Tattoos & permanent makeup: The intradermal application of inks for the purpose of
permanent makeup (also known as micropigmentation).
pigments in these inks raise concerns about
tattoo removal, adverse reactions to tattoo colors, and
infections that result from tattooing. Many pigments used in tattoo
inks are not approved for skin contact at all. Some are industrial
grade colors that are suitable for printers' ink or automobile
some, tattoos are an aesthetic choice or an initiation rite. Some
choose permanent makeup as a time saver or because they have
physical difficulty applying regular, temporary makeup. For others,
tattooing is an adjunct to reconstructive surgery, particularly of
the face or breast, to simulate natural pigmentation. People who
have lost their eyebrows due to alopecia (a form of
hair loss) may choose to have "eyebrows" tattooed on, while
vitiligo (a lack of pigmentation in areas of the skin) may try
tattooing to help camouflage the condition.
primary complications that can result from tattooing include:
Infection. Unsterile tattooing equipment and needles can transmit
infectious diseases such as hepatitis. All tattooing equipment
should be clean and sterilized before use. Even if the needles
are sterilized or never have been used, it is important to
understand that in some cases the equipment that holds the
needles cannot be sterilized reliably due to its design. In
addition, the person who receives a tattoo must be sure to care
for the tattooed area properly during the first week or so after
the pigments are injected.
Removal problems. Despite advances in laser technology, removing a
tattoo is a painstaking process, usually involving several
treatments and considerable expense. Complete removal without
scarring may be impossible.
Allergic reactions. Although allergic reactions to tattoo pigments
are rare, when they happen they may be particularly troublesome
because the pigments can be hard to remove. Occasionally, people
may develop an allergic reaction to tattoos they have had for
Granulomas and keloids. Granulomas are nodules that may form around
material that the body perceives as foreign, such as particles
of tattoo pigment. If you are prone to developing keloids --
scars that grow beyond normal boundaries -- you are at risk
keloid formation from a tattoo. Although keloids may form
any time you injure or traumatize your skin, keloids tend to
occur more frequently as a consequence of tattoo removal.
MRI complications. There have been reports of people with tattoos
or permanent makeup who experienced swelling or burning in the
affected areas when they underwent
magnetic resonance imaging (MRI). This seems to occur only
rarely and apparently without lasting effects. Tattoo pigments
may also interfere with the quality of the image. This seems to
occur mainly when a person with permanent eyeliner undergoes MRI
of the eyes. Mascara may produce a similar effect. The
difference is that mascara is easily removable.
most common problem that develops with tattoos is the desire to
remove them. Removing tattoos and permanent makeup can be very
difficult. Skill levels vary widely among people who perform
tattooing. The main complication with eyelid tattooing is improperly
placed pigment. You may want to ask the person performing the
procedure for references and ask yourself how willing you are to
risk permanently wearing someone else's mistake.
Although tattoos may be satisfactory at first, they sometimes fade.
Also, if the tattooist injects the pigments too deeply into the
skin, the pigments may migrate beyond the original sites, resulting
in a blurred appearance.
Another cause of dissatisfaction is that the human body changes over
time, and styles change with the season. The permanent makeup that
may have looked flattering when first injected may later clash with
changing skin tones and facial or body contours. People who plan to
have facial cosmetic surgery are advised that the appearance of
their permanent makeup may become distorted. The tattoo that seemed
stylish at first may become dated and embarrassing. And changing
tattoos or permanent makeup is not as easy as changing your mind.
Methods for removing tattoos include laser treatments, abrasion,
scarification, and surgery. Some people attempt to camouflage an
objectionable tattoo with a new one. Each approach has drawbacks:
Laser treatments can lighten many tattoos, some more easily and
effectively than others. Generally, several visits are necessary
over a span or weeks or months, and the treatments can be
expensive. Some individuals experience hypopigmentation -- a
lightening of the natural skin coloring -- in the affected area.
Laser treatments also can cause some tattoo pigments to change
to a less desirable shade.
Unfortunately, knowing what pigments are in your tattoo or
permanent makeup has always been difficult and has become more so as
the variety of tattoo inks has multiplied. Inks are often sold by
brand name only, not by chemical composition. Because the pigments
are sold to tattoo parlors and salons, not on a retail basis to
consumers, manufacturers are not required by law to list the
ingredients on the labels. Furthermore, because manufacturers may
consider the identity and grade of their pigments "proprietary,"
neither the tattooist nor the customer may be able to obtain this
have been reports of individuals suffering allergic reactions after
laser treatments to remove tattoos, apparently because the laser
caused allergenic substances in the tattoo ink to be released into
Dermabrasion involves abrading layers of skin with a wire
brush or diamond fraise (a type of sanding disc). This process
itself may leave a scar.
Salabrasion, in which a salt solution is used to remove the
pigment, is sometimes used in conjunction with dermabrasion, but
has become less common.
Scarification involves removing the tattoo with an acid solution
and creating a scar in its place.
Surgical removal sometimes involves the use of tissue expanders
(balloons inserted under the skin, so that when the tattoo is
cut away, there is less scarring). Larger tattoos may require
repeated surgery for complete removal.
Camouflaging a tattoo entails the injection of new pigments either
to form a new pattern or cover a tattoo with skin-toned
pigments. Dr. Toombs notes, however, that injected pigments tend
not to look natural because they lack the skin's natural
Temporary tattoos, such as those applied to the skin with a
moistened wad of cotton, fade several days after application.
However, some colors are not approved for temporary tattoos. Henna
is approved only for use as a hair dye, not for direct application
to the skin. Also, henna typically produces a reddish brown tint,
raising questions about what ingredients are added to produce the
varieties of colors labeled as "henna," such as "black henna" and