Putting your face in someone else's hands A recent study has explored women's experiences of medical tattooing. The study's authors and contributors are Nicola Stock, Nicholas Sharratt, Georgia Treneman-Evans, Kerry Montogomery (Alopecia UK), Rae Denman, Diana Harcourt and the VTCT Foundation Research Team at the Centre for Appearance Research. We caught up with Dr Nicola Stock to find out more about the study... Why did you carry out this research? We know that having an appearance-altering condition, such as alopecia, and its ongoing treatment can have a significant impact on people’s lives and emotional health. We also know that despite the wide range of medical treatments available, the success rate of these treatments can vary and the side effects can be unpleasant. As a result, alternative treatments, such as medical tattooing, are becoming more popular. However, medical tattooing is a largely unregulated industry and we don’t yet have a good understanding of the benefits and risks involved, or how to achieve the best outcome for the individual. We wanted to find out what motivated women to choose medical tattooing and how we could learn from their experiences to support others. How did you carry out this study? We carried out individual telephone interviews with 25 women aged 26-67 years who had experience of medical tattooing related to hair loss in the past five years. Most participants reported a form of hair loss as a result of alopecia, lichen planopilaris or ectodermal dysplasia, and had chosen to have their eyebrows and/or eyeliner tattooed. Each interview lasted around an hour. We transcribed all of the interviews and looked for common themes. What did you find? Motivations for medical tattooing Participants reported that traditional treatments had either failed, provided temporary results and/or produced a range of upsetting side-effects. Participants described feeling “abandoned” by medical professionals once traditional treatment options had been exhausted. Although participants felt they had adjusted to losing the hair from their head, they had found the loss of their eyebrows and eyelashes to be especially distressing. Participants’ primary reasons for choosing medical tattooing therefore included appearance-related concerns and a loss of self-confidence, identity and/or femininity. Participants also discussed the time and effort involved in applying daily make-up, and the ongoing worry that this make-up would be smudged or removed throughout the day. Experiences of medical tattooing Most participants had found out about medical tattooing through a recommendation and/or from posts on internet forums. Prior to undergoing medical tattooing, participants had concerns about the process, including anxiety about needles and the pain involved, and whether the outcome would look natural. Participants were therefore reassured if they received a full consultation and didn’t feel rushed or pressured. Participants had sought treatment at a range of venues, including high street beauty salons, specialist private clinics, and high street tattoo studios. Although all of these require a different level of specialism, professional qualifications and referral processes, the key factor in making sure participants had a good experience was having trust in their practitioner. Most participants were satisfied with the outcome and would recommend medical tattooing to others. Ongoing concerns Medical tattooing often requires regular ‘top-ups’ to stop tattoos fading or losing colour over time. The costs of upkeep were therefore a concern to participants. Participants felt that medical tattooing should be properly regulated to avoid people experiencing a bad outcome or being taken advantage of. Participants also felt that GPs and dermatologists could be better informed about medical tattooing as a potential treatment option. Participants strongly believed that although alopecia is not a life-threatening condition, it is a life-changing one, and the emotional impact of hair loss should not be undervalued. Participants also stated that treatment to restore appearance due to a medical condition should be distinguished from the beauty industry and should be recognised as a medical need. Advice to others Participants advised others to do their research and not take medical tattooing lightly. They encouraged individuals who are considering medical tattooing to find an experienced practitioner who is prepared to spend time making sure the shape and colour is right, to perform an allergy test, and to explain the process and aftercare in full. They also recommended taking a photograph to show the practitioner what they looked like before losing their eyebrows and eyelashes to alopecia. What’s next for this work? We are publishing this study in a leading journal aimed at health professionals. We will also be presenting this research at future national and international conferences. We hope this will help to raise awareness of medical tattooing and its risks and benefits among health professionals and individuals who have experienced hair loss. Acknowledgements from the authors: Thank you to everyone who gave their time to participate in this study and to the charities, including Alopecia UK, who helped with recruitment. This study was funded by the VTCT Foundation (registered charity #1155360; http://www.vtctfoundation.org.uk). If you have any questions or comments about this study, please contact [email protected] or [email protected], or visit: www.uwe.ac.uk/car. Thank you to Nicola for sharing the initial findings of this study. We look forward to reading the final published paper and hope this will lead to wider recognition of the positive impact that medical tattooing can have for those with alopecia.