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.

If anyone had told Claudia that she would get a tattoo at age forty-eight, she would have said they were crazy. Now she's delighted with her new look.

"When people ask me, 'where's the tattoo?' I tell them they're looking at it. The eyeliner and lip color are permanent. People say it looks like makeup, and I tell them they're right."

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

"Cosmetic reasons is one area, but there are many more practical applications," says Charles S. Zwerling, MD, FACS, director of the American Academy of Micropigmentation. 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 are also 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 also helps 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

The most common procedures are eyeliner, eyebrows, and lip liner, says Dr. Zwerling. Another popular procedure is a "para-medical" one—areola restoration.

"Areola restoration after breast reconstruction is a very acceptable procedure and offers dramatic results," says Dr. Zwerling. Cosmetic tattooing also is used to relax scars and blend them into the surrounding skin.

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 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. What varies, says Dr. Zwerling, is how much pigment is used, the color, and whether manual or electrical instruments are employed. Pamela Netz, owner/operator of a permanent cosmetic salon in Tucson, Arizona, and a member of the Society of Permanent Cosmetic Professionals (SPCP), prefers hand tools.

"They don't seem to hurt people as much or to cause as much swelling," she explains. "And there's no scabbing because there's no bleeding." Highly skilled machine technicians can also provide a light touch.

Before having your procedure, you should have a consultation with the technician and review your medical history, says Netz. "We like to know if clients need antibiotics before dental or medical procedures, and in the case of lip procedures, if they get cold sores."

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 and an antibiotic ointment 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 very delicate. For some women, the color lasts for more than a decade without fading significantly.


To help prevent problems, the Centers for Disease Control and Prevention (CDC) has set standards for the industry.

If you take anticoagulants or immunosuppressive drugs or have an acute illness, do not undergo permanent cosmetic procedures. According to Dermatology Times, anyone with a history of ]]>oral herpes]]> should take an antiviral drug before getting permanent makeup.

Also, not following standard sterile procedures may be a vehicle of transmission for different pathogens, like viruses (eg, ]]>hepatitis C]]>).

Possible Removal

High-energy, short-pulse lasers, (eg, Q-switched lasers, emitting visible and near-infrared light) have been developed for removing tattoos, with little risk of scarring. The mechanisms of action, and possible adverse effects other than scarring and hypopigmentation, are not fully understood. People with cosmetic tattoos should be very 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? Dr. Zwerling recommends seeking a technician who is certified by the American Academy of Micropigmentation. He also notes that there are many qualified technicians who are not certified with the Academy and that not all certified technicians have the artistic touch for some procedures.

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.