We do know that the process of tattooing was a very intense and painful process.  They used needles, sharpened awls, or thorns to pierce the skin and trace images of animals, monsters, or other significant marks.  Tattooing would be on faces, necks, chests, and other parts of their bodies.  While the punctured skin was fresh and bleeding they would rub charcoal, which mixed with the blood and penetrated the skin.  The image would then be imprinted on the skin.  The custom was very common and most of the Natives did have some form of tattoo art on their bodies.  When this operation is performed over the entire body it is dangerous, especially in cold weather. Many died after the operation, either as the result of a kind of spasm which it produces, or for other reasons. The natives therefore are dying as martyrs to vanity because of this bizarre custom.

Many artists who painted Indians tried to capture the body art they saw.  It is difficult to determine how much of what is painted is actually true.  Artists are known for their imaginations when painting America, especially Indian.  They may have depicted them more strange looking because that is what they wanted to see or because that is what would sell.  One artist, George Catlin had a goal to make sure the paintings he did of Indians were very accurate.  He also paid special attention to the tattoo markings.  He saw that Indians would have tattoos for past battles and also tribal identities.  Tattooing was a sign a accomplishment and bravery.