8th WIN n’ LEARN

Cosmetic and Medical Applications of Tattoo

Presenters: Jacqueline Kihwele Lutfi Abdallah

• Humans for generations have used tattoos for a number of reasons which serve as marks of status and rank, symbols of religious and spiritual devotion, decorations for bravery, sexual lures and marks of fertility, pledges of love, punishment, protection, and as the marks of outcasts, slaves and convicts.

• There is evidence that tattoos were used for medical reasons.

The American Academy of Dermatology distinguishes 5 types of tattoos:

1. Traumatic tattoos, also called "natural tattoos"2. Amateur tattoos; 3. Professional tattoos, both via traditional methods and modern tattoo machines; 4. Cosmetic tattoos;5. Medical tattoos.

Reconstructive and Cosmetic tattooing

Areolar reconstruction• Breast reconstruction after mastectomy is

fundamental to the psychosocial health of the patient and helps her regain a positive body image.

• Tattooing of the nipple-areola complex is usually the final step of the breast reconstruction process.

Bilateral mastectomy with delayed expander/implants reconstruction, and nipple areola tattoo

Source: http://www.northwesternplastics.com/baBreast-Reconstruction.html

Tattooing as camouflage• Tattooing is used to repigment the skin in conditions that

cause hypopigmentation or hyperpigmentation including burns.

• It is also used as an alternative to laser treatment in port-wine stain and in cosmetic surgery of the scalp.

• Tattooing is used for micropigmentation of the lips and fingertips in patients who have vitiligo. However, this should be reserved for those with stable vitiligo, since tattooing may trigger another patch of vitiligo at tattoo sites.

• Although medical management exists for vitiligo, it is often ineffective for lip vitiligo since the success of medical therapy depends on the pigment-cell reservoir at the site of depigmentation.

• The lips lack such a reservoir of melanocytes, so tattooing may be an option.

Vitiligo Depigmentation Skin Camouflage

Source: http://www.artisticcosmeticsolutions.com/scar_camo.html

Tattooing to hide surgical scars• decorative tattooing to camouflage

cosmetically undesirable scars

• It is a valid option, especially in younger patients, among whom tattooing is common and acceptable.

Cleft Lip Surgery Scar Camouflage

Source: http://www.artisticcosmeticsolutions.com/scar_camo.html

Corneal Scarring, • Perforating injury, measles keratitis, and other

conditions can result in cosmetically disfiguring discoloration of the cornea.

• When microsurgical reconstruction is ineffective or is not an option, corneal tattooing has been reported to provide satisfactory results at up to 4 years.

Left (A) central scar after perforating injury in childhood, Right(B) mature cataract Result immediately postoperatively after

tattooing a pupil.

Source: Pitz S, Jahn R, Frisch L, Duis A, Pfeiffer N. Corneal tattooing: an alternative treatment for disfiguring corneal scars. Br J Ophthalmol 2002; 86:397–399.

Patient with visible corneal opacity on the left and tattooed cornea on the right. The process was done in conjunction with an Ophthalmologist when he rejected corneal transplantation and

contact lens.

‘Permanent makeup’• Permanent makeup is the use of tattoos to

enhance eyebrows, lips (liner and/or lipstick), eyes (liner), and even moles, usually with natural colors, as the designs are intended to resemble makeup

• tattooing may be beneficial to people with allergies to conventional makeup or with disabilities that make applying makeup difficult

Permanent make up drawn to enhance eyebrows, lips (liner and/or lipstick), eyes (liner).

Source: http://www.phundeals.com/deal/detroit/200-500-permanent-makeup-bloomfield-esthetics-7

Medical application from history

Ötzi is a mummified human discovered in 1991 in the Schnalstal glacier in the Alps, on the border between Austria and Italy. He died around 3300 BC.

• Medical tattoos has been used in the ancient times for several purposes, the major use was a therapeutic, such tattoos has been seen in Ötzi the Iceman, has several tattoos, concentrated at joints: parallel lines on the right foot and ankle, bars along the lower spine, lines on the left calf, and crosses inside the right knee and left ankle. X-rays revealed chronic degeneration of bone and cartilage in the spine and arthritic wear and tear of the knees and ankles, suggesting the practice of the ancient folk remedy of tattooing to relieve pain.

MEDICAL ALERT TATTOOING

• Medical alert tattooing is a form of medical identification similar to medical alert jewelry, i.e. bracelets and necklaces, to alert first responders to a medical condition or to specific desires for care, such as do-not-resuscitate (DNR) directives.

• New phenomenon (practiced by the patients on their own without medical consultation can be found on the internet).

• These practice are seemingly underreported in the medical literature with its advantage and potential drawbacks.

• E.g. A woman with a tattoo warning of a past severe reaction to succinylcholine during anesthesia. She had been advised to wear medical alert jewelry, but she instead chose a tattoo.

Medical warning tattoo drawn just below the wrist of the diabetic patient

Source: http://www.medicinenet.com/tattoo_pictures_slideshow/article.htm

Pathologist Dr. Ed Friedlander on the left and Dr. Albert Cutter M.D display their tattoo with a medical directive to not use CPR.

Source: http://www.ctvnews.ca/medical-tattoos-offer-important-health-information-1.774009http://www.aarp.org/health/conditions-treatments/info-06-2012/medical-alert-tattoo.html

Organ donor tattooIn the case of a person who had his consent to be an organ donor tattooed on his chest or other part of the body, the tattoo was viewed as not equivalent to signed documentation

Source: http://ttelroc.blogspot.com/2011/05/caregiver-tattoos.html

RADIATION ONCOLOGY

• Tattooing is used in radiation oncology to ensure accurate targeting of radiation therapy.

• Typically, several small, black marks 1 to 2 mm in size are applied by a medical professional using an 18- or 19-gauge hypodermic needle and india ink.

Tattoo on the chest of the patient on the final treatments of the breast cancer which mark the outline of the plate

Source: http://nancysbreastcancerjourney.blogspot.cz/2012_07_01_archive.html

ENDOSCOPIC TATTOOING

• In laparoscopic gastrointestinal surgery, lesions are often difficult to visualize and localize since the surgeon is unable to palpate the bowel directly to identify the diseased segment; this increases the risk of resecting the wrong segment of bowel.

• Endoscopic tattooing of the segment to be resected greatly improves the accuracy of laparoscopic procedures.

The serosal appearance of the non palpable colonic lesion marked with india ink (black stain) as seen during laparoscopic

resection

Source: Willium & Wilkins, Baltimore p.55

FORENSIC MEDICINE

• Specialists in forensic medicine use primary markers such as fingerprints and dental records and secondary markers such as birthmarks, scarring, and tattoos to identify victims.

• Tattoos are useful for identification when fingerprints or dental records are unavailable

Tsumani ocean waves on the left and devastation caused from the air on the right

Source: http://esl-bits.net/listening/Media/2011-06-16/Tsunamis/http://news.nationalgeographic.com/news/2012/04/pictures/120412-indonesia-tsunami-earthquake-science-world/#/2-tsunami-flooding-destruction_51402_600x450.jpg

• However, as the body decomposes, tattoos can discolor and fade, making them hard to identify. Application of 3% hydrogen peroxide to the tattoo site has been reported to aid in identification, and infrared imaging has shown promise.

“21st Century Medicine , think broader , think three dimensional”

Thank you