Micropigmentation, or cosmetic tattooing, is offered by a growing number of aesthetic plastic surgical practices today. The most common applications are cosmetic, for permanent eyeliner, eyebrows or lip color. Micropigmentation for permanent blush and eye shadow is also possible, though infrequently performed. Other uses by plastic and reconstructive surgeons include recreating the coloration of the areola around the nipple following breast reconstruction; restoring the color of dark or light skin where natural pigmentation has been lost through such factors as vitiligo, cancer, burns or other scarring; and eliminating some types of birthmarks or previous tattoos.

Micropigmentation of the skin utilizes a handheld device that pierces the skin hundreds of times per minute with a tiny needle or cluster of needles. Using this device, organic pigment is placed underneath the skin. The results are permanent, although changes or fading of pigment color may occur. Pigments should be medically sterile and are nonallergic, but it is often recommended that a dot of color be placed on a hidden area of the patient's skin and observed for up to one month to be sure no redness or swelling develops.

Patient Selection

Patients who elect cosmetic tattooing to simulate the appearance of make-up have a variety of reasons for doing so. Some simply want to save the time and trouble of applying cosmetics on a daily basis. They like being able to participate in swimming or sports activities that work up a sweat without worrying about their make-up smudging or running. Women who experience "creeping" of their lipstick into the fine wrinkles around the mouth may find micropigmentation of the lips an attractive option. Women for whom it is difficult or impossible to apply make-up, due to poor eyesight, arthritis or other disabilities, may find that micropigmentation helps them to feel more confident about the way they look. Individuals who have experienced loss of eyebrows or eyelashes due to aging or trauma are also good candidates for cosmetic tattooing.


Proper application of permanent eyeliner requires a thorough analysis of hair color, eye color and skin tone as well as the shape of the eye. Pigment can often be used to help visually correct eye contours that are less than ideal.

When performed under the supervision of a licensed physician, local anesthesia can be used in the upper and lower eyelid. An eyelid plate protects the eye. The pigment is placed in the skin adjacent to the lash line. The procedure requires up to 90 minutes, and typically costs between $800 and $1,200, although this may vary with the geographic area.

A slight tingling sensation may be felt for a day or two following the procedure. This may be accompanied by some watering of the eyes, slight swelling and pinkness. An antibiotic ointment may be prescribed and cold compresses recommended. No additional make-up should be applied to the eye area for at least a couple of days.

Eyebrow Definition

Eyebrows are carefully drawn using precise angle and arch measurements based upon the relation between the brows, nose, pupil of the eye and bony ridge above the eye. Standard pigment colors or custom-blended colors may be used. Eyebrow color should be consistent with other hair tones, although usually a couple of shades darker.

Local anesthesia is injected in the eyebrow area. The micropigmentation device is manipulated with a stroking technique to create a hair-like appearance, with some skin tone showing through the strokes. The procedure usually requires up to an hour and typically costs between $750 and $1,000, although this may vary with the geographic area.

Lip Color

The procedure for lips is done in two stages. First, the lips are lined and any changes to the lip shape are drawn. Since pigment changes in the vermillion can vary significantly with the individual, the lip lining stage of the procedure helps to establish how the pigment can be expected to look on the particular patient. The second part of the procedure adds color to the lip. Local anesthesia is used for this procedure, which may require up to 90 minutes for each of the two stages. The cost is typically around $750 to $1,000, although this may vary with the geographic area.


The primary risk involved in micropigmentation procedures is infection, which can be effectively treated with topical and oral antibiotics. When micropigmentation procedures are supervised by medical personnel, needles are always sterile and are never reused. Surgical gloves are worn, and the tip and ink barrel of the implantation device is sterilized with an autoclave (steam sterilization) before each new patient.

The important issues of needle disposal and sterilization, as well as the technical skill and artistic judgment necessary to achieve good results, have prompted many aesthetic plastic surgeons to recommend that micropigmentation be performed only by appropriately trained personnel under medical supervision. Unfortunately, many lay people have taken short courses on micropigmentation and are performing these procedures with no medical background or federal oversight. Some states require that the procedure be performed in a doctor's office, but other states do not regulate it at all.

In addition, some micropigmentation devices currently on the market cannot be fully sterilized, posing a possible risk to patient safety from infections such as hepatitis B or HIV.

Finally, any woman considering permanent make-up should remember that reversal of the procedures is extremely difficult or sometimes impossible -- another good reason to select a trained and experienced practitioner who works under medical supervision.


The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world's leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; Active Members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International Active Members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.


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