Copyright 2015 Linda H Dixon MD.
All rights reserved. 

QUESTIONS – Permanent Make-up/Cosmetic Tattoos/Micropigmentation

Dr Linda Dixon, President of the American Academy of Micropigmentation

Firstly, what’s the difference between the terms ‘permanent make-up’, ‘cosmetic tattoos’ and ‘micropigmentation’?

ANSWER: Each term means similar meanings.  In some countries, such as Australia, the term used is “semi-permanent makeup” since colors fade. In other countries, micropigmentation is favoured because tattooing is frowned upon. Cosmetic tattooing is preferred by those who insist it’s all tattooing. Micropigmentation was coined by Dr. Charles Zwerling in approximately 1984 when he and Dr. Frank Christensen, both ophthalmologic surgeons, introduced pigment into the eyelid under a microscope. Dr. Zwerling founded the American Academy of Micropigmentation and is the Author of Micropigmentation Millenium published in 2011.
Why would someone choose to get a cosmetic tattoo? What are the benefits of this over traditional make-up?

Ten Reasons women choose to get semi-permanent makeup or micropigmentation:

1. Convenience. You just need more time.

2. Sensitive skin or allergies

3. You wear glasses or contact lenses or have had Lasik surgery

4. Arthritis or painful hands

5. Difficulty applying makeup or you don’t like the way it smears and disappears

6. Aging changes in brows, lips, eyes

7. Active, outdoor lifestyles

8. If you like a natural “no makeup” look

9. Hair loss from alopecia, chemotherapy, accidents,mburns or cosmetic surgery.

10. Color correction. Scar camouflage, breast areola loss, cleft lip and vitiligo*.

We all know true beauty comes from the inside. A pleasant personality and winning

smile are the keys for a happy, pleasing countenance.

I understand micropigmentation can replace traditional make-up, but can it also have other uses?

Medical Micropigmentation is utilized for scar camouflage, including cleft-lip, and also to restore dignity to breast cancer patients who have undergone mastectomy and restorative surgery and need the areola-nipple complex micropigmentation. In this case, it is the final touch in the fight! Many of us offer this procedure at not charge.

If someone were to get ‘permanent make-up’ say eyeliner… what would the process be from the decision to the final result?

Let’s say someone wants permanent eyeliner. Step 1. Make an appointment for a consultation with one or more professionals.  2.  Wear your eyeliner makeup to your consultation the way you would like it to be applied (tattooed).  3.  Advise the professional of any health concerns, mental or physical, that you have.  4. Photographs are taken of you with and without your regular makeup at the consultation.  5. Ask any questions and address any concerns you may have at this time.  6. Review the informed consent and complete your health history.  7. Return for procedure.  8. Topical anesthetic will be applied for 20 minutes prior to procedure. 9. Upon completion you should receive aftercare instructions and make a follow up appointment for 4-6 weeks for focus visit.

How much time can this process save women? (or men?)

The amount of time you save depends upon how long it takes for you to apply your eyeliner each day. Multiply that by 365 days a year, approximately, and you’ll realize what a savings it is to invest in permanent makeup. Also appreciate the fact that micropigmentation is to make you look like yourself only better… naturally. You can always add more makeup for special occasions.

When was the procedure first used? Was it originally designed to replace make-up or for something else? (I read it was to aid alopecia patients?)

Interestingly, women in Egypt rubbed sand into their cheeks and then red dirt. So cosmetic tattooing is several thousand years old. Japanese Geisha girls had some makeup tattooed as well. In the late 80’s the first organized classes for micropigmentation took place. Personally, I had walked into a tattoo parlour in Maui, Hawaii in 1989 and persuaded a tattoo artist to try to tattoo a line around my eyes because I was allergic to regular makeup. Cold turkey. It really hurt but I sat very still.

Why should someone consider getting permanent make-up?

Someone should consider getting permanent makeup, or at least a consultation, if they want to be less self-conscious, save time and look good 24/7.

If I were to get permanent make-up, do I still need to wear traditional make-up?

You do not have to wear any traditional make-up if you have your eyeliner, brows and lips done. Some women actually get cheek color as well but there is a downside to that.

Is the process painful?

On a scale of 0-10, with 10 being very painful, most clients are in the range of 1-3 for eyeliner and brows. Lips can be more sensitive being up to 5-6 initially.  The good news is that once the skin has been opened and a topical anesthetic is applied again, clients can experience very little if any discomfort.

What are the risks involved? And how common are these?

Risks are rare. Professionals are trained to thoroughly evaluate clients before they begin the procedure.

If patients aren’t happy with the results, can they get them removed?

There is no guarantee than any method can remove permanent makeup completely. Most chemical and laser procedures result in some scarring or changes in skin texture.  It’s difficult if not impossible to satisfactorily remove some permanent makeup.

Although it’s called permanent make-up, does it really last forever?

Not all permanent makeup is permanent. In fact, in Australia it is called semi-permanent makeup because oftentimes it can fade enough to be barely visible, unlike most body tattoos. However, when carbon black is used then the tattoo is largely permanent.

Some practitioners are obviously better than others…. What should we look for to know we are choosing a good professional?

Word of mouth and independent assessment are important. Make sure your professional offers you a consultation before you make your final decision. See if they are members of a non-profit Professional Organization headed by medical professionals such as the American Academy of Micropigmentation.  See: http://www.micropigmentation.org

Can beauticians complete the process or only medical doctors/plastic surgeons?

The process can be completed successfully by a diverse group of individuals ranging from backgrounds as beauticians, nurses, electrologists, tattooists, physicians and artists. They each contribute something unique to the profession when they are well-trained.The most important thing for a beginner is to have a good trainer. Otherwise, they may get discouraged and quit.

Can anyone get cosmetic tattoos?

Not anyone should get a cosmetic tattoo. For instance, if they are pregnant or nursing they should wait to get any procedure done. Clients on blood thinners should get a doctor’s clearance. Most technicians are not physicians and cannot be the judge of whether to do procedures on clients with conditions that require medical treatment.

How, when and why did you get involved with cosmetic tattoos?

In 1979, as a young mother of six children and a busy lady doctor practicing anesthesiology day and night, I could not wear any makeup around my eyes because I was allergic to traditional makeup. Being in the operating room meant masks and caps and the patients could only see your eyes. So it occurred to me to ask a tattoo artist if she could tattoo on my eyeliner while I was on vacation in Hawaii.  She thought I was crazy but I asked her if she could tattoo a line and put it around my eyelids. She said “It will hurt!” I promised to sit very still and I did. However, that was the beginning of my efforts to create safe and effective topical anesthetics for use during permanent makeup.  That was in 1996.  With pain control the field began to grow rapidly and word spread that procedures didn’t have to hurt a lot.

Anything else you wish to add Dr. Dixon?


This industry is moving rapidly. The range of services is expanding and doctors, especially from the specialties of plastic surgery, reconstructive surgery and hair transplant surgery are recognizing the benefits of micropigmentation.  For more information go to: www.micropigmentation.org