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Lightening and removal of permanent makeup and tattoos using chemical removers: Dermatological rationale and clinical protocols
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ABSTRACT
Background: Permanent makeup and decorative tattoos involve the placement of exogenous pigment particles within the superficial dermis. Despite advances in application techniques and pigment formulations, a substantial proportion of patients subsequently seek pigment lightening or removal due to aesthetic dissatisfaction, color alteration, pigment migration, or evolving personal preferences.
Objective: This narrative review summarizes the dermatologic rationale for chemical remover–based pigment removal and outlines key clinical considerations associated with multi-phase chemical formulations used in permanent makeup and tattoo correction.
Methods: A narrative literature-based analysis was conducted focusing on dermatological principles underlying chemical remover–based pigment removal. Mechanisms of action were examined in the context of controlled epidermal and dermal stimulation, inflammatory and osmotic responses, and subsequent regenerative processes potentially facilitating pigment extrusion or redistribution.
Results: Chemical remover–based approaches demonstrate a physiologically grounded mechanism that may support gradual pigment lightening through epidermal and dermal regenerative responses. When performed under appropriate clinical conditions and protocols, these methods may provide a viable option for pigment correction, particularly in cases involving complex pigment compositions or when laser treatment is limited or contraindicated.
Discussion: Key clinical considerations include proper patient selection, awareness of indications and contraindications, and adherence to established treatment protocols. Expected post-procedural skin responses and regenerative processes play an important role in the gradual reduction or redistribution of pigment particles. A commercially available multi-phase chemical remover may be referenced in clinical discussion for illustrative purposes, though such references do not imply product endorsement.
Conclusion: Chemical remover–based pigment removal represents a clinically relevant alternative or adjunct to laser therapy in permanent makeup and tattoo correction.
Key words: Permanent makeup, Tattoo removal, Chemical removers, Pigment lightening, Aesthetic dermatology
INTRODUCTION
The skin is a complex, multilayered organ composed of the epidermis, dermis, and hypodermis, performing protective, barrier, immune, and sensory functions. Permanent makeup and tattoo procedures are based on controlled microtrauma of the skin with pigment implantation predominantly into the papillary layer of the dermis. This depth ensures long-term color retention and relative stability of the result [1].
From a dermatological perspective, permanent makeup and tattoo pigments represent exogenous particles retained within the dermis and interacting with immune, inflammatory, and reparative skin processes. Therefore, pigment removal should be considered not only as an aesthetic intervention but also as a dermatologically relevant procedure requiring an understanding of skin biology and wound healing.
According to international aesthetic reviews, up to 30–40% of permanent makeup clients report partial dissatisfaction with the results within 3–5 years, while 15–20% actively seek correction or removal. In the segment of small tattoos, this figure may reach 25%, particularly in cases of impulsively performed procedures [2].
Therefore, methods for pigment lightening and removal are becoming increasingly clinically relevant. Despite the widespread use of laser removal, this method is not suitable for all patients. Effective laser procedures depend on wavelength selection, pulse duration, fluence, skin phototype, and target chromophore characteristics; inappropriate parameter selection increases the risk of adverse skin reactions [3].
Methods of Pigment Lightening and Removal
In contemporary practice, three main approaches are used:
- Laser removal, based on the principle of selective photothermolysis, in which pigment particles are fragmented by laser radiation of different wavelengths without disrupting the integrity of the skin surface.
- Lightening and removal using a chemical remover, which involves the intradermal introduction of specialized chemical suspensions using permanent makeup or tattoo equipment.
- Combined methodology, involving the sequential use of laser treatment and chemical remover, with the choice of approach depending on the initial clinical presentation, pigment depth, and pigment composition.
The selection of the appropriate method is individualized and depends on the chemical properties of the pigment, the depth of its implantation, the condition of the skin, and the regenerative capacity of the patient’s body [4].
Principle of Action of the Chemical Remover
The remover is introduced into the dermis using a needle and a tattoo machine (Fig. 1), in a manner similar to the permanent makeup procedure. The composition reaches the depth of pigment deposition and initiates a controlled inflammatory response, with subsequent epidermal renewal processes similar to mechanisms described in superficial chemical exfoliation and controlled skin regeneration [5]. As a result, the pigment undergoes chemical interaction, is lightened by acids, or is drawn toward the skin surface through osmotic processes and subsequently eliminated together with the forming crust.
This mechanism is physiological, as it is based on the natural responses of the skin to microtrauma and inflammation, during which the pigment is either chemically altered or mechanically evacuated from the dermis [4,6,7].
Intellect Permanent Remover: Composition and Phases (The mention of a specific commercial product does not imply endorsement. The product is referenced solely as an example of a commercially available multi-phase chemical remover):
Intellect Permanent Remover is a three-phase system comprising an acid phase, a saline phase, and an alkaline phase, each of which performs a specific function.
Acid phase
The acid phase contains approximately 30% acids with different molecular weights and has a pH of 2.7–3.5. Its composition includes:
- Glycolic acid, characterized by a low molecular weight, allowing it to penetrate deeper layers of the skin and stimulate epidermal renewal;
- Lactic acid, which has a larger molecular size and acts primarily on the surface, providing gentle hydration and enhancing the penetration and distribution of glycolic acid [8–10].
Saline phase
With a pH of 5–7, the saline phase contains sea salt and osmolites, which, together with excess water, draw pigment out of the skin. The saline phase also functions as a neutralizer of the acidic composition. Witch hazel extract provides a soothing effect.
Alkaline phase
The alkaline phase has a pH of 8.5–9.2. Despite its high pH, it does not contain zinc, magnesium, or calcium oxides. The alkaline environment induces controlled skin irritation and stimulates regenerative processes. Arginine simultaneously increases pH and accelerates healing, while lactic acid partially neutralizes its effect, thereby reducing the risk of chemical burns [4,8,9].
Adaptation of Compositions and Protocols
The classic application schemes include:
- acid → saline → alkaline;
- alkaline → saline → acid.
In reported clinical practice, variation in acid concentration and pH modulation has been described as a means of adapting chemical exposure to individual skin characteristics. Such adaptations underscore the importance of practitioner expertise and individualized clinical judgment rather than standardized procedural modification.
Procedure Algorithm
In clinical practice, remover-based pigment lightening is typically performed according to a structured protocol that includes patient assessment, skin preparation, controlled intradermal application of the remover, and post-procedure care. The sequence of steps may vary depending on the anatomical area, pigment characteristics, and individual skin response.
Clinical Stages of Remover-Based Pigment Lightening
Remover-based pigment lightening is performed through a sequence of clinically defined stages that aim to ensure patient safety, controlled tissue interaction, and predictable skin response. The procedure is preceded by patient consultation, during which the mechanism of action of the chemical remover is explained and relevant medical history, including chronic conditions, is reviewed.
Prior to remover application, the treatment area is carefully prepared using antiseptic measures to reduce the risk of secondary infection. The surrounding skin that may be subjected to mechanical contact during the procedure is also disinfected. Standardized clinical photography is typically obtained under adequate lighting conditions to document baseline skin appearance.
To enhance patient comfort, topical anesthesia may be applied. Informed consent is completed, and the procedural environment is prepared in accordance with hygiene and sterility principles. Equipment used for intradermal application is isolated with barrier protection. Needle configurations are selected according to the treated area, with grouped needles more commonly used for larger zones such as eyebrows, lips, or tattoos, and finer configurations reserved for localized or delicate areas (Fig. 2).
The technical stage of the procedure involves controlled intradermal implantation of the chemical remover, either acidic or alkaline, depending on the selected clinical protocol. Following initial intradermal exposure, additional topical application of the same remover phase may be performed to enhance pigment interaction. Sequential use of saline and subsequent phases is incorporated as part of the multi-phase approach, supporting osmotic processes and modulation of the local inflammatory response.
After completion of the procedure, the treated area is reassessed and documented photographically. The working environment is processed according to standard clinical hygiene requirements. Patients are informed about expected transient skin reactions, including erythema, and are provided with general post-procedure care recommendations to support physiological healing.
Technique of Composition Implantation
Various implantation patterns may be employed to achieve uniform intradermal distribution of the remover. These include zigzag movements, circular movements (“spirals”) upward, circular movements (“spirals”) downward to ensure uniform distribution of the remover, point-by-point application (Fig. 3).
Procedure-Specific Considerations
The release of lymphatic fluid and serous exudate is a normal reaction, particularly when the saline phase is used. Lymphatic discharge may persist for 1–2 hours after the procedure and should be gently removed using a moist cotton pad soaked in green soap or chlorhexidine. Serous exudate facilitates the extrusion of pigment toward the skin surface.
Contraindications
Intervals Between Procedures
-
between remover-based removal sessions: 1–2 months (Fig. 4);
-
between remover procedures and permanent makeup: 1–2 months (Fig. 5);
-
between remover-based procedures and laser removal: 1–2 weeks (Fig. 6).
 |
Figure 4: Representative example of eyebrows with permanent makeup exhibiting an undesirable color change. (Image courtesy of Irina Kan). |
 |
Figure 5: Representative example of eyebrow pigment lightening after a single procedure using a three-phase chemical remover. (Image courtesy of Irina Kan). |
 |
Figure 6: A typical example of lightening eyelid pigmentation after several treatments using a three-phase chemical pigment remover. (Image courtesy of Irina Kan). |
DISCUSSION
The method of pigment lightening and removal using chemical removers is physiologically grounded and versatile. Removers interact directly with pigment particles and skin tissues, making this approach particularly effective for complex colors, flesh-toned pigments, and in cases where laser treatment is contraindicated. Laser technologies remain an important option for tattoo correction, particularly when pigment characteristics are responsive to Q-switched systems [13].
Importantly, the use of chemical removers should be viewed within the broader context of dermatological tissue response rather than as a purely cosmetic technique. The mechanisms involved—controlled inflammation, osmotic fluid shifts, and epidermal regeneration—overlap with fundamental dermatological principles of wound healing and elimination of exogenous pigment particles from the dermis. Consideration should also be given to pigment composition, as some tattoo colorants contain potentially hazardous compounds [14].
Current dermatological evidence confirms that the skin’s response to controlled chemical and mechanical stimulation initiates a cascade of inflammatory and reparative processes that facilitate the evacuation of exogenous pigment particles from the dermis. Similar mechanisms have been described in fundamental studies on the biology of tattooed skin and the interaction between pigments and the cutaneous immune system [1].
The growing demand for permanent makeup and tattoo removal reflects not only aesthetic concerns but also psychosocial factors. According to dermatological and sociological research, up to one quarter of patients with tattoos or permanent makeup consider removal or correction at different stages of life, often due to changes in social roles, professional requirements, or personal attitudes [2,7].
In addition, it is essential to consider the characteristics of skin healing following procedures associated with microtrauma. Studies focused on skin regeneration and scarring emphasize the importance of strict adherence to recommended intervals between procedures and individualized protocol selection, particularly in patients at increased risk of pathological scarring [15,16].
Thus, remover-based techniques occupy a justified position in modern aesthetic and dermatological practice, complementing laser technologies and expanding the possibilities of a personalized approach to patient care.
Limitations
This review has several limitations. The available evidence on chemical remover–based pigment removal is heterogeneous and largely consists of observational reports, technical descriptions, and expert experience rather than large randomized controlled trials. In addition, outcomes may vary depending on pigment composition, depth of implantation, individual skin response, and practitioner technique. Further prospective studies with standardized protocols and long-term follow-up are needed to better define efficacy, safety profiles, and optimal patient selection criteria.
CONCLUSION
The method of pigment lightening and removal using chemical removers is well justified. The growing number of requests for permanent makeup and tattoo removal reflects not only aesthetic concerns but also psychosocial factors. For many patients, unwanted pigment becomes a source of anxiety, stress, and social insecurity. In this context, remover-based techniques perform an important rehabilitative function, helping individuals restore self-confidence and improve their quality of life.
Overall, multi-phase chemical removers represent one of several available approaches to pigment lightening and removal, with potential applicability in selected clinical contexts when laser-based techniques are limited or contraindicated.
Ethical Considerations
All images were anonymized, and no identifying information is presented in this article.
ACKNOWLEDGMENTS
The author expresses sincere gratitude to Irina Kan, permanent makeup specialist, for providing selected clinical photographs used for illustrative purposes in this article. The contributor did not participate in the study design, data analysis, interpretation of results, or manuscript preparation and therefore does not meet the criteria for authorship.
Statement of Human and Animal Rights
All the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the 2008 revision of the Declaration of Helsinki of 1975.
REFERENCES
1. Baumann L. Cosmetic Dermatology:Principles and Practice. 2nd ed. New York:McGraw-Hill Education;2009.
2. Bayat A, McGrouther DA, Ferguson MWJ. Skin scarring. BMJ. 2003;326:88–92.
3. Gonçalves S. Properties and parameters for effective laser hair removal:A review. Our Dermatol Online. 2021;12:452–7.
4. Burris K, Kim K. Tattoo removal. Clin Dermatol. 2007;25:398–406.
5. Goodman GJ. Chemical Peels:Procedures in Cosmetic Dermatology. 2nd ed. Elsevier;2020.
6. Kluger N. Tattoo removal:epidemiology, indications and techniques. Curr Probl Dermatol. 2017;52:97–103.
7. Armstrong ML, Roberts AE, Koch JR, Saunders JC, Owen DC, Anderson RR. Motivation for tattoo removal. Arch Dermatol. 2014;150:343–4.
8. Van Scott EJ, Yu RJ. Alpha hydroxy acids in cosmetic dermatology. J Am Acad Dermatol. 1989;11:867–79.
9. Kornhauser A, Coelho SG, Hearing VJ. Applications of hydroxy acids:classification, mechanisms, and photoactivity. Dermatoendocrinol. 2010;2:148–54.
10. De Cuyper C. Permanent makeup:indications and complications. Clin Dermatol. 2007;25:367–74.
11. Garg G, Thami GP. Micropigmentation:tattooing for medical purposes. Dermatol Surg. 2005;31:928–31.
12. Andreou E, Hatziantoniou S, Rallis E, Kefala V. Why permanent makeup (PMU) is not a lifetime application. Cosmetics (Basel). 2024;11:160.
13. Ross EV, Naseef GS, Lin G, Kelly M, Michaud N, Flotte TJ, et al. Comparison of responses of tattoos to picosecond and nanosecond Q-switched neodymium:YAG lasers. Arch Dermatol. 1998;134:167–71.
14. Engel E, Santarelli F, Vasold R, Maisch T, Ulrich H, Prantl L, et al. Modern tattoos cause high concentrations of hazardous pigments in skin. Contact Dermatitis. 2008;58:228–33.
15. Ogawa R. Keloid and hypertrophic scars are the result of chronic inflammation in the reticular dermis. Int J Mol Sci. 2010;11:2163–74.
16. Baranska A, Shawket A, Jouve M, Baratin M, Malosse C, Voluzan O, et al. Unveiling skin macrophage dynamics explains both tattoo persistence and strenuous removal. J Exp Med. 2018;215:1115–33.
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