Tattoos: From Counterculture to Mainstream…But At What Cost?
By Dr. Juris Bunkis Medical Director, Orange County Plastic Surgery Honorary Consul of the Republic of Latvia
Decorative tattooing is far from a modern invention. Archaeological evidence shows that humans have been marking their skin for over 5,000 years. Ancient Egyptians used tattoos as symbols of status and spirituality, while Polynesian cultures developed intricate tattoo traditions that conveyed identity, lineage, and social standing. Even in more recent history, sailors and soldiers often wore tattoos as badges of honor, reminders of journeys, or expressions of patriotism.
Yet, despite this long history, tattooing in mainstream American society remained relatively fringe until quite recently. When I began my surgical residency some fifty years ago, I do not recall a single classmate with a tattoo. At that time, tattoos were largely associated with bikers, gang members, or perhaps a lone Marine with an eagle or flag on his shoulder. They were not seen in professional settings.
Fast forward to today, and the landscape has changed dramatically. Tattoos are now widely accepted across all demographics—young professionals, parents, even physicians. What was once counterculture is now firmly embedded in popular culture. Estimates suggest that nearly one in three adults in the United States now has at least one tattoo.
However, as with many trends that grow rapidly in popularity, we are beginning to see emerging data that raises important health considerations.
Recent studies suggest a concerning association between tattoos and certain cancers. One study reported that individuals with tattoos had a 21% increased risk of lymphoma, a cancer affecting the lymphatic system. Another, involving nearly 2,700 twins in Denmark and published in early 2025, found a 62% increased risk of skin cancer and nearly a threefold increase in lymphoma among individuals with large tattoos.
Why might this be? Tattoo ink does not simply remain in the skin—it can migrate into the lymphatic system. Many inks contain heavy metals and other compounds that may trigger chronic inflammation or other biological effects over time. While these findings are still being studied, they certainly give pause.
What can be done to mitigate these risks? First, moderation matters—larger tattoos appear to carry greater risk. Second, choosing reputable tattoo artists who use high-quality, regulated inks is essential. Third, monitoring tattooed skin for changes—just as one would monitor moles—is wise.
Patients often ask whether removing a tattoo reduces these risks.
Unfortunately, it is unclear that it does. Laser removal breaks up pigment in the skin, but those particles have already entered the body’s lymphatic pathways. Thus, removal may improve appearance, but it may not eliminate systemic exposure.
As with many lifestyle choices, informed decision-making is key. Tattoos are a powerful form of self-expression—but they are not without potential consequences.
Hard at work, increasing someone else’s chance of developing a lymphoma.
Addressing the Aging Inner Arm
By Dr. Deborah Ekstrom
Orange County Plastic Surgery, Corona del Mar/Newport Beach
Quick Quiz (Test Your Knowledge!)
Which of the following is the most effective treatment for significant loose, hanging skin of the upper inner arm?
A) Topical creams
B) Exercise alone
C) Liposuction
D) Radiofrequency skin tightening
E) Brachioplasty
Correct Answer: E) Brachioplasty
Beginning as early as their 20s and 30s, many women start to notice changes in the inner arms—skin laxity, thinning, and a loss of firmness. Even in very fit individuals, this area can become problematic. Unlike men, who tend to retain thicker skin and more supportive connective tissue, women are more prone to developing this “loose” or “crepey” appearance along the upper inner arm.
What bothers patients most? The inability to wear sleeveless clothing confidently, a sense that the arms appear older than the rest of the body, and the frustrating reality that exercise alone does not correct the issue. While strengthening underlying muscles is beneficial for overall tone, it does not tighten excess skin.
Treatment options vary depending on severity:
Minimally Invasive Options:
Radiofrequency-based treatments, including technologies like Renuvion, can offer mild to moderate skin tightening. These are best suited for patients with early or minimal laxity. Results are subtle and often require patience.
Liposuction:
This is helpful when excess fat is the primary concern and skin elasticity is still relatively good. However, in patients with loose skin, liposuction alone may actually worsen the appearance.
Brachioplasty (Arm Lift):
For patients with significant skin laxity, brachioplasty remains the gold standard. This procedure removes excess skin and reshapes the arm, creating a smoother, more youthful contour. The trade-off is a scar along the inner arm, which typically fades over time but is permanent.
Who is a Candidate?
Ideal candidates are healthy individuals at a stable weight who are bothered by loose, hanging skin of the upper arms. Patients should have realistic expectations and understand the balance between improved contour and surgical scarring.
Risks and Benefits:
The benefits are dramatic and often life-changing—patients regain confidence and comfort in their appearance. Risks include scarring, swelling, infection, and in rare cases, healing issues. Careful surgical technique and proper aftercare significantly minimize these risks.
In summary, while early treatments can help mild cases, brachioplasty remains the most effective solution for significant inner arm laxity. As always, individualized consultation is key to selecting the best approach.
If you have any concerns regarding your inner arm appearance, it may be time to see Dr. Ekstrom for a consultation to go over your options and come up with a plan to help you.
This 36 year old female wished to have her inner arm laxity improved and saw Dr. Deborah Ekstrom of Orange County Plastic Surgery in Corona del Mar/Newport Beach for a consultation. She is shown here before and after a minor inner arm liposuction and a Renuvion treatment. With this treatment, a thin wand is inserted just under the skin and a unique combination of helium plasma and radiofrequency energy are utilized to contract the skin for a smoother, firmer appearance. (Actual patient of Dr. Deborah Ekstrom.)
This 77-year-old fit female, who looked much younger than her stated age due to a prior facelift, severely disliked her inner arm laxity and sought consultation with Dr. Deborah Ekstrom of Orange County Plastic Surgery. She underwent a brachioplasty, as she did not like her “flappy arms”. She is 3 months post op and thrilled she may be able to wear a sleeveless blouse again. (Actual patient of Dr. Deborah Ekstrom or Orange County Plastic Surgery in Corona del Mar/Newport Beach.)
Orange County Plastic Surgery at CosmetiCare
1101 Bayside Drive, Suite 200
Corona del Mar, CA 92625
Take the elevator to the second floor (Suite 200) and check in with the front desk for your consultation or follow-up.
Free Parking Available.
