Published on in Vol 5, No 4 (2022): Oct-Dec

Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/42759, first published .
An Analysis of Information Sources of YouTube Videos Pertaining to Tattoo Removal: Cross-sectional Study

An Analysis of Information Sources of YouTube Videos Pertaining to Tattoo Removal: Cross-sectional Study

An Analysis of Information Sources of YouTube Videos Pertaining to Tattoo Removal: Cross-sectional Study

Short Paper

1Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, RI, United States

2Department of Dermatology, Miller School of Medicine, University of Miami, Miami, FL, United States

3Department of Dermatology, Harvard Medical School, Boston, MA, United States

4Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, United States

5Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States

*these authors contributed equally

Corresponding Author:

Benjamin Gallo Marin, AB

Department of Dermatology

Warren Alpert Medical School of Brown University

222 Richmond Street

Providence, RI, 02904

United States

Phone: 1 6099376474

Email: ben_gallo@brown.edu


Background: The American Academy of Dermatology and the Food and Drug Administration recommend consultation with a dermatologist prior to undergoing laser tattoo removal. However, non–health care professionals offer tattoo removal. Understanding the information available on the internet for patients regarding tattoo removal is important given that individuals are increasingly consulting digital sources to make decisions regarding skin care. Prior research has identified that YouTube contains misinformation on dermatologic health.

Objective: Here, we present a cross-sectional study that determined the sources of information in YouTube videos that discuss tattoo removal and described the content presented to viewers.

Methods: Using the query “tattoo removal,” we reviewed English-language YouTube videos that explicitly discussed tattoo removal. The following data were recorded: profession of the presenter, tattoo removal method discussed, whether an explicit recommendation to see a dermatologist or physician was present in the video, and number of views.

Results: We analyzed 162 YouTube videos. We found that the majority were presented by non–health care professionals (n=125, 77%), with only 4 (3.7%) records of this subset recommending viewers to seek consultation from a dermatologist to ensure safe and adequate tattoo removal.

Conclusions: Based on our findings, we recommend that dermatologists and other health care professionals provide high-quality, evidence-based information to viewers on tattoo removal and encourage dermatology societies to share via their social media platforms information about the importance of consulting a dermatologist for tattoo removal.

JMIR Dermatol 2022;5(4):e42759

doi:10.2196/42759

Keywords



Laser-based technologies are the preferred methods for tattoo removal, and the American Academy of Dermatology and the Food and Drug Administration recommend consultation with a dermatologist prior to undergoing these procedures [1]. However, tattoo removal performed by non–health care professionals and via do-it-yourself methods (eg, scrubs, at-home lasers) are widely advertised [2]. Inadequate tattoo removal may lead to dermatologic complications, including scarring and suboptimal cosmetic outcomes. The free video platform YouTube is often accessed by individuals seeking information on cosmetic procedures. However, prior research has shown that YouTube contains misinformation regarding skin health [3-6]. This study aimed to determine the sources of information of YouTube videos discussing tattoo removal and to describe the contents that viewers are exposed to. We hypothesized that most YouTube videos pertaining to tattoo removal are presented by non–health care professionals, with many videos failing to recommend viewers to seek consultation with a dermatologist for these procedures.


A YouTube query for “tattoo removal” was performed on June 22, 2022. To mitigate selection bias, the search was conducted using incognito mode. Eligible videos were presented in English, featured audio (ie, rather than text-only), and explicitly discussed tattoo removal. Videos that met the inclusion criteria were then independently analyzed by 2 researchers, and the following variables were recorded: profession of the presenter, tattoo removal method discussed, whether an explicit recommendation to see a dermatologist or physician was present in the video, and number of views.


A total of 186 videos were initially identified. After excluding videos unrelated to tattoo removal, without audio, or not in English, we included 162 (87%) of these records in our analysis. Of these 162 videos, most videos were presented by non–health care workers (n=125, 77%), with only 37 (23%) featuring health care professionals (ie, either voice-over or on-screen). Among health care professionals, presenters included dermatologists (n=27, 73%), registered nurses (n=5, 14%), plastic surgeons (n=3, 8%), and physician assistants (n=2, 5%). Laser removal was the most common tattoo removal method discussed across all videos (n=143, 88%); 35 videos from health care professionals addressed this approach, and none of them provided a discussion of technical parameters such as laser settings. The remaining 2 videos created by health care professionals discussed excisional surgery and the ineffectiveness of salt and cocoa butter scrubs. All videos presented by health care professionals suggested that viewers seek tattoo removal through physicians, with treatment in a dermatology office (n=33, 89%) being the most frequent recommendation (Table 1).

Table 1. Presenters and methods in YouTube videos discussing tattoo removal included in this study (N=162).
Presenters and methodsVideos, n (%)
Health care professionals37 (23)

Dermatologists27 (73)

Plastic surgeon3 (8)

Registered nurses5 (14)

Physician assistants2 (5)
Health care professional methods

Laser35 (95)

Excisional surgery1 (3)

Cocoa butter scrub (comment on lack of effectiveness)1 (3)
Non–health care workers125 (77)
Non–health care worker methods

Laser108 (86)

Microneedle patch1 (0.8)

Removal cream1 (0.8)

Lemon juice scrub6 (5)

Yogurt scrub1 (0.8)

Salt scrub6 (5)

Oral herb therapy1 (0.8)

Ink and light1 (0.8)

While 108 videos by non–health care professionals discussed lasers, only 4 (3.7%) explicitly stated that viewers should schedule a consultation with a dermatologist to discuss the removal of their tattoos. The remaining videos focused on the presenters’ experiences visiting laser clinics (n=95) or utilizing lasers at home (n=9). Nonlaser methods discussed in the videos presented by non–health care professionals included the use of scrubs composed of lemon juice (n=6), salts (n=6), and yogurt (n=1); microneedle patches (n=1); creams (n=1); oral herb therapy (n=1); and the application of ink followed by light (n=1) (Table 1). However, 119 videos from non–health care professionals addressed adverse reactions to removing tattoos, most often pain, blistering, and pigmentation changes; scarring as an adverse event was not mentioned in any of these videos. Among the top 15 most-viewed videos (range 578,340-15,982,270 views), 6 (40%) were created by dermatologists and 1 (7%) by a plastic surgeon. The remaining most-viewed videos were presented by non–health care professionals, none of which encouraged viewers to see a physician for consultation on their tattoo removal. Table 2 summarizes the content of the top 15 most-viewed YouTube videos pertaining to tattoo removal.

Table 2. Content of top 15 most-viewed videos in this study.
RankViewsPresenterTattoo removal methodDoes the video recommend seeing a health care professional?Adverse effects discussed
115,982,307Plastic surgeonLaserYesProcedural pain
210,501,863DermatologistSalt and cocoa butter (and its lack of effectiveness)YesNone
39,153,031Patient in tattoo clinicLaserNoProcedural pain
49,018,118DermatologistLaserYesProcedural pain, bruising, scarring
57,879,038Patient in tattoo clinicLaserNoNone
65,301,535DermatologistLaserYesProcedural pain and swelling
71,759,919Patient in tattoo clinicLaserNoProcedural pain
81,549,586DermatologistLaserYesProcedural pain
91,103,570DermatologistLaserYesProcedural pain
101,087,641Patient at homeSalt scrubNoCrusting
111,035,538Patient in tattoo clinicLaserNoProcedural pain, blistering, pigmentation changes
12820,358Patient in tattoo clinicLaserNoNone
13758,979Laser tattoo clinic workerLaserNoPigmentation changes
14653,883DermatologistLaserYesProcedural pain
15578,340Patient at homeLemon juice and baking soda scrubNoNone

We report that most YouTube videos regarding tattoo removal are presented by nonmedical professionals. While the majority of videos discuss laser-based methods, only a small fraction of videos recommends viewers to visit a dermatology office for these procedures. Because we only analyzed videos presented in English, we were unable to discuss the full breadth of available content to viewers presented in other languages. However, we suspect that similar misinformation patterns exist across languages.

With patients increasingly seeking health information via the internet [7,8], it is important to ensure the provision of high-quality online patient educational materials pertaining to dermatology. Therefore, we suggest patients view YouTube videos on tattoo removal with caution. Dermatologists have tools to address the misinformation that YouTube contains regarding tattoo removal. Beyond contributing to high-quality patient education through YouTube videos on the topic, the major dermatology societies of the country could consider implementing a robust campaign using their social media platforms that encourages patients contemplating tattoo removal to seek consultation with a board-certified dermatologist. In the clinical setting, proactively taking “social media histories” for patients with tattoos who may be contemplating their removal and assessing patients’ understanding of the best way to approach these procedures could be an important opportunity to address areas of misinformation. Ultimately, dermatologists should remain aware of the overall poor quality of information regarding tattoo removal that is publicly accessible on YouTube. Educating patients on how tattoos are safely removed is important to ensure the best cosmetic outcomes while also avoiding potentially serious complications.

Acknowledgments

BGM was supported by National Institutes of Health/National Institute of Allergy and Infectious Diseases (NIH/NIAID) R25AI140490.

Conflicts of Interest

CGW has served as a speaker for Cynosure, Inc, including lectures about laser tattoo removal. Other authors report no conflicts of interest relevant to this work.

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Edited by R Dellavalle; submitted 16.09.22; peer-reviewed by D Zheng, V Palmer; comments to author 04.10.22; revised version received 15.10.22; accepted 16.10.22; published 25.10.22

Copyright

©Benjamin Gallo Marin, Ogechi Ezemma, Fabio Stefano Frech, Julio C Flores Servin, Ben S Rhee, Kathleen M Mulligan, Katie A O' Connell, Isabelle Moseley, Carlos G Wambier. Originally published in JMIR Dermatology (http://derma.jmir.org), 25.10.2022.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Dermatology, is properly cited. The complete bibliographic information, a link to the original publication on http://derma.jmir.org, as well as this copyright and license information must be included.