Thinking About Permanent Makeup? Think Twice

Patient Expert

Each week, Health and Beauty Expert Sue Chung will discuss skin health topics suggested by members of the HealthCentral community. To ask Sue a question, send an email to or leave a comment below.

Reader's Question: I've been thinking of getting permanent makeup to replace my thinning eyebrows. Recently, I read that the procedure isn't safe? Is this true?

Sue's Response: Up until a few years ago, the idea of permanent makeup was thought to be relatively safe. Between 1988 and 2003, the Food and Drug Administration (FDA) obtained only five reports of permanent makeup recipients suffering from negative reactions.

According to the most recent issue of the New England Journal of Medicine, permanent makeup procedures may not be as safe as previously thought. Since 2003, the number of people suffering adverse reactions from permanent makeup application has risen dramatically to more than 150.

So what is permanent makeup and why do people choose it? Essentially, permanent makeup is a series of tattoos applied to the face in order to mimic the look of makeup such as eyeliner, lipstick, blush and filled-in eyebrows. Other names for the procedure include dermapigmentation, micropigmentation and cosmetic tattooing. Currently, the FDA does not know the exact number of people who have undergone these procedures.

Many of the people who choose permanent makeup do so because they have lost natural pigment due to scarring, vitiligo, or advanced age. Others choose this procedure because they suffer from visual impairment, an allergy to topical cosmetics and/or unsteady hands due to arthritis.

The risks associated with permanent makeup are similar to getting a tattoo. If not sterilized thoroughly, tattooing equipment can transmit infectious diseases such as hepatitis. Allergic reactions can still occur, especially due to the wide variety of the pigments present in cosmetic tattoos.

Other reactions can cause further discomfort. In some cases, the body will treat tattoo pigments as foreign particles and react by creating keloids (large scars), granulomas (hard nodules) and blisters around the tattooed area. In addition, some patients report having problems with post-procedure MRIs. The tattoo pigments often include metallic components that can create magnetic interference, resulting in swelling and/or burning in the affected areas.

Another major risk of tattooed makeup results from consumer dissatisfaction. Often, the color of a permanent makeup tattoo will fade over time and create the need for later touch ups. A tattoo can also drift, creating the effect of a lipliner moustache or misplaced eyeliner. In other cases, the recipient dislikes the effect of the tattoo and chooses to remove it. The removal of a tattoo is often far more painful and complicated than applying the tattoo itself and can cause major scarring or irregular pigmentation.

On September 27, 2004, the FDA recalled a brand of ink associated with many of the adverse reactions in permanent makeup procedures. Despite this precaution, however, the New England Journal of Medicine now declares that undergoing permanent makeup procedures can result in serious adverse reactions that can cause long-term disfiguration.

If you choose to undergo a permanent makeup procedure, think long and hard about the consequences before going through with it. Even after undergoing painful removal procedures, most tattoos do not fully fade. If you do experience any negative reactions after a permanent makeup procedure, the FDA will receive all reports from both patients and permanent makeup practitioners.