Eyeliner Tattoo Removal:  Case Report
Journal of the American Academy of Dermatology 1999,40:999-1001
Judy K. Chiang, MD, Sidney Barsky, MD, and Darryl M. Bronson, MD Chicago,
Illinois

This article reports a case in which tretinoin* was used
successfully in the removal of an eyelid tattoo.  A 31-year-old Hispanic
woman underwent eyeliner tattooing by a cosmetician at a beauty salon.
Eyelid margins were cleaned with isopropyl alcohol.  Topical lidocaine (10
mg/dose) was applied with a cotton-tipped applicator to the eyelid margins.
Black ferrous oxide (Meicha) was implanted with a triple pronged needle
(Fig 1).

  At the end of the procedure, eyelid margins were cleansed with
saline solution.
Five hours after tattoo placement, the patient arrived at our
clinic for removal of her eyelid tattoo.  After being informed that this
procedure was not performed at our institution, she left with just a refill
of tretinoin 0.025% cream for her acne.  Within 24 hours of the tattooing,
the patient began applying tretinoin cream 4 times a day with a
cotton-tipped applicator to her upper eyelids in the region of the tattoo.
She then applied petroleum jelly to the distal rim of her eyelids to
protect her eyes.  On postoperative Days 4 and 5, the patient noticed
swelling, tenderness, and erythema in the area.  By postoperative day 6,
the patient's tattoo had been effectively removed.  No scarring or residual
pigmentation was noted.  On postoperative day 7, the patient returned to
our clinic to report her success (Fig 2.).

EDITORIAL COMMENT:  This article reports a case in which tretinoin* was
used successfully in the removal of a fresh eyelid tattoo.  Tretinoin is
retinoic acid, from Vitamin A, is best known as Retin-A´®. Shown to
increase collagen production in the dermis, it is prescribed for its
"anti-wrinkle" benefits in aging skin and/or acne treatment.  Anyone who is
familiar with Retin-A® knows that the skin commonly becomes red, irritated,
dry, thin and extremely sensitive to sun exposure.
Retin-A® is available by a doctor's prescription at any drugstore.
It is available in a cream or gel.  This article utilizes a 0.025% strength
of tretinoin in a cream.
1.  When anticipating a procedure in which it is desired to remove
color, one strategy would be to have your client obtain a doctor's
prescription for Retin-A®.
2.  Have the client come in and, after a photograph, apply topical
anesthetic to area.  When ready, use "dry needles" over area.
3.  Apply a little Retin-A® cream to area and instruct her to do so
4 times/day for 5 days.
4.  WARNING: Tell your client that she should expect swelling,
tenderness and redness during the first week.  KEEP OUT OF EYES!  See her
consulting physician if any complications.
5.  Schedule a return appointment in seven days to see and
photograph your client.  Note:  This client's eyeliner was done within 24
hours of starting Tretinoin 0.025%.  Also, the mini-foam applicator is good
to use to apply the tretinoin safely."

My approach will be to "open" the skin on my patients with dry needles
(eyeliner) and microdermabrasion (brows).  I'll then have them apply the
Retin-A Q.I.D.x 5-6 days.  I'll monitor them and have good photographs
before and after.

The thought occurs to me that a lot of color is lost normally during the
healing process- especially with iron oxide pigments.  Not so with carbon
black inks that are used for eyeliner (India Ink, Peliken Ink, Talens Ink).
So there are many considerations in this case.

Lastly, of potential importance, is the thought that color retention can be
affected adversely or positively during the healing process by the tissue
environment (pH, inflammation, infection).  Improved wound healing makes
for better color retention. 

Linda H. Dixon M.D.
Anesthesiology
1569 Aalapapa Drive
Kailua, Hawai'i  96734
808/263-7747 tel
808/261-9070 fax