Why is permanent makeup harmful?

Pigments are injected into the dermis, where they theoretically should remain locally. However:

• some fine particles migrate to the lymphatic system;
• they can be transported with the flow of lymph and blood to organs (liver, spleen);
• when the skin is heated (lasers, sun, procedures), chemical breakdown may occur, releasing toxic metabolites.

Titanium Dioxide (TiO₂)

This is one of the most common white pigments in permanent makeup (used for whitening). It is also found in sunscreens, cosmetics, and food additives (E171).

Danger:

• Internal use (e.g., ingestion) in the form of nanoparticles may be carcinogenic – recognized by the European Food Safety Authority (EFSA) in 2021.
• Toxicity mechanism: titanium dioxide in nanoparticle form can penetrate cells, causing oxidative stress, DNA damage, and inflammatory response.
• Category 2B by IARC: possibly carcinogenic to humans (especially upon inhalation).

In permanent makeup:

• It is the fine particles that enter the skin, meaning there is a risk of systemic entry and accumulation in the body;
• Under ultraviolet light, reactive oxygen species (ROS) may form, damaging cells and accelerating tissue aging.

Other pigments and their risks

Azo dyes. Widely used in decorative cosmetics and tattoos. Upon breakdown (e.g., during laser removal), they form aromatic amines, many of which are carcinogens.

Iron oxides. Often considered safer, but it depends on the form and size of the particles. In large doses and with accumulation, they can disrupt enzymatic activity (particularly related to oxidative metabolism).

Carbon (soot) pigments. One of the most stable and dense pigments. Risks are associated with microparticles entering lymph nodes and the liver.

Why are studies insufficient?

• The permanent makeup and tattoo industry is poorly regulated in most countries.
• There are few long-term clinical studies.
• There is no mandatory toxicological testing of pigments for intradermal injection – they are tested as cosmetics, not as injectable substances.

What does this mean for the body?

• The immune system reacts to pigments as if they were foreign bodies, activating phagocytes and macrophages.
• These cells "capture" the pigment and may carry it to lymph nodes.
• There, chronic inflammatory reactions and changes in lymphatic tissue structure may occur.
• Accumulation in the liver, spleen, or other organs can cause persistent oxidative stress and increase the risk of mutations.