Prisons

My friend Buddy Williams who pierces at Ancient Ink Tattoos & Piercings in Antelope, CA (you may remember him from the microdermals he’s been doing on an older woman) told me an interesting story about a client who came to him for help recently. A guy came in and asked if they removed genital beads, and Buddy said yes. When he was setting up and asked the client to show him the bead, he saw what looked like it must have been at least four beads collected in a single spot — genital beads can be especially prone to migration. Buddy asked him where he’d gotten it done, and got the simple answer, “prison”.

Two years earlier while incarcerated, his cellmate had used a sharpened toothbrush to penetrate and create a pocket in his penis (hey, it’s better than using it as a shiv to stab someone) and implant a large plastic bead. The bead, about 1/2″ in diameter, had been obtained by cutting open a spray paint can — I’m sure you’ve heard the ball rattling around when you shake the can. He wanted it removed because it was starting to become quite painful. It took Buddy about five minutes to get it out (that’s it in the autoclave bag) because of how much scar tissue was around the bead. The body seemed to be both trying to encapsulate the bead and push it out as well, as it must not have been entirely biocompatible — it’s unknown what type of plastic it was, but it had a very grainy surface (which may have been in part from starting to break down), to say nothing of paint residue that may have been on it at the time of implantation.

The bead was also surrounded by a large amount of pus, so it’s definitely a good thing that it was removed. Strange, who’d have thought that prison was not the most ideal place for genital mods… I guess those behind bars should stick to eyeball tattoos.


Partial ear reconstruction with keloid removal

Since I seem to be in the mood for posting stuff about ears being chopped up today, let me share another. My friend Gabriele from Max Art Body Piercing in Rome had a client come in that had a large open lobe that had been previously scalpeled (Ludovico’s ears were 2″ last time I remember them) — as you can tell from the distinctive shape, a “U”-loop of flesh hanging down from the ear — and also had a keloid covering a solid area of it’s upper-outside edge that the client wanted excised, complicating the procedure. To make the procedure even more tricky, they wanted to keep the piercing, but alter its shape and reduce its size. To accomplish all of this, Gabriele cut out the body of the keloid and closed the wound, as well as removing part of the lobe “worm” to tighten the ear to the new size. The jewelry used for the healing is glass with silicone o-rings. Glass is an ideal material, but for some people the o-rings can cause irritation (and must be kept clean to avoid a build up of waste — and becoming a home for bacteria), so the client will have to keep an eye on that. The bruising in the third photo went away quickly, the tissue relaxed, and healing is going well so far.


Tattoo healing failure, fixed

David Newman-Stump, owner and artist at Skeleton Crew Tattoo (skeletoncrewtattoo.com) in Columbus, IN, sent me in some photos to help out in my mission to show people what they should expect from tattoo healing (mostly brought on by this entry). The previous post I made showed color tattoo healing, but this one is black and grey shading.

The picture on the left is how the tattoo healed after being done by a generally talented and respected artist with a solid clientele. Fresh it probably looked great — I imagine quite similar to how it appears in the middle photo. Unfortunately tit didn’t heal well, and the client was left with an undefined, faded ghostly tattoo. Thankfully there was nothing wrong with the fundamental shape of the tattoo so it wasn’t terribly challenging for David to go over the tattoo and put the ink in properly. However, if I left you with just his fresh tattoo, not only would I be misleading you about what a tattoo looks like, but you’d also have no way of knowing that the same thing didn’t happen again. So four months later — completely healed — the picture on the right was taken. Now, it is true that a tattoo will continue to degrade from sun damage and skin aging over the lifetime of the wearer, 90% of the change happens in the first month, so this client can be secure in the joy that their tattoo has been successfully repaired.

You should definitely click and zoom to take a better look at the details.


Eyeball Tattoo Risk: Permanent Black Eye

One of the risks of eyeball tattooing that I’ve been really averse to talking about — almost refusing to believe it in fact — is that in perhaps 10% of people the procedure results in a permanent black eye [EDIT: I am hearing from some practitioners that they believe the risk is MUCH higher than 10%, perhaps high enough to even be a majority of people — either way, take this seriously]. Or whatever color eye that matches the tattoo of course. I wish I could tell you exactly why this happens. No one has been able to come up with a satisfactory explanation. Is the ink somehow pulling into the tear or lymphomatic ducts? Being pulled into the tissue through some sort of capillary action? Is it happening because of over-injection? Is it happening because of too much ink being sprayed over the eye that’s not being injected? We’re just not sure yet — and that’s what’s so troubling about this risk. We have no idea how to definitively mitigate it.

Most people with this that I’ve seen have just some small lines of discoloration, but the results can be quite extreme, as you see here on the left eye of Mechanical Demon (tattoo artist at Harness in Helsinki, Finland). His theory on why he got so much discoloration under the eye was that there was some ink on top of the left eyeball after the operation that they couldn’t remove. He figures that while he was dreaming that night, that the combination of the eye’s natural movement and normal self-cleaning mechanisms could have moved the ink down under the lower lid at which point it penetrated the tissue rather than being excreted. He also adds that the discoloration is not close to the surface as with a normal tattoo — it’s much deeper, as if the subcutaneous tissue is black. He’s tried lightening the black patch by tattooing over it with skin tone tattoo ink, with some positive results but not completely covering it. He also wore makeup over it for the first year, but has learned to enjoy it.

It’s important for people to understand that even though eyeball tattooing is now five years old, it is not completely understood. It is likely that this risk can be greatly reduced by minimizing the amount of ink used, and by cleaning any residual ink of the eye — but I can’t promise that. You can see one possible result — I believe on the extreme end — in this photo by Matti Keski-Kohtamäki.


Healed Tattoos Are What You Live With

There’s been an incredible amount of debate about tattoo healing after my post two days ago — with a disturbing amount of denialism, and an especially deranged argument on Facebook — but the fact is, when you get a tattoo, you have to live with the healed version, not the fresh version. The tattoo artist on the other hand, thanks to their handy camera, may forever live with the fresh version. Photos don’t need to heal.

A fresh tattoo looks different because it’s not covered by an ink-free layer of surface skin — it is, in fact, covered by a layer of tattooed dead skin that may or may not have the same ink in it as the deeper skin — plus the ink particles haven’t had time to settle into their permanent locations. For starters this means that a healed tattoo will almost always have less intense colors and less deep blacks, and there will be some flattening and blending of tones. The degree of these changes depends on factors including the types and colors of ink and, the nature of the wearer’s skin, and the tattooist’s technique — and of course a client can destroy a tattoo with bad aftercare but that’s not what this entry is about. Also, the order the ink was put in won’t matter as much in a healed tattoo — in a fresh tattoo, the visually dominant color will be the last one put in, temporarily hiding what’s beneath it, but in a healed tattoo it will be more of an “average”. In a flat oldschool tattoo this doesn’t make much difference, but in a tattoo with a lot of shading and color nuance it can make a huge difference. And of course all this is assuming a best case scenario — if the tattoo artist has a light hand or otherwise didn’t put in the ink properly, there can also be fading, sometimes dramatic.

A reputable tattoo artist will always aim for the healed tattoo to look as good as possible, not for the fresh tattoo to look as good as possible. In many cases they may even need to create a fresh tattoo that doesn’t look as good as the healed one, and as a result, some unethical artists who are looking to win a convention tattoo award (and often do) that’s being judged that day, make decisions that don’t do the client any favors as discussed to death previously.

I’m very happy to say that the best thing to come about from this discussion is a number of artists vowing to make sure that their portfolios contain as many healed photos as possible. Healed photos are the only way a client can truly know what they are paying for, and are essential. Any tattoo artist that doesn’t have plenty of healed tattoos in their portfolio is one I’d be very nervous about.

On that note — and sorry for taking so long to get here — I’d like to share with you two tattoos, fresh and healed, from Mike Shultz at Altered Image Tattoo & Piercing in Indianapolis (alteredimagetattooindy.com). Compare the tattoos fresh and healed ones. Look at them closely — see how the colors and levels change — and you’ll get some insight into healing, and the decisions that Mike made to give his clients a tattoo that they should be happy with forever, not just something that will win him a Best of Show. Thank you to all the tattoo artists out there who have pledged to give the world an honest impression of what they’re capable of and including plenty of healed and unedited photos (or better yet, both, spreading an understanding to the public of how tattoos heal) in their portfolio.

Be sure you zoom in to really appreciate both my comments and Mike’s artistry.