KeywordsCosmetic tattooMicro-pigmentEyeliner tattooEyebrow tattooMicrobladingLip-liner tattooCosmetic pigmentationScarsBreast reconstruction tattooing
Tattooing for medical or aesthetic purposes is commonly referred to as micropigmentation but the terms are used interchangeably . Tattooing is the process of depositing metabolically inert pigment granules into the dermis for medical indications and is considered permanent or semi-permanent depending on the depth and type of pigment. Professional pigments are non-toxic, non-allergenic, minute particles that are stable within the tissue (Thami 2018; Garg and Thami 2005). There are several reasons patients desire tattoos for aesthetic purposes, e.g., tremors, convenience, poor vision, allergies to makeup, and camouflage of various conditions such as vitiligo, scars, and birthmarks (De Cuyper 2008). Improvement of self-confidence for some people is a welcome benefit of having cosmetic enhancement.
Tattooing was first used as a medical procedure to help camouflage nevi, scarring, or lip asymmetry . Earlier, tattoos were used in a variety of ways e.g. to mark prisoners, identify gladiators and slaves, and as body art in different cultures (Thami 2018; Vassileva and Hristakieva 2007). While tattooing for medical reasons was first documented in the 1800s, it was initially used cosmetically as eyeliner in 1984 on disabled women who did not have the desire or the ability to apply makeup on a daily basis. That earlier tattooing procedure was found to be safe and effective (Angres 1984).
Tattooing or micropigmentation in aesthetics is performed by using one or more tattoo needles mounted on a manual or electrically driven device or by using a hand-held instrument with a row of very fine needles. Different shades of pigmentation can be achieved by using combinations of white, yellow, black, red, camel yellow, and brown pigments (Thami 2018; Garg and Thami 2005; Vassileva and Hristakieva 2007).
The permanent tattoo pigment, once deposited into the skin, is retained intracellularly as well as extracellularly within collagen bundles for many years and permanent dyes can last long after death (Garg and Thami 2005; Wolfley et al. 1988). The most common element in tattoos is iron oxide, therefore, the patient must be aware that before any MRI scanning, the technician needs to be informed (Thami 2018). Some patients with tattoos have complained of a burning sensation during an MRI study and this can be an uncomfortable experience. Interestingly, there have been no dermal burns in the tattooed areas and the burning sensation immediately stops when the MRI is discontinued. It has been shown that the pigment from common tattoos does not reach a high enough temperature to cause thermal damage to the skin (Alsing et al. 2018).
Cosmetic results of permanent or semi-permanent micropigmentation depend on the depth of pigment deposition, uniformity of pigment, location and placement, and vascularity of the area (Vassileva and Hristakieva 2007). Therefore, it is imperative that the practitioner have in-depth knowledge of the skin and tissues, but just as importantly, have an artistic eye. Tattooing/micropigmentation is generally safe without significant adverse effects but careful consideration of patient expectations and safety issues by using universal precautions are paramount for good outcomes.
Risks from any type of tattooing include potential infections such as syphilis, tuberculosis, viral infections such as common warts, hepatitis B and C, and human immunodeficiency virus (HIV) (Garg and Thami 2005). These blood borne infections can be transmitted through repeated use of the same tattooing needles from one patient to another. Policies and guidelines in the USA and other countries have been adopted to help prevent spread of infections (Islam et al. 2016). Tattoo practitioners must use aseptic technique, universal precautions, and disposable needles.