Guidelines for removing permanent makeup

C.Bettina Rümmelein


Permanent makeup (PMU) is a frequently implemented cosmetic procedure performed by beauticians. From a technical point, PMU is considered a facial tattoo. Failed procedures or a change of mind can lead to the desire for removal. The purpose of this retrospective evaluation of patients who came to the clinic with the desire to remove PMU between 2011 and 2015 was to explore the problems, side effects, and results in order to define treatment guidelines for other doctors. We evaluated 87 individual cases in total. In treatable cases, i.e. 52 out of the 87 cases, laser treatments were performed using a nanosecond Q-switched neodymium-doped yttrium aluminium garnet (Nd:YAG) laser. It takes between 1-12 treatments to remove the PMU. In three cases, the colour of the PMU could not be removed by laser and remained after the treatment. In two cases, laser treatment had to be terminated due to colour changes towards the green-blue spectrum. Before PMU removal, laser test shots are urgently recommended as unforeseeable colour changes can cause severe aesthetically unpleasant results. Covered up PMU (skin colour) is particularly susceptible to changes in colour. Heat-induced shrinking of the eye area can cause an ectropium. Surgical solutions also have to be taken into consideration. The use of proper eye protection with intraocular eye shields is mandatory. This article is an attempt to set up some guidelines for the treatment of PMU removal.


permanent makeup; PMU; tattoo; Q-switched laser; colour removal; doctor; aesthetician

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Worp J, Boonstra A, Coutinho RA, van den Hoek JA. Tattooing, permanent makeup and piercing in Amsterdam; guidelines, legislation and monitoring. Euro Surveill 2006; 11(1): 34–36.

Hauri U. Tinten für permanent makeup (PMU) und zur tätowierung / Organische pigmente, konservierungsmittel, verunreinigungen (German) [Ink for permanent makeup (PMU) and tattoo / Organic pigments, preservatives, con-taminants][Internet]. Department of Health, Canton Ba-sel-Stadt; 2013 [cited 2016 Feb 8]. Available from:

The Committee of Ministers. Resolution ResAP (2008) 1 on requirements and criteria for the safety of tattoos and permanent make-up (superseding Resolution ResAP (2003) 2 on tattoos and permanent make-up)[Internet]. 1018th meeting of the Ministers’ Deputies, Strasbourg, The Council of Europe; 2008 [cited 2016 Feb 8].

Available from: _details.aspx?ObjectID=09000016805d3dc4

Prinz BM, Vavricka SR, Graf P, Burg G, Dummer R. Efficacy of laser treatment of tattoos using lasers emitting wavelengths of 532 nm, 755 nm and 1064 nm. Brit J Derm¬atol 2004; 150(2): 245–251. doi: 10.1111/j.1365-21 33.2004.05658.x.

Schönewolf NL, Rümmelein B, Bogdan-Allemann I, Dummer R. Tätowierungen und wie man sie wieder los wird (German) [Tattoos and how to remove it]. Schweiz Med Forum 2010; 10(19–20): 340–343.

Anderson RR, Margolis RJ, Watenabe S, Flotte T, Hruza GJ, et al. Selective photothermolysis of cutaneous pig-mentation by Q-switched Nd: YAG laser pulses at 1064, 532, 355 nm. J Invest Dermatol 1989; 93(1): 28–32.

Herd RM, Alora MB, Smoller B, Arndt KA, Dover JS. A clinical and histologic prospective controlled compara-tive study of the picosecond titanium: Sapphire (795 nm) laser versus the Q-switched alexandrite (752 nm) laser for removing tattoo pigment. J Amer Acad Dermatol 1999; 40(4): 603–606.

Mao JC, DeJoseph LM. Latest innovations for tattoo and permanent makeup removal. Facial Plast Surg Clin North Am 2012; 20(2): 125–134. doi: 10.1016/j.fsc.2012.0 2.009.

Lee CN, Bae EY, Park JG, Lim SH. Permanent makeup removal using Q-switched Nd:YAG laser. Clin Exp Der-matol 2009; 34(8): 125–134. doi: 10.1111/j.1365-2230.20 09.03268.x.

Weiss ET, Chapas A, Brightman L, Hale EK, Karen JK, et al. Successful treatment of atrophic postoperative and traumatic scarring with carbon dioxide ablative fractional resurfacing: Quantitative volumetric scar improvement. Arch Dermatol 2010; 146(2): 133–140. doi: 10.1001/arch dermatol.2009.358.

Kluger N, Koljonen V. Tattoos, inks, and cancer. Lancet Oncol 2012; 13(4): e161–e168. doi: 10.1016/S1470-20 45(11)70340-0.

Choudhary S, Elsaie ML, Leiva A, Nouri K. Lasers for tattoo removal: A review. Lasers Med Sci 2010; 25(5): 619–627. doi: 10.1007/s10103-010-0800-2.



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