Damage to the Skin and Deep Within

My name is Chrissy Siegel. I'm a nipple tattoo artist in Columbus Ohio. I've been a registered nurse for 25 yrs. I've worked in critical care (burns, Nicu, oncology) and a decade in plastic surgery (9 yrs in an academic setting and 1 year in private practice). I did medical tattooing for 8 plus years in an academic medical setting before training with professional body tattoo artists. I got into tattooing a little backwards compared to a permanent makeup artist or body artist that transitioned to paramedical tattooing. I was a nurse that was started tattooing with zero experience which is the case with most nurses assigned to tattooing in the office setting.

I'm making a video and writing this blog to help women decide which route they want to go making their own choice on how to complete their breast reconstruction. Additionally to clear up misconceptions that you've may have been told about tattooing that likely came from your physician or their staff/nurse. Also for those woman who have had a botched reconstructive nipple tattoo done by her surgeon and she's asking questions like "Why did it fade? Why does it look this way? Why do I have to have more touch ups and will the next touch up look better? Well.... they're not gonna tell you. Perhaps because they may not know the answers or maybe they don't to want change what they're doing. But I will tell you. 🗣
Today I'm going to discuss the differences between the type of tattooing done in medical offices and by some aestheticians/permanent make-up artists (who have unfortunately taken the wrong areola training) and what professional paramedical tattoo artists provide.

🇺🇸 Here in the US, decisions are made by each individual hospital or physician office regarding choosing staff who will preform the tattoo, equipment used, and inks. Most hospitals/ physician offices here have archaic thoughts still using permanent make up machines and semi permanent pigments because they were told they're safer, FDA approved, or they're "organic". Well, guess what else CAN be organic...carbon black tattoo ink. The repeated touch ups and ugly results, full of scar tissue, are for some reason accepted by the medical community as normal and it his needs to stop. ✋ Stop being accepted and just stop happening completely. I sometimes feel it's a trap,🪤 I suppose, set by the company "rep" who sell an expensive machine, expensive needles that said machine only takes, and then their pigments which are unstable/ low in lightfastness with awkward fading and turning of colors. (Terry Lively does a nice explanation on lightfastness and the blue wool scale on her youtube channel). So, after purchasing this expensive bundle of items, apparently they feel invested and keep accepting the awful results because it's a "medical tattoo". This is insanity.... these medical tattoos may have been the standard of care in 2005 or even 2010 but now, they are not. Patients know more now, they want more, and deserve more than this.

Medical tattooing is not regulated by insurance either in this country since it's a private payor system here. They'd probably prefer to have it done and over with once, to avoid repeat payouts but doctors on the other hand....bill each and every time for payment for multiple "touch ups". So, they're content to collect the money each visit you have. It's a money driven incentive indeed. Physician offices that continue to tattoo in house with terrible results do it for the money, not the results. I repeat... it's for money. 💲 Why do a beautiful breast reconstruction and ruin it with a terrible tattoo? Physicians that truly care about you will refer you to a professional tattooer. Bottom line.

I will continue to explain this further and back it up with my personal experience.
I did nurse tattooing for almost a decade. I wanted the ladies to have better results!!! So, I quit my job and trained with reputable tattoo artists both fundamentally and then for nipple specific training of course. Quitting nursing allowed me to devote all my time to only tattooing and really hone my craft to give results people deserve 💯.

There are 5 things I believe, no... I know to be wrong with medical tattooing. These tattoos I'm referring to are interchangeable...the same cosmetic tattoos done by nurses and some by aestheticians or inadequately trained pmu artists that I now fix regularly.

1. Many physicians will inject lidocaine💉 intadermally (like a tb shot) which takes up the exact space I am trying to deposit ink into... this quite possibly is the worst thing to do. The ink is a liquid suspension and your body absorbs the liquid and the color particulate gets embedded into the dermis, trapped and held there. If the space is flooded, overflowing with lidocaine, this will not ideally happen. It's a huge interference and 10000% not necessary anyway. Topical creams are fine and adequate.

2. They will allow tattooing as early as 2 months after your last surgery. This is so insane, it really could have a whole discussion of it's own.

3. The ink. It is semi permanent, many times full of fillers, thick and creamy, and bottled as the same facial formulas that just happen to be made in nipple colors. The staff tattooing most likely does not know color theory/mixing for undertones. Plus, they only have maybe a handful of colors to use for the entire population of the universe. It doesn't matter anyway if they get the color right because this ink FADES y'all. MANY TIMES TO WEIRD SALMON, PEACH, OR GREY/PURPLE TONES..... THIS MEANS REPEATED TOUCH UPS.
In the USA, tattoo ink is considered a cosmetic product by the FDA, which means it's ingredients can be subject to regulation, but the ink itself isn't subject to approval like you think. (The people that sell equipment to doctors tell them their semi permanent pigments are FDA APPROVED but technically they're not like you are led to believe)

📝Per this article from fda.gov :
"The tattoo manufacturer and distributor are responsible for the safety of the products that they sell to retailers. The FDA monitors the safety of tattoos and permanent make-up and alerts the public when the agency becomes aware of any issues associated with inks."

Note* I am licensed with City of Columbus Health Department and Franklin County Health Department who have both emailed me when the FDA has concerns regarding an ink ingredient or a recall on specific ink due to contamination due to microorganisms. Ultimately it's the responsibility of the artist to choose quality ink for their craft such as a company that meets high standards such as EU standards and/or CTL certification.

https://www.fda.gov/cosmetics/cosmetic-products/tattoos-temporary-tattoos-permanent-makeup

4. The equipment is wrong for body tattooing. Breasts are located on the body, not the face. So it's my belief that body art tattoo equipment is appropriate to be used.
✒ physicians typically use permanent makeup machines. Most nurses I know in multiple states use the Nouveau Contour system including inks and needles. It's a big racket. The machines are low powered meant for the thin skin on the face (dictated on speed to run rather than voltage from a power supply) so, because of this, the technician ends up making more passes, tearing up tissue and being much more heavy handed.
✒ The needle cartridges are also configured for small linear strokes/ small surface areas like brows and eyeliner, not the diameter of an areola and not scar tissue. Small needle groupings tightly configured so trying to cover surface area with that destroys the skin horribly compared to a nice big curved mag. Think stepping on a sharp pebble over and over again or walking on pea gravel without causing injury. Or painting a wall with a fat brush or a little artists brush. Efficiency =less trauma! The energy from our power sources are evenly distributed across the mag, not pinpointing and damaging. 📝 Note: a professional tattooer can whip shade with a smaller needle for texture or to layer color but that's not who I'm talking about here... these unskilled technicians are using small needles, going over and over in multiple passes, pressing too hard, damaging the skin.

5. Leading me to the next point of unskilled nontattooer staff providing this service. Not only unskilled but uneducated on the tattoo profession. As I stated previously, they most likely do not know color theory or possibly cannot even draw at all. If you cannot even draw a nipple on paper, why would you ever try on a human being??? Because it's in their job description. There is a lot that goes into these nipple tattoos like proper placement, size, symmetry, 3D effects, realism and details in addition to proper needle choice and techniques including working safely with scar tissue and radiated skin. They cannot execute proper techniques because they've not been taught. They also believe misinformation handed down to them and in turn passing it along to the patients. I've heard many times from ladies I do corrections on that they were told by the nurse "your skin just won't hold ink". This is even said to people with existing body art tattoos. Never mind that yellow rose on your ankle that's been there since 1993... the problem must be YOUR SKIN. 🚫 False. The problem is not your skin....it's all of this I am mentioning here. 😲 It's a multifaceted problem. 😲 Another untruth told over and over is that that "professional tattooers go too deep in the skin and it's unsafe for the implants and reconstruction in general". This is 100% False! 🚫 They are lying to you. Professional tattooers hit the sweet spot of the dermis because we know better and we've had adequate training. Unskilled folks are abraiding tissue repeatedly because they don't see take on the 1st (or multiple passes) thus, being too heavy handed blowing through the sweet spot creating an increase in bleeding, increase inflammation, and ink can't be captured and stay where there's no dermis left and ....SCAR .

❓So what kind of education/training do most nurses or office aestheticians get to earn that little certificate you see on their wall? As an RN at a major university medical center, I personally watched 6 hours of videos from the Beau Institute, then watched another nurse tattoo a patient and I was turned loose... (see one, do one, teach one). Then 2 years into it, I had 2 day "training" by an pmu trainer and then later by another nurse from MD Anderson in Texas. They both did the same thing I was already doing per by the awful videos from before. These 2 day training sessions or online are typical in a medical setting for cosmetic tattooing. I've spoken to nurses in TX, NC, FL, IL, IN, and KY and the all had similar, inadequate training and use similar equipment and inks. So, nurses and permanent makeup artists really need to research they training they take. Lots of training cost incredible amounts of money and the is terrible. Please understand this is not just a problem in the states. It is in the UK, Europe, Canada, and beyond. It’s more like a GLOBAL PROBLEM.

🗣Combine ALL OF THIS and its the perfect storm of DAMAGE done to fragile tissue REPEATEDLY for touch ups. Its UNETHICAL, DISFIGURING, AND DANGEROUS! It's not just dangerous physically but also to mental health‼️

❓So....who do we hold responsible?
I believe it's not the fault of the nurses, they are doing what they've been taught. I asked for better ink, better equipment, better training and kept getting told "No, what we do here is the standard of medical tattooing. It may not look perfect but, it's safe and it's good enough. This is your job description so if you don't like it, you can look elsewhere. We have nurses lined up out our door to have your job". No lie. This old surgeon with an archaic attitude and his academic administrative assistant (let me repeat that again so it sinks in) not a medical person, but a COO was in charge of making all the clinical decisions in our office and they both told me this was "good enough". I guarantee it wouldn't be good enough for their spouse, sister, mother, or daughter. They'd send them somewhere better...
The employee on the other hand, is doing their job. Nurses are wonderful people, empathetic people who care about humanity and want to help heal. Their heart is in the right place and want to do good...that's why they're nurses. I'm one too. I did exactly this. I didn't learn why it was wrong until I trained with a reputable, educated tattooer.

❓OK, SO WHY DOESN'T THE DOCTOR HAVE HIS STAFF PROPERLY TRAINED?
1. First of all, the physician/department must be able to disregard the old medical tattooing acceptance and see the NEED to offer better.
2. Secondly, as stated before, the staff on hand may not be interested in tattooing, not be artistic or not be able to draw.
3. The physician has to invest in the staff's training, new equipment, and scheduling to dedicate to tattooing. It is impossible to become expert level doing something a fraction of the time....nurse duties usually come 1st: office hours, phone calls, calling in meds, FMLA paperwork, TE fills, pulling drains, assisting in procedures, scrubbing instruments. The list is pretty long and then, oh yeah, do tattoos on Tuesday afternoon. To be good, you need dedicated staff to tattoo.
4. There's a risk, a BIG RISK, that once fully trained and comfortable, the staff will eventually leave to start her own independent business. 👋 yep, bye girl 👋 Think real hard about that part 🧐. Being a "boss girl" 💪and living the American dream is pretty glorious. Making her own flexible schedule with work life balance including time for kids. No more making her hourly wage and getting PTO time denied for vacations. She now is armed with everything she needs to be on her own to have her rewarding work, making her own money, instead of her already rich boss...richer. So she bolts and now the doctor is out a nurse and a tattoo artist.. 💣 The real the truth. 💣 compete clause be damned lol!

🎀 Again, if your tattoos were done in your reconstructive physician office 5-10-15 years ago, they probably didn't know any better option was available honestly. I started Living Story Tattoo in 2015 and there weren't a lot of artists at that time offering this service. Plus, the docs were like I said, in the trap, thinking what they were offering was indeed the standard of care. However, there is NO excuse NOW. Especially with social media and information available at your fingertips to patients and doctors alike. Physicians now, can no longer state these tattoos are good, acceptable, or the standard of care.
So, it comes down to either keep doing terrible restorative tattooing in house or refer your beloved patients out to an experienced, reputable, tattoo artist in the community. In Central Ohio where I live, most physicians do this. There are a few who still do office medical tattooing which comprises the majority of corrective tattooing that I do. I work 5 days a week and at least one of those days, I'm correcting/covering up a poorly done nipple tattoo.
I firmly believe the responsibility lies in the hands of the decision makers. The head of the departments in academic settings or the private practice owner/physician allowing this to take place in their office. That's who is willing to bill your insurance repeatedly for garbage tattoos and making payments on their luxury car at the expense of your mental health.


Damage is being done.

Damage to the Skin and Deep Within by awful tattooing. Our body image and self confidence are closely intertwined and a bad "finishing touch " can be devastating. The good news is, if you've had an unsatisfactory tattoo, a professional paramedical tattoo artist can most likely fix it. I personally fix them all the time. Nipple tattooing is supposed to be a beautiful grand finale to complete a breast reconstruction and it can be.
Areola Restorative Tattooing really does help close the chapter 🎀
I hope this helps explain the differences between what your physician may offer you versus what a properly trained tattoo artist can. Education is needed for the survivors!!!

XOXO,

The Nipple Fairy 🧚‍♀️

Also posted on Blogger May 12,2021- http://livingstorytattoo.blogspot.com/2021/05/damage-to-skin-and-deep-within.html