Sir, a 30-year-old male attended the A&E department at Whipps Cross Hospital complaining of temperature, severe pain, swelling and difficulty eating, swallowing and bad taste following the cosmetic split of his tongue by a tattooist. Examination revealed a bifid tongue (Fig. 1). The cut edges were approximated with a cotton thread-like material, swollen, erythematous and tender to touch. The patient was pyrexic with elevated blood pressure. Local anaesthesia was infiltrated into the tongue; the 'sutures' were removed, the tongue cleaned with betadine and the edges re-approximated using absorbable sutures. The patient was admitted overnight for intravenous antibiotics and steroids and discharged the following day.

Figure 1
figure 1

Bifid tongue on presentation

Full size image

All surgery carries risks but in the case of tongue surgery, specific risks include bleeding, swelling, lingual nerve damage, infection, scarring and speech distortion.1 Failure to assess medical history prior to performing such surgery could have morbid consequences. Sterilisation of equipment in an autoclave and disposable gloves are necessary to avoid transmission of infections such as hepatitis and HIV.2 Psychological evaluation of patients wishing to undergo body modification or mutilation procedures is also an important part of pre-operative assessment to identify disorders such as body dysmorphic disorder.

When a random sample of tattooists in the East London area were telephoned and asked if they carried out tongue splitting, none of them alleged that they were licensed to perform it. We contacted the General Medical Council, who advised that the procedure carried out by the tattooist was not classed as 'surgery' as it was carried out for 'cosmetic rather than health reasons'. They stated that they are solely responsible for regulating registered medical professionals and had no jurisdiction over tattooists.

There is no minimum formal training requirement for tattooists, and no clear laws preventing a tattooist from carrying out a cosmetic tongue splitting procedure. Consumers have protection under general consumer law if they are dissatisfied, and may report tattooists to local authority enforcement officers.3

Healthcare professionals should consider petitioning the government to introduce regulation and registration for tattoo artists and banning procedures that involve cutting or stitching by non-medical professionals.