Tattoo Ordinance Change Info
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MEMORANDUM
August 9, 2004
TO:
The Honorable Mayor and City Council Members
FROM:
Michael C. Van Milligen, City Manager
SUBJECT: Request to Change Tattoo Ordinance
Tanya Tigges has requested the City modify the existing Tattoo Ordinance to allow the
practice if micro-pigmentation without a physician's supervision. Micro-pigmentation,
also known as dermagraphics, permanent makeup/cosmetics, cosmetic tattooing,
intradermal implants, and dermal pigmentation is tattooing.
Micro-pigmentation technicians are not certified by a third party, but simply through the
school in which the training was received. There are no state or federal
certifications/licenses for this technique.
Based on the recommendation of Dr. John Viner and Dr. Erin Kennedy, and the fact that
micro-pigmentation is tattooing, it should require the same level of medical oversight
and supervision since they are one in the same. If the requirement for physician
oversight is not required for the practice of micro-pigmentation, it appears that it would
also need to be removed as a requirement for general tattooing.
The current City Ordinance states, "practice of tattooing be limited to physicians or
osteopaths licensed in the state, or to individuals directly under their supervision."
Public Health Specialist Mary Rose Corrigan is recommending that no change be made
in the current City Ordinance.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
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Michael C. Van Milligen '-
MCVM/jh
Attachment
cc: Barry Lindahl, Corporation Counsel
Cindy Steinhauser, Assistant City Manager
Mary Rose Corrigan, RN, Public Health Specialist
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MEMORANDUM
TO: Michael C. Van Milligen, City ~
FROM: Mary Rose COrriga~N, Public Health Specialist
SUBJECT: Request to Change Tattoo Ordinance
INTRODUCTION
This memorandum is in response to Tanya Tigges' request to modify the existing Tattoo
Ordinance to allow the practice of micro-pigmentation without a physician's supervision.
BACKGROUND
The City of Dubuque addresses the practice of tattooing under Section 23-2 of the City
Code of Ordinances. In addition to being licensed as a tattoo establishment through the
Iowa Department of Public Health, the City Ordinance requires that the "practice of
tattooing be limited to physicians or osteopaths licensed in the state, or to individuals
directly under their supervision."
DISCUSSION
Micro-pigmentation, also known as dermagraphics, permanent makeup/cosmetics,
cosmetic tattooing, intradermal implants, and dermal pigmentation is tattooing. The
micro-pigmentation procedures are performed by depositing pigment, or ink dyes, into
the dermal layer of the skin with a specially designed motorized instrument and a sterile
needle or group of needles. Micro-pigmentation is usually performed around the eyes,
eyebrows and lips.
Micro-pigmentation technicians are not certified by a third party, but simply through the
school in which the training was received. There are no State or Federal
certifications/licenses for this technique. Micro-pigmentation is often performed in
physician practices, specifically by plastic surgeons or by technicians in physician-
managed clinics.
Dr. John Viner, MD, Medical Advisor for the City of Dubuque Health Services
Department recommends that "cosmetic tattooing should be considered along with
existing policies of tattooing in our community, by my perspective and recommendation.
Medical supervision recommended." (See attached letter) Similarly, Dr. Erin Kennedy,
MD, Plastic Surgeon in Dubuque stated that micro-pigmentation is tattooing and there
are numerous risks involved in the process. In addition to potential allergic reactions
with ingredients in the dyes used, there are risks to vision, lid inclusion, infection risk
involving paraorbital cellulitis, sagittal sinus thrombosis, and possible vision loss. Dr.
Kennedy believes any micro-pigmentation activity should be performed under the
direction of a physician. She personally does not perform micro-pigmentation in her
practice, nor does she intend to engage in this practice in the future.
RECOMMENDATION
Based on the recommendation of Dr. John Viner and Dr. Erin Kennedy, and the fact that
micro-pigmentation is tattooing, it should require the same level of medical oversight
and supervision since they are one in the same. If the requirement for physician
oversight is not required for the practice of micro-pigmentation, it would also need to be
removed as a requirement for general tattooing. Therefore, I recommend the physician
oversight requirement for tattooing remain in the City Ordinance. However, if this
requirement is removed, the City would not need any special ordinances nor provide
oversight, and would simply direct tattoo establishment owners to obtain an Iowa
Department of Public Health license.
COUNCIL ACTION
Please advise staff to either prepare a repeal of the current Tattoo Ordinance, Section
23-2, or leave it as is with the physician supervision requirement intact.
MRC/cj
" Dubuque
Internal
Medicine
- Doctors For Adults"
July 22, 2004
Dubuque [ute",al Medieine, P.c.
1515 Delhi Street, Suite 100
Dubuque, Iowa 52001-6389
5631557.9111
The Food and Drug Administration updated their position on 07/01/2004
regarding a cosmetic tattoo. They noted among other things that the color
additives used in this procedure are not approved by FDA for tattoo use.
These pigments are typically approved for printing and automobile
pigments.
Internal Medicine
R. S. Bartsch, MD,
J, M, Comptoo, M,D" FAc.P,
W, J. Dal1, MD,
M, J. Kirkendal1. MD,
C. J, Konz, MD,
p, J, Leeson, M,D,. FAc.P,
R, W, Lengeling, MD,
M, 0, Liaboe, M,D,
C, A, Longo, M,D,
A, G. Meurer, M,D,
B, D, Moran, MD,
G,M,Moran,M.D,
D, K, Mozena, MD,
K, E, Nelson, MD,
G. v, Ridgley. ¡", M,D,
H. A, Salas, M,D.
R, W, Schope, M,D,
D, L. Sorenson. M,D,
J, p, Vin". M,D" FAe.P,
Travel Medicine
R. J. Fairley, M,D" M,P,H,
Cardiology
e. A, Longo. MD,
T, W, Marbn. M,D" FAe.e.
Endocrinology
R, A, lve"on, MD,. FAe.P,
D, M, Putz.MD,
Gastroenterology
I. M, Koontz, MD,
R, W, Lengeling, M,D,
Infectious Diseases
J, p, Vin". M,D" FAe.P,
Medical Oncology
M, E, Hem1ann, MD,
D, W, Zenk. M,D,
Nephrology
D, M, Ringold, MD,
J, E, Whalen. MD,
Nenrology
R, S, Sims. M,D,
Pulmonary Medicine
R, W, Schope. MD,
Medical Director
R, J, Fairley. MD., M,P,H,
Mrs. Mary Rose Corrigan
Dubuque Health Department
1300 Main Street
Dubuque, Iowa 52001
Dear Mrs. Corrigan:
The question has been raised about the health safety of micro pigmentation
tattoo. This is a cosmetic tattoo which involves subcutaneous pigment
introduction by needle. Of course, this is a facial procedure, induding
around eyes.
The City of Dubuque requires medical supervision for tattoo application.
I have checked with the American Medical Association policy regarding
this procedure. The AMA H-440.909 "Regulation of Tattoo Artists and
Facilities" recommends State regulation.
AMA policy H-440.934 expresses concern for the sterilization of
instruments in noncommercial enterprises, such as tattoo parlors because
ofthe danger of blood infected contaminated fluids.
The FDA sites six specific problems with cosmetic tattoo. I believe that
most important from the public health standpoint is the danger of infection
and they specifY hepatitis, by which they mean hepatitis B and C. The Red
Cross Policy is that an individual cannot donate blood for one year after
this tattoo procedure which is in reference to this hepatitis risk. There is
also a notable case in the popular press of an actress who is hepatitis C
infected due to tattoo exposure.
Page 2
Mrs. Mary Rose Corrigan
Dubuque Health Department
Dubuque, Iowa 52001
07/22/2004
I do not want to discount the other five points referred by the Food and Drug Administration update.
Removal problems are difficult with cosmetic tattoos. Allergic reactions to dyes and pigments are not
uncommon. Granuloma development is also a frequent problem. Keloid development, either with the
original tattoo or with removal of tattoo is a situation of which the dermatologists are well aware. An
added problem from cosmetic tattoo has complication in magnetic resonance imaging. Apparently, there
is metal!ic content in pigments which can be disrupted or moved in the presence of the strong magnet
of MRI scanning. Patient dissatisfaction is not unusual with cosmetic tattooing due to fading and
distortion.
Cosmetic tattooing should be considered along with existing policies of tattooing in our community, by
my perspective and recommendation. Medical supervision recommended.
Sincerely,
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John P. Viner, M.D.
JPV/rs
Chapter 23
HEALTH AND SANITATION
ARTICLE I. IN GENERAL
Sec. 23-2. Tattooing:
(a)
(b)
(c)
Definitions: For the purpose of this Section, the following words and phrases
shall be construed as follows:
(1) Tattoo Artist: Any person engaged in the practice of tattooing.
(2) Tattoo Establishment: Location where tattooing is practiced.
(3) Tattooing: To puncture the skin of a person with a needle and insert indelible
permanent colors through the puncture to leave permanent marks or designs.
Prohibition: The practice of tattooing shall be limited to physicians or osteopaths
licensed in the State, or to individuals directly under their supervision.
Registration: Tattoo establishments and tattoo artists shall register annually with
the City Health Services Division and indicate the physician or osteopath under
whose supervision they are operating. (1976 Code, § 18-2; Ord. 17-96, § 1,3-18-
1996)