The science of body art and tattooing.


The process of creativity takes courage, in some cases, more so than others.  Be it the painful practice of tattooing, piercing, or even scaring, body art is currently at its bohemian peak in spite of the (ill)famous warning – think before you ink. The name of a loved one etched over the collarbone, a prince Albert Piercing (over the male genitals), painting the hair red (like a certain mermaid), or henna application has been around since the Middle Ages and continues to be a medium of self-expression.

Body art: Religious and cultural significance:

The history of tattoos can be traced back to 12,000 B.C. Tatau in the Tahitian language means to mark. The Dayak tribes of Borneo carved tattoos over their hands as a means to illuminate the darkness of the afterlife.  The Inuits of Alaska tattooed themselves in preparation for death rituals, as they believed a tattooless person could not cross over and hovered between the dead and the living. The ability to withstand the pain of body tattooing and piercing is often linked to a passage into adulthood —something that could be seen as a fitness indicator because it demonstrates both strength and reproductive viability.

In many ancient cultures including the Hindus, Mayans, Aztecs, and Egyptians, body art especially tattoos and piercings have been construed as a self-mortification ritual. Whether it was the crucifixion of Christ, or an Indian sadhu piercing his cheeks and tongue with small spears, nearly every culture has a sect that regards physical suffering as a vital step in spiritual development. Some theologists believe that voluntary endurance of pain via body piercing and tattooing is a way to tap into a primal urge seeking meaning in life and birth cycles.

How did it all begin?

The earliest tattoo rituals began as cuts under the skin to cause scarification. Later, people learnt to beautify these with colors, from soot or plants. The older tattoo technique was a way more painful experience involving repeated hammering into the skin with a needle dipped in colored ink. The modern coil tattoo machines rely on alternating electromagnetic currents that are fixed to multiple needles which facilitate a quicker ink deposition under the dermal layer of the skin making the tattoo more realistic, detail-oriented, and faster. The technique today is sterile, refined and less uncomfortable thanks to availability of local anesthetics, single-use needles, and better post-procedural care.


So what happens at your tattoo site?

The dermis comprises of macrophages and dendritic cells, which attack the deposited ink as the immune system registers the ink as a foreign substance.  This is why your skin swells and puffs up after your new ink has been completed. The macrophages engulf the ink particles and store them inside their body as ‘vacuoles.’ This ink can’t be broken down as easily as bacteria, it remains intact in the dermis. When these macrophages die, the ink is released and consumed by a new crop of macrophages. This cycle continues in perpetuity, which is what allows tattoos to maintain their permanence.

Now a little something about piercings:

Fashion, Religion, and superstition.

Body Piercing has a long (and sensual) history. From the European Middle Ages, sailors believed that piercing one ear improved long-distance vision.   A daith piercing, in the innermost fold of your ear, is believed to help with anxiety and migraines. Many Indians believe that a nose piercing helps retain female fertility and beauty for a longer while. Then there are more exotic piercings like the belly button piercing which is believed to improve your sexual appeal. The genital and nipple piercings which some believe make the sexual experiences more intense for both partners.

In ancient Mesoamerica, body ornamentation via tattooing and piercing was used as a specific adulthood ritual: as boys became men, and girls became women. Their body art began to tell a story of gender and adulthood. In many African cultures, scarring displays important life events: for girls, scarring is done after the first menstruation and marriage, and for boys, scarring occurs for their first kill in battle.

 Psychology of body art:

Freud postulated the following theory about why some prefer to decorate their body temporarily or permanently. The tattooing or a piercing on the skin is also a nonverbal way of communicating and expressing feelings.  The skin is like a transition area between the self and others. Tattoos on this barrier express the deepest unconscious conflicts. It may be a way to take back your identity or feel included as a part of a group (a Trans group, a Sufi sect, the gothic culture). Tattooing might also be related to erotogenic masochism inherent in the body (a way of acting out repressed memories or feelings instead of verbalizing them). While tattoos and piercings in modern Western societies have been associated with certain marginalized or social groups, such as criminals, drug addicts and prostitutes, they are popular in the young today due to their exotic and esoteric origins.

Is it safe?

If done in professional settings, following universal safety precautions, mostly the tattoo and body piercing is a safe, albeit painful experience. Also, the healing time and the post-procedural care vary as per the various sites, and in some cases, the piercing may take up to twelve months to heal. Another fact to consider is Tattoo Regret, which many have, especially if they have gotten the names of their ex tattooed or have a change of faith. Undoubtedly, the development of new laser systems in dermatology has provided an advantage in the tattoo removal procedures, but it is painful, expensive procedure, and not always 100 % fruitful.

Even in a perfectly professional setting, there is always a chance of delayed complications after a tattoo or a piercing. These include local pigmentary changes (hypopigmentation and hyperpigmentation at the tattoo site), keloid formation (especially with piercings), paradoxical darkening of cosmetic tattoos and allergic reactions, the presence of ghost images after a poorly executed tattoo removal session, scarring and textural changes around the body art area, lichenoid– granulomatous–papulonodular reactions, flares of existing dermatologic illness such as scar sarcoidosis, discoid lupus, cutaneous vasculitis, and pyoderma gangrenosum.

Some tattoo inks may include known carcinogens, raising the risk of cancers under the skin.  MRI-induced tattoo complications (with poor quality tattoos containing Iron Oxide), including first or second-degree burns or tingling and tightening and stinging pain, have been reported. Many experience increased photosensitivity after tattooing due to the nature of the tattoo ink, especially in colored tattoos.

The risk of HIV, Hepatitis B, Hepatitis A, Syphilis, staphylococcus, and even leprosy should always be considered while tattooing and piercing and hence the use of single-use needles are a must. Also, do check if the person tattooing you is vaccinated against Hepatitis B, uses gloves, wipes the area with antiseptic solution during the process, and if the place is sanitized and hygienic. The same goes for piercings. Also, be aware of the tattoos you must never get due to their criminal intonations. The teardrop tattoo especially is common among jail inmates, star tattoos or a rose on the chest are often used by the Mafia, and Crosses or dots on knuckles often denote the years spent in prison. One must also avoid getting hate symbols or tattoos belonging to other cultures.

After Care:

Always wash your hands before touching the newly pierced or tattooed site. This helps prevent a skin infection. In the case of piercings, leave the rings or barbels in for six weeks or more, even at night. Removing the starter rings or barbels too early may cause the piercings to close. Gently wash your piercings with mild, fragrance-free soap and water at least once a day. Thoroughly rinse your piercings after washing them before putting them on again. Make sure there is no residual soap left at the site. Be sure to avoid getting water in at the tattoo or piercing site. Using petroleum jelly that comes in a squeeze tube, gently apply a thin coat around each opening or the tattooed area. You always want to use a squeeze tube because it will prevent you from transferring any germs that may be in an open jar to your piercings. The petroleum jelly will keep the piercings moist. A moist wound heals faster. Keep an eye on sites. If the site gets sore, red, or puffy, or a hole oozes yellowish liquid, you may have an infection. If any of these doesn’t go away quickly, see a board-certified dermatologist. Avoid using unproven home remedies for any skin condition.


  1. Kıvanç Altunay, ˙I.; Mercan, S.; Özkur, E. Tattoos in Psychodermatology. Psych 2021, 3, 269–278.
  2. Review of General Psychology © 2012 American Psychological Association 2012, Vol. 16, No. 2, 134 –143


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About the author

Dr. Pallavi Sawant-Uttekar is a Jill of all trades. She did her MD Physiology in KEM Hospital, Mumbai, followed by a Diploma in Diabetes. After practicing in Mumbai for about 5 years and then dabbling in medical writing for 2 years with WebMD she shifted to Germany, learnt German and is currently pursuing a house post in Gerontopsychiatry in Baden Wuerttemberg, with plans to do her Masters in Geriatrics. She is a passionate writer and an occasional poet. She has to her credit, multiple journal publications as well as short stories published in various anthologies.



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