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It looks like it hurts - a lot.

Alison Trowbridge, a 48-year-old Ogden resident, is lying on two bamboo mats with her right thigh exposed. She's about to get a tattoo through an ancient process called kakau (pronounced "ca cow"). It doesn't involve the whining of a modern-day tattoo gun. It's done by tapping a series of needles into the skin.

You wouldn't say Trowbridge had the most calm look on her face. Just before she stepped on the mats, she was asked if she was nervous. "Noooooo," she said with a quivering grin that implied otherwise.

With Trowbridge lying on her side on the mats, the process begins to look more like water torture than tattooing. No wonder it seems painful.

But the tattoo artist, Hawaiian Keone Nunes (pronounced Kay-own-ay) says it's not as bad as getting a regular tattoo, and it draws less blood.

Nunes is one of the few who practice the art of kakau in North America. He was here in Salt Lake City for the third annual Salt Lake City International Tattoo Convention at the Salt Palace Convention Center where he was plying his trade to anyone who wanted a tattoo the old-fashioned way.

The convention, which concludes today and is put on by Salt Lake City's Lost Art Tattoo, hosts scores of tattoo artists and companies from as far away as England and Japan.

Kakau is a long-lost art that started more than 2,000 years ago in the Pacific Islands as a way of tattooing natives "to increase the spiritual power of the family," Nunes said. He learned it more than eight years ago from another master in the craft.

"This is reflective of thousands of years of history and culture and pain and suffering," Nunes said. "With all of the modernization of everything, I can honestly say this is the only thing that once you lay down here and you feel it, you feel exactly what the ancestors felt thousands of years ago."

While modern-day tattoos involve a gun that vibrates an ink-dipped needle into the skin, kakau uses a tool called a moli, which is a series of needles made from hippopotamus tusk - Nunes said it's the strongest ivory - tied to a wooden stick.

Nunes dips the moli into the dark green ink - made from the Kukui nut in the Pacific Islands - and then taps the moli with another pine-wood stick. The work is mostly done in the monochromatic green.

Tap, tap, tap, tap. While the image of a needle being hammered into Towbridge's skin may look discomforting, it surely beats the humming sounds of tattoo guns all around the convention center.

"It's not bad," she said as droplets of blood formed with every line Nunes made. "But when you hit a nerve, you know it!"

Mato Taufa, a 34-year-old financial analyst for McKay-Dee Hospital Center in Ogden who just had a second tattoo put on his left shoulder by Nunes, said the artist is much more careful than the guy who put a tattoo on his other arm 10 years ago with the same technique "in a basement in West Valley City."

"That one hurt," Taufa said with a wince, rubbing the decade-old tattoo as if it still hurt. "My arm was just swollen - it was bruised. But this guy has a light touch."

Taufa, who is Tongan, said he chose this procedure to get in touch with his cultural background. The design he just had put on is of a traditional Tongan-Samoan framework.

With the kakau tattoo, the other difference is that the person getting it done doesn't choose the design - the artist does. It's part of the tradition, Nunes said, because "it's the tattooist who knows what's appropriate. It's like going to a doctor and telling him what surgery to do."

So Nunes will sit down with a client and talk about the person's past and what he or she wants reflected in the design. Then he spends another 10 or 15 minutes making the design and drawing a template on the person with blue and red Sharpie markers before tapping.

"To me, I really respect tattoists who use machines. It's just not what I want to do. For me, this is where it's at," said Nunes, who also teaches Hawaiian studies at the University of Hawaii and is teaching kakau to five apprentices. "We're so close to having it eradicated from our own cultural perspective that I thought it was important to continue the tradition."