Permanent Makeup: Why and How?

Want to throw away your eyeliner, lip liner, and blush forever? Some women are turning to permanent makeup, or cosmetic tattooing, for makeup that does not run or smear.

Permanent Makeup Returns

Cosmetic tattooing was practiced by several ancient Mediterranean cultures, as evidenced by the tattooed mummies found by archaeologists. Cosmetic tattooing experienced a rebirth in the United States in the late 1970s, and today there are a growing number of cosmetologists, tattoo artists, nurses, and aestheticians in the industry.

Not Just Vanity

For women who have arthritis, stroke, Parkinson's disease, multiple sclerosis, or other conditions that cause tremors, putting on makeup can be an impossible task. Permanent makeup eliminates their frustration. Women with vision problems, who are blind, or who have cataracts may also be good candidates.

Cosmetic tattooing also helps women who have allergies or hypersensitivity to makeup. Female athletes and other physically active women are turning to permanent cosmetics, as are business women, entertainers, models, and housewives.

For women who have lost their hair because of chemotherapy, permanent eyebrows and eyeliner can restore self-esteem and eliminate the need to reapply eyebrows every day. Cosmetic tattooing can also help with vitiligo—a condition in which the skin loses pigment. Permanent makeup can blend lightened skin tones with the surrounding normal-colored skin.

Permanent Cosmetic Procedures

Some of the most common procedures are eyeliner, eyebrows, and lip liner. Another popular procedure is a "para-medical" one—nipple areola restoration. During the procedure, the skin can be re-toned to match the surrounding area more closely.

Blush application is not recommended for anyone who gets much sun exposure. Women with vitiligo who choose permanent makeup must also limit their time in the sun. The tattoo does not protect people from the sun’s UV rays. Both procedures usually require several sessions to complete.

How Is It Done?

Regardless of the body area or the technique, the concept is always the same: placing iron oxide or titanium dioxide pigments below the skin. The amount of pigment, the color, and whether manual or electrical instruments are used can vary.

Before having your procedure, you should have a consultation with the technician and review your medical history.


Permanent makeup application has its risks, including:

  • Infection
  • Allergic reactions
  • Granulomas, or nodules that form around material that the body perceives as foreign
  • Keloid formation, or a scar that grows beyond normal boundaries
  • Complications, such as swelling or burning in the affected areas when having an MRI—rare

Oh, the Pain?

The amount of discomfort from this type of tattooing depends on your pain threshold, the skill of the technician, and the procedure. Several topical anesthetic and desensitizing products are used to make the procedure as pain-free as possible.

After the Procedure

Expect some bruising and swelling. These can last 2-3 days for eye procedures and up to one week for lips. Ice can relieve symptoms, and you should avoid using alpha-hydroxy acid products or topical tretinoin on tattooed areas because they can lighten the pigments.

Both sunlight and regular light can lighten the color. One reason is that pigments are not placed as deep or as heavy as they would be on, say, the arm, because facial skin is delicate. For some women, the color lasts for more than a decade without fading significantly.


The Food and Drug Administration considers permanent makeup ink to be a cosmetic. They are approved under the Federal Food, Drug, and Cosmetic Act. The practice of tattooing is regulated by local jurisdictions—not the FDA.

Possible Removal

Lasers have been developed for removing tattoos. However, removal can take several treatments and be expensive. There may also be scarring with removal. People with cosmetic tattoos should be careful when undergoing laser treatments in the area.

Choosing a Technician

Shop for a permanent cosmetic technician the same way you would for a doctor. Learn about the industry and the procedures, and visit the location you are considering.

Find out the following information about the technician:

  • What is his/her background? What continuing education has he/she pursued?
  • How much experience does he/she have in the type of procedure you want? Advanced procedures, such as facial blush and areola restoration require special training.
  • Ask to see a portfolio of the individual's work.
  • Does he/she belong to a professional organization such as the American Academy of Micropigmentation?

Ask yourself the following when visiting the site:

  • Is the working environment clean?
  • Are new sterile needles used for each client?
  • Is the technician professional and neat with short, clean nails?
  • Are new gloves used for each client?
  • What type of anesthetics do they use?
  • How much does it cost? What is the policy on touch-ups?

Several national organizations offer guidelines for technicians and referrals for consumers, including the American Academy of Micropigmentation and the SPCP. Technicians can get certified by the Academy.


American Society of Plastic Surgeons
Society of Permanent Cosmetic Professionals


Canadian Dermatology Association


De Cuyper C. Permanent makeup: indications and complications. Clin Dermatol. 2008;26(1):30-34.
Information for the public. The Society of Permanent Cosmetic Professionals website. Available at:
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Accessed April 21, 2016.
Other permanent cosmetic procedures. The Society of Permanent Cosmetic Professionals website. Available at:
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Accessed April 21, 2016.
Permanent make up FAQ. The Society of Permanent Cosmetic Professionals website. Available at:
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Accessed April 21, 2016.
Permanent make up may cause permanent problems. League of Permanent Cosmetic Providers website. Available at:
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Accessed April 21, 2016.
Tattoos & permanent makeup. Food and Drug Administration website. Available at:
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Updated August 31, 2015. Accessed April 21, 2016.
Last reviewed April 2016 by Michael Woods, MD
Last Updated: 4/21/2016

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