Introducing Dr Nicolas Kluger (@the_tattoed_derm), a fully qualified Dermatologist and professor at Helsinki University Hospital. Dr Kluger specialises in skin diseases and has spent years researching how tattoos impact the skin...he's also covered in tattoos himself. We asked him some questions about how tattoos age, the risk factors and the steps you can take to minimise aging.
For us to understand how a tattoo ages, I think it is important for us to understand what actually happens to the skin when you get tattooed. Could you explain?
From a microscopic point of view, as soon as the needles pierce the skin, there is a local non-specific inflammation with tissue oedema and the superficial capillaries in the skin dermis are ruptured with a moderate bleeding. During the healing phase, plugs made of exudate block the skin perforations made by the needles. The superficial layers of the epidermis will progressively peel off during the next weeks, rejecting all the pigment that stays “too high” in the epidermis. Thereby only tattoo pigments persisting in the dermis will be responsible for the final aspect of the tattoos (a “mat” aspect after the epidermis has regenerated over the tattoo) and insure its permanency. There is a progressive phagocytosis of the pigments by macrophages (in other words those cells are in charge of eating the pigments) and they migrate to the local drainage nodes. Remaining pigment is localized mainly in fibroblasts and macrophages that did not migrate. Lastly, some pigments can sit in the connective tissue in the dermis, between collagen bundles
The tattoo does not remain histologically inert over the course of a lifetime. There is a non-specific macrophagic activation and discrete inflammatory changes (moderate fibrosis of the papillary dermis, capillary proliferation and non-specific lymphocytic infiltration) that can be observed.
What happens to your skin as it ages and why do tattoos start to fade?
I think it is important to remember that skin aging is associated with several different factors. Chronological ageing is inevitable, even though because of genetic diversity, not everyone displays the same signs of chronological ageing at a given age. Hormones, at menopause for women, are also involved in aging. Sun ageing affects sun-exposed areas such as the face, neck, décolleté or hands and varies again according to where you live and also your skin fairness. Lastly, smoking is also responsible for skin ageing.
Normal skin aging includes loss of laxity of the skin, increased pallor, increased dryness, increased fragility (more bruises, easy skin tears, nail fragility…), irregular pigmentation and hair loss.
Tattoos inevitably fade. Tattoo fading originates either from light induced decomposition in tattooed skin or from pigment transportation to other anatomical locations in the body via lymphatic system. Migration of pigments via macrophages may explain why lines become blurry.
Tattoo colour fading/bleaching can be compared to colours that bleach on textiles or book covers after sun exposure for instance. However, interestingly almost nobody perceives a change of the tattoo colour. The change of colour concentration can be overlooked because of the very high colour strength of such azo pigment.
What role does collagen play in skin ageing?
During skin ageing, there is a loss of density and thinning of the dermis is linked, which is related to the reduction of all its components: collagen and elastic fibres, glycosaminoglycans of the extracellular matrix, in particular hyaluronic acid. There is therefore an overall decrease in the viscoelasticity of the dermis.
What are the main risk factors that can accelerate tattoo aging?
Excessive sun exposure, either just after tattooing or chronic, repetitive and unprotected sun exposure of the tattoo during the life of the bearer.
What can be done to minimise tattoo aging?
- Choose well your professional tattooist. Avoid amateur tattooists because with inexperience the tattoo pigments are deposited too sparsely and the tattoo fades faster.
- Avoid small/micro tattoos and excessive small details, as they will anyway fade away and/or become blurry within years.
- Avoid areas at risk of rapid aging such as face, hand, palms, soles, neck, elbows.
- Respect the aftercare procedures, as given by the tattooist, including sun protection. Protect from the sun as often as possible by using clothes or applying sunscreen.
For colours, lighter colours will have the tendency to disappear faster, this is peculiarly the case of white. This is the reason why tattooists use white only for small details in their tattoos.
Tattooists will confirm that tattoos small tattoos/small details will not age well, cautions is warranted also for the tattoos that look like “watercolours”
Areas do have an impact. There are areas that are notoriously known to age less well, areas that are sun exposed all the time such as the face or fingers, palms and hands. Areas that are exposed to repetitive traumas such as elbows and those prone to aging like the neck.
Once a tattoo has faded is there anything that can be done to reverse it?
No, there is nothing that can be done to reverse tattoo fading.
At that stage only two solutions to correct fading 1) Get a new tattoo/cover or the tattoo touched up 2) “Finish the job” by completing tattoo removal, by laser preferably.
Number one tip for preventing fading?
I don’t think there is a “number one” tip as skin and tattoo aging is multifactorial.
I would say 1) choose a good tattooist 2) respect the tattoo aftercare (both will ensure the best tattoo for the start) and 3) protect your tattoo from the sun. These would be the basic tips to respect.
Finally, are my tattoos still going to look good when I’m 60?
Well, it will depend at which age you got them and how your skin aged. If you get them when you were 59, they will look good. If you got them when you were 18, there is a chance that they have changed. It is a matter of personal perspective, you will just have to accept how they are.