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J Cosmet Med 2021; 5(1): 16-23

Published online June 30, 2021

https://doi.org/10.25056/JCM.2021.5.1.16

A medical perspective of the practice of semi-permanent makeup in South Korea

Chang Won Koh, MD, PhD1 , Kyoungjin (Safi) Kang, MD, PhD2

1Department of Public Health Service, Seoul National University Bundang Hospital, Seongnam, Rep. of Korea
2Seoul Face 21 Clinic, Seoul, Rep. of Korea

Correspondence to :
Chang Won Koh
E-mail: kcwbnl@gmail.com

Received: May 24, 2021; Revised: May 31, 2021; Accepted: June 1, 2021

© Korean Society of Korean Cosmetic Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: Despite existing problems with infection control and healthcare regulations associated with semi-permanent makeup, its practice by non-medical personnel at non-healthcare institutions continues to pose fatal risks to the safety of the community.
Objective: The aim of this study is to seek for improvement measures on the Korean legal system regarding the practice of semipermanent makeup by investigating current conditions of the procedure and materials used, reviewing past clinical reports of complications associated with tattooing, and assessing domestic and foreign laws and regulations of semi-permanent makeup.
Methods: Both domestic and foreign studies and publications on the regulatory system with regards to semi-permanent makeup, in addition to clinical cases of complications associated with semi-permanent makeup, were reviewed.
Results: Tattoo procedures in South Korea and Japan are strictly restricted to medical personnel, while other countries also regulate the practice of tattoo with a license-based system rather than a qualification-based system such that non-medical personnel can perform under medical supervision. The duration and placement of pigments in the dermis of the skin and its possible complications associated with the procedure have been confirmed; short-term side effects are bleeding, infection, allergic reaction and Koebner phenomenon, and long-term side effects are foreign body reaction, granuloma. Local infections caused from tattoos include warts, herpes simplex; systemic infections include hepatitis B and C, HIV; toxic immune reactions include erythema multiforme, vasculitis, granuloma. To address these issues, examination of patient history for potential indications, established protocol for medical waste management, and stringent regulations for hygiene product management are necessary.
Conclusion: Measures such as the establishment of a license-issuance system that is inclusive of education and training on the proper practice of semi-permanent makeup and stricter management of tattoo-related materials and devices should be enforced in order to ensure infection control and the safety of the public health.

Keywords: healthcare regulation, infections, license-issuance system, safety of public health, semi-permanent makeup, tattooing

Fig. 1.There is a prominent viral cytopathic effect on the keratinocytes, which includes vacuolization, enlargement, and nuclear basophilia with a prominent granular layer, and a horny layer with a pronounced basket-weave pattern (A: H&E, ×200; B: H&E, ×400). Cited from from the article of Jung JY, et al. (Ann Dermatol 2009;21:92-4) [31] with original copyright holder’s permission.
  1. Tattoo [Internet]. San Francisco, CA: Wikipedia [cited 2020 Mar 2].
    Available from: https://en.wikipedia.org/wiki/Tattoo.
  2. Mazza JF Jr, Rager C. Advances in cosmetic micropigmentation. Plast Reconstr Surg 1993;92:750-1.
    Pubmed CrossRef
  3. Woo J, Song Y. A study on the awareness, cosmetic behavior, satisfaction and re-treatment of semi-permanent make up. J Korean Soc Cosmetol 2019;25:91-105.
  4. Jung YJ. A study on the educational satisfaction of private certificates and the necessity of regular education of semipermanent makeup [dissertation]. Gyeongsan: Daegu Haany University; 2016.
    CrossRef
  5. Kim SW. Checklist and tattoo contracts to legalize nonmedical personnel tattoos and to ensure the rights of tattoo consumers. KHU Glob Bus Law Rev 2019;12:125-59.
  6. Jung YJ, Lee JH. Improvement study for semi-permanent makeup institutionalization. J Invest Cosmetol 2019;15:215-28.
  7. Long GE, Rickman LS. Infectious complications of tattoos. Clin Infect Dis 1994;18:610-9.
    Pubmed CrossRef
  8. Garg G, Thami GP. Micropigmentation: tattooing for medical purposes. Dermatol Surg 2005;31(8 Pt 1):928-31; discussion 931.
    Pubmed CrossRef
  9. Traquina AC. Micropigmentation as an adjuvant in cosmetic surgery of the scalp. Dermatol Surg 2001;27:123-8.
    Pubmed CrossRef
  10. Kim SY. A study on adult women’s cosmetic tattoo experiences and comparison of health concern and health practice between the cosmetic tattooed and non-cosmetic tattooed groups. J Korean Acad Community Health Nurs 2017;28:69-77.
    CrossRef
  11. Kim SM, Yun SK, Kim HU, Ihm CW. Micropigmentation on scalp and eyebrow scars is worth practicing. Korean J Dermatol 2008;46:305-9.
  12. Park JS, Ko EB. Kim JH, Kim SK. The base reaearch of safely management of decorative tattoo. Seoul: National Evidencebased Healthcare Collaborating Agency; 2015.
  13. Koh HJ, Kim YS. A study on the activity of Korean semipermanent make-up system. Korean J Aesthet Cosmetol 2003;1:11-23.
  14. Park JS, Kim SK, Kim MJ, Kim SK. Pilot study for understanding the present situation of decorative tattoos. Seoul: National Evidence-based Healthcare Collaborating Agency; 2007. p. 86-101.
  15. Kim HH. A study on the actual surver of semi-permanent make-up and improvement plan for the legal system. [dissertation]. Busan: Silla University; 2018 .
  16. Doumat F, Kaise W, Barbaud A, Schmutz JL. Basal cell carcinoma in a tattoo. Dermatology 2004;208:181-2.
    Pubmed CrossRef
  17. Kim CJ. Necessity and policy direction of legalizing tattooist. Seoul: Policy Materials of Parliamentary Inspection of the Administration; 2007.
  18. Yang SM, Kim HH. A study on the actual survey of semi-permanent make-up and improvement plan for the legal system. J Korean Soc Cosmetol 2018;24:482-94.
  19. Cho SB, Lee SJ, Shim JH, Kim DH. Case analysis of side effects following illegal therapeutic attempts by non-medical personnel. Korean J Dermatol 2008;46:1507-12.
  20. Malakar S, Lahiri K. Successful repigmentation of six cases of herpes-labialis-induced lip leucoderma by micropigmentation. Dermatology 2001;203:194.
    CrossRef
  21. Stinco G, De Francesco V, Frattasio A, Quinkenstein E, Patrone P. Malignant melanoma in a tattoo. Dermatology 2003;206:345-6.
    Pubmed CrossRef
  22. Khodadost M, Maajani K, Arabsalmani M, Mahdavi N, Tabrizi R, Alavian SM. Is tattooing a risk factor for hepatitis C transmission?: an updated systematic review and metaanalysis. Hepat Mon 2017;17:e14308.
    CrossRef
  23. Lee KB, Yi JY, Kim HO, Kim CW. A case of granulomatous reaction to tattoo pigment. Korean J Dermatol 1988;26:554-9.
  24. Callaghan MF, Negus C, Leff AP, Creasey M, Burns S, Glensman J, et al. Safety of tattoos in persons undergoing MRI. N Engl J Med 2019;380:495-6.
    Pubmed CrossRef
  25. Kim JH. The invasiveness of tattoo and unlicensed medical practice. Korean Criminol Rev 2007;18:165-200.
  26. Krecké N, Smola S, Vogt T, Müller CSL. HPV-47-induced and tattoo-associated verrucae planae: report of a case and review of the literature. Dermatol Ther (Heidelb) 2017;7:549-54.
    Pubmed KoreaMed CrossRef
  27. Wu CH, Thong HY, Huang CC, Chen PH. Report of two cases of cutaneous Mycobacterium abscessus infection complicating professional decorative tattoo. Dermatol Sin 2017;35:40-3.
    CrossRef
  28. Cho SB, Lee SJ, Shim JH, Kim DH. Case analysis of side effects following illegal therapeutic attempts by non-medical personnel. Korean J Dermatol 2008;46:1507-12.
  29. Shin JB, Seo SH, Kim IH, Son SW. Case analysis of side effects following illegal therapeutic attempts by non-medical personnel. Korean J Dermatol 2007;59:124.
  30. Yoon J, Kim AY, Jun RM, Han KE. The effect of eyeliner tattoo on meibomian gland dysfunction and the ocular surface. J Korean Ophthalmol Soc 2020;61:146-52.
    CrossRef
  31. Jung JY, Shin HS, Won CH, Cho S. Facial verruca plana that developed after semipermanent tattooing. Ann Dermatol 2009;21:92-4.
    Pubmed KoreaMed CrossRef
  32. Kwon SH, Choi J, Byun SY, Kim BR, Na JI. A case of foreign body granulomatous reaction to a red lip cosmetic tattoo successfully treated with carbon dioxide laser. Korean J Dermatol 2014;52:142-3.
  33. Park AY, Hong JY, Kim HJ, Chung E, Kim JE, Lee J, et al. A case of tattoo-acquired verruca plana. Korean J Dermatol 2019;57:162-4.
  34. Kim SM, Kim JB, Choi HM, Ro BI, Cho HK, Ko EJ. Verruca plana developed after tattooing. Korean J Dermatol 2019;57:168-9.
  35. Hong E, Lee JD, Cho SH, Woo YR, Kim HS. Two cases of delayed adverse reaction to semi-permanent eyebrow tattoo: review and case report in Korea for granulomatous reaction. Korean J Dermatol 2020;58:334-9.
  36. Her Y. Koebner phenomenon following tattooing of a patient with psoriasis. Korean J Dermatol 2020;58:67-8.
  37. Kim SH, Shin DH. A study on the current state and the necessity of institutionalization of tattooing for beauty purposes. J Converg Inf Technol 2020;10:201-10.
  38. Park JS, Kim SK, Kim MJ, Kim SK. Pilot study for understanding the present situation of decorative tattoos. Seoul: National Evidence-based Healthcare Collaborating Agency; 2015. p. 130.
  39. Park KS. Semi-permanent make-up. Seoul: SIDAEGOSI; 2017.
  40. Korean Law Information Center. Judicial precedent [Internet]. Sejong: Korea Ministry of Government Legislation; c2019 [cited 2020 Mar 2].
    Available from: http://www.law.go.kr/LSW//main.html.
  41. Seo EK, Kang SW. Awareness and practice on the prevention of bloodborne infection among semipermanent makeup workers. J Korea Soc Beauty Art 2015;16:147-57.
  42. Ministry of Health and Welfare. Hepatitis C prevention and control program. Seoul. Ministry of Health and Welfare. 2016.
  43. Kim MY, Youn CS. An exploratory study on the semi-permanent make up legislation. J Beauty Ind 2019;13:81-102.

Article

Original Article

J Cosmet Med 2021; 5(1): 16-23

Published online June 30, 2021 https://doi.org/10.25056/JCM.2021.5.1.16

Copyright © Korean Society of Korean Cosmetic Surgery.

A medical perspective of the practice of semi-permanent makeup in South Korea

Chang Won Koh, MD, PhD1 , Kyoungjin (Safi) Kang, MD, PhD2

1Department of Public Health Service, Seoul National University Bundang Hospital, Seongnam, Rep. of Korea
2Seoul Face 21 Clinic, Seoul, Rep. of Korea

Correspondence to:Chang Won Koh
E-mail: kcwbnl@gmail.com

Received: May 24, 2021; Revised: May 31, 2021; Accepted: June 1, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Despite existing problems with infection control and healthcare regulations associated with semi-permanent makeup, its practice by non-medical personnel at non-healthcare institutions continues to pose fatal risks to the safety of the community.
Objective: The aim of this study is to seek for improvement measures on the Korean legal system regarding the practice of semipermanent makeup by investigating current conditions of the procedure and materials used, reviewing past clinical reports of complications associated with tattooing, and assessing domestic and foreign laws and regulations of semi-permanent makeup.
Methods: Both domestic and foreign studies and publications on the regulatory system with regards to semi-permanent makeup, in addition to clinical cases of complications associated with semi-permanent makeup, were reviewed.
Results: Tattoo procedures in South Korea and Japan are strictly restricted to medical personnel, while other countries also regulate the practice of tattoo with a license-based system rather than a qualification-based system such that non-medical personnel can perform under medical supervision. The duration and placement of pigments in the dermis of the skin and its possible complications associated with the procedure have been confirmed; short-term side effects are bleeding, infection, allergic reaction and Koebner phenomenon, and long-term side effects are foreign body reaction, granuloma. Local infections caused from tattoos include warts, herpes simplex; systemic infections include hepatitis B and C, HIV; toxic immune reactions include erythema multiforme, vasculitis, granuloma. To address these issues, examination of patient history for potential indications, established protocol for medical waste management, and stringent regulations for hygiene product management are necessary.
Conclusion: Measures such as the establishment of a license-issuance system that is inclusive of education and training on the proper practice of semi-permanent makeup and stricter management of tattoo-related materials and devices should be enforced in order to ensure infection control and the safety of the public health.

Keywords: healthcare regulation, infections, license-issuance system, safety of public health, semi-permanent makeup, tattooing

Fig 1.

Figure 1.There is a prominent viral cytopathic effect on the keratinocytes, which includes vacuolization, enlargement, and nuclear basophilia with a prominent granular layer, and a horny layer with a pronounced basket-weave pattern (A: H&E, ×200; B: H&E, ×400). Cited from from the article of Jung JY, et al. (Ann Dermatol 2009;21:92-4) [31] with original copyright holder’s permission.
Journal of Cosmetic Medicine 2021; 5: 16-23https://doi.org/10.25056/JCM.2021.5.1.16

References

  1. Tattoo [Internet]. San Francisco, CA: Wikipedia [cited 2020 Mar 2]. Available from: https://en.wikipedia.org/wiki/Tattoo.
  2. Mazza JF Jr, Rager C. Advances in cosmetic micropigmentation. Plast Reconstr Surg 1993;92:750-1.
    Pubmed CrossRef
  3. Woo J, Song Y. A study on the awareness, cosmetic behavior, satisfaction and re-treatment of semi-permanent make up. J Korean Soc Cosmetol 2019;25:91-105.
  4. Jung YJ. A study on the educational satisfaction of private certificates and the necessity of regular education of semipermanent makeup [dissertation]. Gyeongsan: Daegu Haany University; 2016.
    CrossRef
  5. Kim SW. Checklist and tattoo contracts to legalize nonmedical personnel tattoos and to ensure the rights of tattoo consumers. KHU Glob Bus Law Rev 2019;12:125-59.
  6. Jung YJ, Lee JH. Improvement study for semi-permanent makeup institutionalization. J Invest Cosmetol 2019;15:215-28.
  7. Long GE, Rickman LS. Infectious complications of tattoos. Clin Infect Dis 1994;18:610-9.
    Pubmed CrossRef
  8. Garg G, Thami GP. Micropigmentation: tattooing for medical purposes. Dermatol Surg 2005;31(8 Pt 1):928-31; discussion 931.
    Pubmed CrossRef
  9. Traquina AC. Micropigmentation as an adjuvant in cosmetic surgery of the scalp. Dermatol Surg 2001;27:123-8.
    Pubmed CrossRef
  10. Kim SY. A study on adult women’s cosmetic tattoo experiences and comparison of health concern and health practice between the cosmetic tattooed and non-cosmetic tattooed groups. J Korean Acad Community Health Nurs 2017;28:69-77.
    CrossRef
  11. Kim SM, Yun SK, Kim HU, Ihm CW. Micropigmentation on scalp and eyebrow scars is worth practicing. Korean J Dermatol 2008;46:305-9.
  12. Park JS, Ko EB. Kim JH, Kim SK. The base reaearch of safely management of decorative tattoo. Seoul: National Evidencebased Healthcare Collaborating Agency; 2015.
  13. Koh HJ, Kim YS. A study on the activity of Korean semipermanent make-up system. Korean J Aesthet Cosmetol 2003;1:11-23.
  14. Park JS, Kim SK, Kim MJ, Kim SK. Pilot study for understanding the present situation of decorative tattoos. Seoul: National Evidence-based Healthcare Collaborating Agency; 2007. p. 86-101.
  15. Kim HH. A study on the actual surver of semi-permanent make-up and improvement plan for the legal system. [dissertation]. Busan: Silla University; 2018 .
  16. Doumat F, Kaise W, Barbaud A, Schmutz JL. Basal cell carcinoma in a tattoo. Dermatology 2004;208:181-2.
    Pubmed CrossRef
  17. Kim CJ. Necessity and policy direction of legalizing tattooist. Seoul: Policy Materials of Parliamentary Inspection of the Administration; 2007.
  18. Yang SM, Kim HH. A study on the actual survey of semi-permanent make-up and improvement plan for the legal system. J Korean Soc Cosmetol 2018;24:482-94.
  19. Cho SB, Lee SJ, Shim JH, Kim DH. Case analysis of side effects following illegal therapeutic attempts by non-medical personnel. Korean J Dermatol 2008;46:1507-12.
  20. Malakar S, Lahiri K. Successful repigmentation of six cases of herpes-labialis-induced lip leucoderma by micropigmentation. Dermatology 2001;203:194.
    CrossRef
  21. Stinco G, De Francesco V, Frattasio A, Quinkenstein E, Patrone P. Malignant melanoma in a tattoo. Dermatology 2003;206:345-6.
    Pubmed CrossRef
  22. Khodadost M, Maajani K, Arabsalmani M, Mahdavi N, Tabrizi R, Alavian SM. Is tattooing a risk factor for hepatitis C transmission?: an updated systematic review and metaanalysis. Hepat Mon 2017;17:e14308.
    CrossRef
  23. Lee KB, Yi JY, Kim HO, Kim CW. A case of granulomatous reaction to tattoo pigment. Korean J Dermatol 1988;26:554-9.
  24. Callaghan MF, Negus C, Leff AP, Creasey M, Burns S, Glensman J, et al. Safety of tattoos in persons undergoing MRI. N Engl J Med 2019;380:495-6.
    Pubmed CrossRef
  25. Kim JH. The invasiveness of tattoo and unlicensed medical practice. Korean Criminol Rev 2007;18:165-200.
  26. Krecké N, Smola S, Vogt T, Müller CSL. HPV-47-induced and tattoo-associated verrucae planae: report of a case and review of the literature. Dermatol Ther (Heidelb) 2017;7:549-54.
    Pubmed KoreaMed CrossRef
  27. Wu CH, Thong HY, Huang CC, Chen PH. Report of two cases of cutaneous Mycobacterium abscessus infection complicating professional decorative tattoo. Dermatol Sin 2017;35:40-3.
    CrossRef
  28. Cho SB, Lee SJ, Shim JH, Kim DH. Case analysis of side effects following illegal therapeutic attempts by non-medical personnel. Korean J Dermatol 2008;46:1507-12.
  29. Shin JB, Seo SH, Kim IH, Son SW. Case analysis of side effects following illegal therapeutic attempts by non-medical personnel. Korean J Dermatol 2007;59:124.
  30. Yoon J, Kim AY, Jun RM, Han KE. The effect of eyeliner tattoo on meibomian gland dysfunction and the ocular surface. J Korean Ophthalmol Soc 2020;61:146-52.
    CrossRef
  31. Jung JY, Shin HS, Won CH, Cho S. Facial verruca plana that developed after semipermanent tattooing. Ann Dermatol 2009;21:92-4.
    Pubmed KoreaMed CrossRef
  32. Kwon SH, Choi J, Byun SY, Kim BR, Na JI. A case of foreign body granulomatous reaction to a red lip cosmetic tattoo successfully treated with carbon dioxide laser. Korean J Dermatol 2014;52:142-3.
  33. Park AY, Hong JY, Kim HJ, Chung E, Kim JE, Lee J, et al. A case of tattoo-acquired verruca plana. Korean J Dermatol 2019;57:162-4.
  34. Kim SM, Kim JB, Choi HM, Ro BI, Cho HK, Ko EJ. Verruca plana developed after tattooing. Korean J Dermatol 2019;57:168-9.
  35. Hong E, Lee JD, Cho SH, Woo YR, Kim HS. Two cases of delayed adverse reaction to semi-permanent eyebrow tattoo: review and case report in Korea for granulomatous reaction. Korean J Dermatol 2020;58:334-9.
  36. Her Y. Koebner phenomenon following tattooing of a patient with psoriasis. Korean J Dermatol 2020;58:67-8.
  37. Kim SH, Shin DH. A study on the current state and the necessity of institutionalization of tattooing for beauty purposes. J Converg Inf Technol 2020;10:201-10.
  38. Park JS, Kim SK, Kim MJ, Kim SK. Pilot study for understanding the present situation of decorative tattoos. Seoul: National Evidence-based Healthcare Collaborating Agency; 2015. p. 130.
  39. Park KS. Semi-permanent make-up. Seoul: SIDAEGOSI; 2017.
  40. Korean Law Information Center. Judicial precedent [Internet]. Sejong: Korea Ministry of Government Legislation; c2019 [cited 2020 Mar 2]. Available from: http://www.law.go.kr/LSW//main.html.
  41. Seo EK, Kang SW. Awareness and practice on the prevention of bloodborne infection among semipermanent makeup workers. J Korea Soc Beauty Art 2015;16:147-57.
  42. Ministry of Health and Welfare. Hepatitis C prevention and control program. Seoul. Ministry of Health and Welfare. 2016.
  43. Kim MY, Youn CS. An exploratory study on the semi-permanent make up legislation. J Beauty Ind 2019;13:81-102.

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