Port Wine Stains in the Medical Tattoo Industry


There’s a big discussion about whether or not to tattoo Port Wine Stains in the Medical Tattoo industry. When I trained it was advised this was a contraindication and not to be tattooed. During my time as a practitioner, I turned a lot of people away who had enquired about this concern. Over that period I spoke with the patients and discussed their concerns and how their own personal research had shown that certain countries offered this treatment, therefore why not the UK. So I decided to do my own research on this. This led me to the medical research listed here:

COSMETIC TATTOOING AS A TREATMENT OF PORT WINE STAINS. Eddy M, Van Der Velden, Bert D, De Jong, M.D., Ph.D.Henk B, Van Der Walle, M.D., Ph.D., Ernst Stolz, M.D., Ph.D., and Ben Naafs, M.D., Ph.D.

Trial and Risks

I found that a few clinics in France offer this treatment as well as the medical research above. I spoke to one patient who has expressed she would be willing to trial this treatment. We spoke about the potential risks:

1. There may be no change at all, as the pigment will be going into blood vessels and may be removed by the lymph system.
2. If the pigment is retained it may look unnatural and may look like pigment under skin, rather than natural skin.
3. There is a risk of infection- any time the skin is broken infection is a risk. This would be managed by the aftercare process.
4. Unknown risks due to it being a trial treatment.
5. Potential of titanium dioxide longevity which may cause an increase of white pigment over a number of years.

Lessening the visibility

My patient was willing to take these risks for the potential benefit of lessening the visibility of her PWS. She covered it with Camouflage cream every day whether at home or out in public. If the treatment didn’t work she would continue to camouflage the area.

As she lived a long way from the clinic we discussed a treatment plan that would allow enough healing time in between treatments alongside not too much time that the pigment would fade.

Tattooing the Port Wine Stain

Treatment started in 2017. We never expected to cover the whole PWS as it covered over half the face. In some areas it’s very dark, and in others quite light with regular skin tones intermingled. The treatments lasted up until 2021 and resulted in a 50-60% visible reduction. The main difference is that she now only wears camouflage when she is going for a night out, and leaves it bare when at home and popping out to the shops, etc. This gives her back time each day which is not taken up by applying camouflage cream, as well as confidence in her day-to-day life.

As mentioned the main reason people don’t tattoo PWS is because of the titanium dioxide in the lighter pigments. Titanium dioxide does not fade from the skin whereas the rest of the pigment does. Over a number of years, as the pigment fades, and Colour Boosts are performed, the build-up of titanium dioxide may increase due to retention, so it is presumed that over a number of years, there will be a large number of white dots; areas of white pigment. This cannot be removed.

Well informed patients

This is definitely an argument for why not to use lighter pigments, but practitioners use these on scars, hypopigmentation, grafts, etc so surely the same risk occurs there? This is a risk that may be a concern in 10-20 years’ time, so younger patients need to be extra aware of this.

The patient needs to be well informed, of all risks, and given time to make an informed decision.

Worth a read: Everything you need to know about Port Wine Stains in one handy Q&A guide – Rae Denman

In my experience the majority of PWS patients who come to see me, wear Camouflage cream and feel in themself they probably will do so for the rest of their lives. What medical tattoo gives them is the freedom to either:

➡️Wear less camouflage cream, making it quicker, and easier in the mornings.
➡️Not wear camouflage cream all day, or every day, but be free to choose to go camoless.
➡️Stop wearing camouflage cream altogether!

Now we have 6 years of experience in tattooing PWS and how it changes over a number of years. We need to keep looking at this over the next 10-20 years before we can fully say it is a beneficial treatment that is definitely worth the risks, so I will continue to treat well-informed patients, and monitoring them over the years. Photos are taken every year, and their experience and perception of their PWS taken into account.


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