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Areola Simulation

For breast cancer survivors, it can often be a dysmorphic process to undergo breast reconstruction surgery. Men and women who have undergone a mastectomy often find it taxing on their self-esteem. To gain a sense of normalcy again, for those who want it, it’s possible to get areolas simulated through an areola tattoo. This is a tattooing method which reconstructs the way your nipple looks, by implanting pigment or ink in the area, to make it appear more natural and realistic.

The end result is essentially a new nipple, designed specifically with your needs and expectations in mind. An areola tattoo is a powerful artistic procedure for one main reason, it restores the self-confidence of breast cancer survivors after their surgeries. An added bonus is that it is a much quicker alternative to nipple reconstruction surgery.

Areola simulation is mostly performed on breast cancer survivors who have undergone mastectomies; however, many individuals also benefit from this procedure whose nipples have been adversely affected by surgeries, third degree burns, skin graphs and more. Areola simulation is for anyone who is unhappy with the way their nipples look.

During the consultation, an experienced medical permanent makeup artist will work with you to design an areola tattoo that looks exactly how you want, each tattoo is unique to the individual and their needs.

It is difficult to say how long the areola tattooing process will take, as it is highly dependent on the experience level of the artist, the skin texture, the presence of scars etc.


Permanent makeup is easiest described as cosmetic tattooing. The specialised techniques used for permanent cosmetics are often referred to as “micro-pigmentation” or “semi-permanent makeup.” The cosmetic implantation technique deposits coloured pigment into the upper reticular layer of the dermis (skin).

Permanent cosmetic procedures are performed using various devices, including, but not limited to, digital rotary machines and hand devices. The process includes a consultation, the application of anaesthetics (dependent on artist), followed by the “implantation” of pigment into the skin using specialised needles. Permanent makeup is to be performed in a clean and sterile environment. At least one or more follow up visits is strongly recommended for evaluating the healed design work and colour of the pigment.

Interest in permanent cosmetics spans the young, to the more mature. Permanent makeup is intended to enhance ones features and boost self-confidence.

It is especially valuable to people who can’t wear traditional cosmetics due to allergies and skin sensitivities; active people who want to look their best for sports activities such as swimming, hiking, biking, tennis, aerobics; and those who don’t want to worry about “sweating off” or reapplying cosmetics.

Permanent cosmetics also benefits the vision challenged who have difficulty applying their cosmetics; and others with dexterity related conditions such as arthritis, Parkinson’s disease, multiple sclerosis, stroke survivors, and busy people who don’t have time to apply and refresh makeup throughout the day and evening.

Permanent cosmetic procedures can have a subtle or dramatic effect, depending on your requirements.

Procedures include:
• Eyebrows – Shaded, Strokes or a Combination
• Eyeliner - Top and/or Bottom, Lash Line Enhancements
• Lip liner or Full Lip Colour
• Medical Camouflaging – Burn Victims, Scars etc.
• Cosmetic Camouflaging – Stretchmarks
• Scalp Micropigmentation – Baldness and Hair Density
• Areola Re-pigmentation – For Breast Cancer Survivors

The industry is constantly evolving, new procedure trends can be expected frequently. Some of these include but are not limited to freckles and beauty spots.

PLEASE NOTE that some of these procedures use more advanced techniques (para-medical techniques) and thus require an experienced artist with advanced training.

Permanent cosmetic procedures are considered permanent because pigment is tattooed into the upper reticular part of the dermal layer of the skin and thus, cannot be washed off. However, as with any tattoo, fading can and often does occur.  Therefore, periodic maintenance is required which is often referred to as touch-ups, colour boosters or colour refreshers.

The fact that most people will require periodic colour refreshment of their permanent cosmetics is the opportune time to re-evaluate your overall appearance profile and decide whether any changes would be appropriate.

The longevity of permanent cosmetics varies from person to person depending various environmental, medical and biological factors such as – sun exposure, topical products and treatments applied to the skin, medication etc.

Permanent makeup procedures vary in cost, this is dependent on the artist’s experience level as well as location.

It can take anything from 1:30 to 4:00 hours, this is dependent on the artists experience level, procedure type, and the area size that needs to be covered.

Most people experience some discomfort. This severity of the discomfort varies in accordance with each individual’s pain threshold. Various topical anesthetics have been developed for the permanent cosmetics industry which does help to minimize discomfort. Your technician should discuss the methods available with you to determine which is most appropriate for your specific procedure and pain threshold.

To put this into perspective: thousands of body art tattoos are performed annually, possibly millions.  As a rule, traditional tattoo professionals do not use any anesthetics for their tattoo procedures. Anesthetics for permanent cosmetics are more of a tattoo service luxury because of the nature of the tattoo location and the fact that permanent cosmetics falls into the beauty treatment category.

If proper sterilization and disinfection guidelines are met, permanent cosmetics are completely safe. Professionals in the permanent cosmetics industry routinely attend Occupational Safety and Health Administration (OSHA) classes. The guidelines that get taught at these classes include (but are not limited to) the following.

IMPORTANT! Things to look out for:

  • Only new and sterile needles should be used for each client. New, sterile needles should be opened in your presence.
  • Disposable sterilized one-time use machine parts should be purchased by the artist and disposed of in a sharps container immediately after the procedure has been completed.
  • Personal protection equipment such as disposable one-time use aprons and gloves should be new for each client and changed during the procedure if needed.
  • The technician should be clean and neat.
  • Disposable one-time use chair/bed covering should be new for each client.
  • The room or treatment area should be in an area free from other contaminants. The SPCP whom is affiliated with PCASA has taken a position against permanent cosmetic procedures conducted at trade shows and in salons where nail dust, aerosols or other chemicals are present.

l thought the procedure is considered permanent, these procedures do have flexibility in changing colour and shape to some extent, depending on the expertise of your artist. Keep in mind that colours will appear darker immediately following the procedure due to oxidation but will soften and lighten during the healing process. The healing time is different for each individual and each procedure.

After the procedure has healed and you are able to form an objective opinion about the outcome, you can reassess and decide which would be the best path forward. You can either tweak the colour and shape, select a new artist who is able to render results more in-line with your expectations, or undergo removal with either laser or alternative removal techniques.

Take note of the following:

  • If you cannot communicate with your artist, it is possible that your desires will not be realized. It is important to bring visual aids to make sure your artist understands your expectations.
  • If your artist recognizes your requests but does not take your desires for colour or design into account, you should not proceed with the procedure.
  • Most well-trained artists will not perform a procedure if the design and/or colour requested by the client is not reasonable. If your requests are turned down by one or more artists, re-think what you are asking for.
Choose an artist carefully by considering the individual’s training, experience, compliance with local laws, and the artist’s “before and after” photograph portfolio. It is important to remember that the shape and proper placement of the procedure is as important as the right colour. Professionals have studied colour theory and skin undertones which results in the colour requested. Unskilled people who have not pursued the required education do not have the knowledge required to translate pigment colour to skin to achieve the desired outcome. The preferred look is obtained during the course of consultation, initial procedure and follow-up appointment(s). Interaction between the client and the artist is of utmost importance.

Often the tattooed colour is not perfect after the initial procedure heals. Permanent cosmetic procedures are a process and at least one follow-up to the initial procedure should be scheduled. It is recommended that any required detail work to the original procedure be performed no sooner than four weeks after the original procedure. The minimum standard for follow-up detail work for lip procedures is six weeks. Lips have a different healing agenda than procedures performed on other parts of the face due to their delicate nature.

The cited time frames will vary depending on the health profile and age of the client, but these are good minimum standards for consideration.

Permanent cosmetic procedures require no downtime and is considered non-invasive.

Pinpoint bleeding is totally normal during procedures. Afterwards, minor swelling can be expected. Bruising is rare but can occur for various medical reasons, such as a person being on blood thinners. There is also some tenderness for a few days afterwards and scabbing is part of the healing journey.

Other less often reported side effects are difficult to determine due to the individuality of each person’s biological system. This is why professional permanent cosmetic artists require a client history profile to assess different factors that may contribute to your experience after the tattooing procedure has been completed.

People can develop an allergy to anything, at any time. However, pigment allergies are considered rare. Some doctors recommend that people with environmental allergies or allergies to conventional makeup have permanent cosmetic procedures because they can eliminate the need for cosmetic products that people are sensitive to.
Ask your artist if they use pigments that are formulated from powders taken from the FDA’s Food Drug and Cosmetic (FD&C) listings. Although the FDA does not at this time approve or disapprove tattoo pigments, the SPCP considers pigments formulated from the FD&C listing the safest origin of pigment powders for permanent cosmetic pigment formulations.

With today’s health standards, the possibility that you would have any problems or reactions from these procedures is almost non-existent. PCASA member professionals are given continued opportunities for education in practicing precise methods of disinfection and sterilization. Post procedural instructions, if followed carefully by the client, will greatly reduce any risk.

Numerous studies have shown that even for people who have large body tattoos, there is little to no potential risk for irritation resulting from an MRI. In the rare instance where discomfort resulted, it was localized and very temporary. However, with that said, it is important to advise your MRI artist that you have permanent cosmetics.

The opportunities for skilled Permanent Cosmetics artists are impressive. Career and business opportunities will however vary depending on location and the individual artist’s training and skill level. Many nurses and a few doctors, as well as hair, skin, and nail care professionals, are choosing to train in permanent cosmetics.


  • Members are to maintain high professional standards consistent with sound practices
  • Members are to conduct business relationships in a manner that is fair to all.
  • Members will promote professionalism in the cosmetic tattoo/permanent makeup industry without discrimination against any fellow member’s background.
  • Members will further the interests of the Association and encourage cooperation throughout the cosmetic tattoo industry.
  • Members will refrain from any immoral or unethical behavior in their business dealings.
  • Members will strive to participate in continuing education to upgrade and improve their knowledge and skills.
  • Members will use only those tattoo products, imported from reputable companies and will not use any product deemed unsafe or improper by the FDA.
  • Members agree that manufacturers and distributors of equipment or supplies, including pigments and anesthetics, will not provide false or misleading statements to the consumer and will fully disclose all ingredients.
  • Members will utilize safe practices of sterilization of all machine or device components that can potentially be contaminated by bloodborne pathogens. Disposable parts, including needles, will not be reused.
  • Members agree the application of permanent makeup is in fact tattooing. Members will not deceive their clients regarding this aspect of permanent cosmetics by stating “this is not tattooing.”
  • Members understand the process of tattooing is not temporary or completely painless. Members will make no false or misleading statements to the public in their advertisements, brochures, or consultation materials regarding the process of tattooing.
  • Members agree that any training program at the fundamental level shall be no less than 100 hours (Not less than 65 classroom hours) in duration and shall include practical components under direct instructor supervision. Members agree not to teach any such program which falls short of these minimum standards (refer to PCASA Training Guidelines).
  • Members may not appropriate any Association materials, including items such as articles, videos, images, and membership lists for their own personal gain. Members may not reproduce or use any of said materials, including the membership list, for any reason without the prior written approval of the Board.
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