Permanent Cosmetics, Tattoos and MRI

Medical Blog
2013
August

Magnetic resonance imaging (MRI) uses radio waves and strong magnetic fields to make images of the body, such as of the brain, spine, shoulders, knees, and other joints. The employed magnetic fields are often tens of thousands of times as strong as the Earth’s average magnetic field. The 1.5 Tesla machine installed where I work is 30,000 times as powerful as that encountered under normal daily circumstances. The strong magnetic field raises safety issues. Some individuals – such as those with pacemakers and various implanted metallic devices – are not candidates for MRI.

As a physician who interprets MRI studies, I am often asked about the safety of scanning patients with tattoos and permanent cosmetics with MRI. Permanent cosmetics, also called micropigmentation or permanent makeup, include permanent eyeliner, permanent lip-liner, full lip, and tattooed eyebrows. Permanent makeup has become more common. Some women cite timesaving as their reason for opting for permanent cosmetics. Others have difficulty applying traditional make-up because of neurological disorders (such as Parkinson’s disease or multiple sclerosis) or because of poor vision. Allergies to traditional make-up can prompt an additional subgroup of people to consider having micropigmentation. This procedure may also be desirable cosmetically for those who have lost eyebrows, such as because of alopecia or repeated hair plucking.

Older tattoo procedures commonly employed metal pigments. Nowadays, it’s common to use vegetable-based or plastic dyes in permanent cosmetics. Red or black dyes may contain iron oxide. It is a point of debate whether this small metal particle might have been responsible for rare adverse skin reactions in persons undergoing MR imaging and who have permanent cosmetics.

In one study from 2002, 135 individuals who had permanent make-up also had MR imaging. 133 reported no adverse reaction. Only 2 reported minor, transient sensations associated with the procedure: 1 person had slight tingling; the other experienced a burning sensation. In both cases, the symptoms were short-lived and resolved completely. The current evidence suggests that permanent cosmetics are not a contraindication to MR imaging; that is, permanent makeup should not exclude someone from having an MRI if it is needed. Most individuals with permanent cosmetics will not notice anything unusual or experience any unpleasant sensation from having an MRI. Rarely, MR imaging can produce some local heating of tissue in the area of a tattoo. A cool compress can help alleviate this burning sensation. Mild, temporary swelling of skin has also been reported. It’s unclear whether the iron oxides in certain tattooing dyes contribute to local skin reactions. Vegetable-based dyes appear to be less likely to cause negative reactions with MRI than tattoo dyes that contain metal pigments. Overall, individuals with permanent makeup have experienced less adverse events from MRI than those with large decorative tattoos.

Pigments used for tattooing and permanent makeup can cause some image distortion on the MR pictures, usually confined to the region of the tattoo. This is related to inhomogeneities in the magnetic field. Mascara can produce a similar effect. This mild image distortion is only over a small area, and it typically does not compromise the value of the study. In those with permanent eyeliner, there is some image distortion of the eyeballs on the MRI, but the quality of brain images is not significantly affected. Picture quality at sites remote from skin tattooing is not impacted.

It should be noted, as a general rule, that there is a greater risk from avoiding an MRI when one is deemed medically necessary or advisable by a physician (or other qualified healthcare professional) than from any potential negative interaction between the MRI and the tattoo or permanent cosmetics.

MRI technologists routinely screen patients prior to MR imaging to be sure that no contraindication to MR imaging exists. If you have permanent make-up, let the technologist know. He or she will keep in contact with you during the test, usually via an intercom. Notify the technologist during the exam if you experience any unusual sensations, burning, or pain. Most individuals with permanent cosmetics can be safely and uneventfully scanned with MRI. In the very small percent of patients who do experience a problem, the adverse reaction is minor and temporary.

Be sure to talk with your doctor or ask to speak with the radiologist if you have any concerns about the safety of an MRI you are having done.

 

Reference:

Shellock FG. Reference Manual for Magnetic Resonance Safety, Implants, and Devices: 2007 Edition. Biomedical Research Publishing Group, Los Angeles, CA, 2007; pp.117-121.

 

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