What’s in your tattoo? Before you get or remove a tattoo, check your ink.

The steady buzz of machinery fills the air. An artist, deep in concentration, is bent over his work. The metallic humming stops for a moment, and he wipes away a film of blood and ink from a woman’s arm. A mermaid, tattooed in black, takes shape as the needles puncture his client’s skin.

Lots of people have tattoos. Although numbers for the U.S. aren’t exact, Pew Charitable Trusts estimates that almost 40 percent of people born after 1980 have a tattoo.

But that statistic also means increasing numbers are also considering tattoo removal, a growing industry with hundreds of thousands of clients per year.

But what happens to the ink when a tattoo is removed? According to some experts, the ink doesn’t just disappear. It can get stuck inside the body’s drainage system. And since tattoo ink manufacturers may not be forthcoming about their formulas, those seeking to remove tattoos should be aware that their tattoo ink is more than just a color on a palette.

“What happens when you laser a tattoo, we know far less about that,” said Bruce Klitzman, who is an associate professor at Duke University of surgery, biomedical engineering and cell biology.

In May, the U.S. Food and Drug Administration recalled inks from an ink manufacturer in May due to microorganism contamination. A spokesperson for the U.S. Food and Drug Administration told The News & Observer in an email the agency randomly tests tattoo inks for heavy metals and microbial contaminants.

First, it’s helpful to understand how tattoos are made. A common misconception is that tattoo ink is injected under the skin. That’s not so, Klitzman said.

“The tattoo artist puts a pool of ink on the surface and pokes the skin with a needle,” said Klitzman. “It’s when the needle is withdrawn that a vacuum is created in that hole and it draws the ink down into the skin.”

A tattoo is able to endure because macrophages, a kind of immune cell, hold onto ink. When they die, they pass the ink on to other macrophages.

“The macrophages that reside there are the garbage trucks that come along, recognize materials as being foreign, and try to eat them and digest them,” Klitzman said.

Kora Udell gets a tattoo from Eddie Cook-Hernandez at Area 51 Tattoo Studio in Raleigh, N.C., Friday, August 9, 2019. Ethan Hyman

Ink ingredients

Because tattoo inks are intended for professional artists and not the general public, manufacturers are not subject to the same labeling requirements as other cosmetics. And while an ink manufacturer might register its products with the FDA, that doesn’t mean the product was approved for use inside human skin.

Tattoo ink manufacturers are wary of naming their ingredients and don’t list specific pigments because they’re trying to prevent others from reproducing their ink, said Dan Morin, who works in Tommy’s Supplies in Somers, Conn. Tommy’s produces and sells StarBrite Colors tattoo ink.

Morin said Chinese companies create their own inks and put them in bottles with fake StarBrite labels, then sell them online. A quick search on and showed that StarBrite ink is available in a variety of colors — but Morin says his company doesn’t sell their products on those sites.

Frankie Wood-Black is Division Chair of Engineering, Physical Science and Process Technology at Northern Oklahoma College and has written about tattoo ink chemistry. In the past, Wood-Black said, some U.S. tattoo inks were made of mineral pigments that contained lead, mercury, chromium and nickel. Some of these metals are still found in inks around the world. One study found that the same industrial grade pigments used in car paint and printer ink may be in tattoo inks.

Shane Smallwood owns Area 51 tattoo shop in downtown Raleigh. He said he is cautious of tattoo inks and kits sold on sites like Amazon. He said cheap inks shipped in from other countries could be made of anything, including the potentially dangerous mineral pigments listed by Wood-Black. Smallwood said he trusts the ink he uses, and buys it from distributors that sell only to licensed tattoo artists.

TJ Lopez works at Intenze Inks, a company that makes vegan tattoo ink. Lopez said that Intenze consults what he called an FDA “banned list” of pigments to avoid potentially harmful products.

The FDA spokesperson said the agency doesn’t have a list of banned pigments, but has a list of color additives often used in foods and medicines, none of which are approved for tattoo inks.

Lopez and Morin said their companies are strict about ingredients because they sell products to the European Union, which is drafting rules to regulate tattoo inks.

A European Commission study found that most European tattoo inks are imported from the U.S., and that over 60% of tested inks contained azo-pigments, which can degrade into what are called aromatic amines. The amines are potentially carcinogenic, and are produced when tattoos are exposed to sunlight or lasers.

Since tattoo ink is not regulated by the FDA, it remains up to states to determine how they handle inks. North Carolina House Rep. Deb Butler was co-sponsor of a bill — one that eventually died — to increase regulation of piercing, scarification and branding. She said she is concerned about the safety of tattoo ink and speculated that a possible solution is to pass a law saying any ink sold in North Carolina has to be proven safe.

“It certainly is an interesting issue and one that may be a source of litigation,” said Butler. “We don’t want citizens to be exposed to carcinogens and faulty removal processes.”

What happens during tattoo removal?

Klitzman, from Duke, said ink from a tattoo slowly leaks through a person’s lymphatic system. Some of it is excreted, and some of it is retained in the lymph nodes, which he said can collect ink like a coffee filter holds onto grounds. He doesn’t see much of a problem with that slow leak of ink over time from a tattoo.

Tattoo removal
Dr. Eric Bernstein, dermatologist and director of Mainline Center for laser surgery, uses a laser to remove a tattoo from a client’s abdomen. Jessica Plugis

Dr. Eric Bernstein, a dermatologist and director of Mainline Center for Laser Surgery in Ardmore, Pa., uses lasers for tattoo removal. These lasers pulse extremely quickly — at a rate of less than a billionth of a second, according to Bernstein — and use heat to break up the tattoo ink into small particles.

The laser causes an inflammatory response that encourages the body to carry the broken-up ink particles away and excrete them.

“We are removing tattoos to make people feel better, but no one knows if it’s better to get the ink out or leave it where it is,” Bernstein said.

Klitzman said that potentially hazardous chemicals in tattoos might not cause health problems like cancer because they’re released in small amounts, or walled off from other tissues inside of macrophages.

“But when you laser it, it’s expected that we get a much higher release of some of these molecules that could have health problems, and that’s something that has not been studied much at all,” said Klitzman.

If the ink particles aren’t trapped in the lymph nodes, he said, they are then dumped into the bloodstream to circulate throughout the body.

People who want to remove their tattoos removed should find experienced dermatologists and plastic surgeons who understand the consequences, Klitzman suggested. He said choosing the right physician for laser removal is even more important than choosing the right tattoo artist.

As for those who do get tattoos, Klitzman suggests registering them so scientists could track potential health impacts over time.


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