Maybe you have unsteady hands or poor eyesight that make it difficult for you to apply eyeliner, lipstick or other cosmetics. Perhaps you have medical reasons to add pigmentation to certain areas of your body. Or perhaps you lead a busy life with little time to do your makeup, or can’t find makeup that lasts long enough on your skin.

If any of these are true, you may have considered looking into permanent makeup as a solution. But you probably wonder exactly how it works, or if permanent makeup is even safe. Many also question if permanent eyeliner, for example, can be removed once it’s applied.

When considering whether or not this type of procedure is worth it, it’s usually the word “permanent” that creates a pause. Interestingly this can be the best (or potentially the worst) aspect of the procedure depending on certain factors. We asked cosmetic dermatologist Shilpi Khetarpal, MD, to offer her insight to see if permanent pigmentation is right for you.


How does permanent makeup work?

Permanent makeup also called a cosmetic tattoo or Micropigmentation, is done with the use of a pen containing iron oxide that tattoos the skin and creates the look of makeup. A tattoo can mimic eyeliner or lipstick, or it can darken and create the look of thicker eyebrows. It can also camouflage scars and help with the look of an uneven hairline.

Who might want permanent makeup?      

“Certainly people with physical limitations or medical conditions may seek out this procedure, but anyone can have it done,” Dr. Khetarpal says.


In particular people with cataracts, arthritis, multiple sclerosis, Parkinson’s disease or those who have suffered from a stroke may find this procedure appealing. It can help them look their best while avoiding the physical challenges of applying makeup.


It can offer an option to those who have allergies to traditional makeup. It also offers a cosmetic solution for patients experiencing certain medical conditions to restore the skin to pigmentation, like after breast surgery or hair loss due to some illnesses.


Are these tattoos really permanent?

The most important thing people should know is that permanent makeup is not easily removed — and there are risks involved, Dr. Khetarpal says.


“Removing tattoo pigment can be very difficult depending on the color. It’s a long, painful, expensive process to remove the ink —​ and sometimes the ink can’t be entirely removed,” she says.


On the other hand, while this makeup never washes off entirely, it will usually fade over time as skin cells are constantly being replaced. So you may need to revisit it again in time.

How do I find a good practitioner?

While most of the people doing the procedure are aestheticians or tattoo artists, you can also search online for physicians performing micro-pigmentation in your area.

Dr. Khetarpal says to do your research and ask:

How long have you done cosmetic tattooing?

May I see your credentials?

Can I see photos of your past work?

“Make sure they use medical-grade sterilization and high-quality ink. Also, look for someone who gives natural results and ask about their follow-up care policy,” Dr. Khetarpal says.


Be sure you know your skin type and have a consultation before scheduling any procedure. Ask for their credentials or certification. Is the office clean? Also consider after visiting, talking, and observing —  do you feel confident going forward?

You can request a tour of the facilities including the room where the procedure will take place. Make sure to confirm whether you’ll need anesthesia (usually local).


What are the risks of Micro-pigmentation?

There’s always a risk of infection when needles are involved. This is especially true if the needles used haven’t been properly sterilized.

“Your body can react to the foreign ink particles and form areas of inflamed tissue,” Dr. Khetarpal says. “If you’re prone to them the tattoo process also can leave keloid scars.”

People also can be allergic to a particular color or type of tattoo ink.

“Once you have a reaction it can be very difficult to treat, but this can be avoided by doing a test area behind the ear to see if there’s a reaction,” Dr. Khetarpal says.

Other possible complications include bleeding, crusting, swelling, loss of eyelashes, severe eyelid injury, and ectropion (which occurs when the eyelid is turned away from the eyeball).

According to the U.S. Food and Drug Administration pigments also can interfere with cranial MRI scans by affecting the quality of the images. Rarely, MRI scans can cause swelling or burning in the area of a tattoo.

How much does permanent makeup cost?

The amount varies by the practitioner and the complexity of the work you’re requesting and because it’s cosmetic, it’s likely not covered by insurance.

Focus first on finding reputable places before you factor in cost. Also strongly consider delaying or forgoing if you don’t find a good fit.

What younger people should consider with all tattoos

While the promise of permanent makeup can be appealing, you should think carefully about this decision, especially if you’re a younger person. Remember that areas on the face (such as the eyes, eyebrows, and lips) change over time with age.


“Beauty trends also change with time. Full lips and thick eyebrows are flooding social media these days, but this may not be the case five or 10 years from now,” Dr. Khetarpal says. “Always start with a minimalistic approach to look natural — because less is more.”

It’s also very difficult to mimic the appearance of eyebrow hair with tattoo ink, she adds.

What follow-up care is involved?

You could need multiple treatments, so make sure you talk about this with your practitioner. You also may need to touch up the tattoo as pigment fades with time.

“There’s a reason micro-pigmentation is considered permanent,” Dr. Khetarpal says. “And when it comes to the face you put forward each day to the world, you want to make sure you’ve fully and carefully considered the commitment you’re really making.”



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