Art or medicine? Japan's cosmetic tattoo artists in limbo

Ginowan, Japan — Tattoo artist Remy delicately injects pigment into Koki Hatanaka's bald scalp, creating the illusion of hair follicles. This gray area cosmetic procedure is increasingly scrutinized by Japanese health authorities who view permanent makeup as reserved for medical professionals. Japan stands apart from a global trend, imposing severe consequences on those who practice it without proper licensing, including 44-year-old Okinawan Remy.

Industry insiders claim their craft—ranging from fake hair to filled-in eyebrows and lip tints—is more akin to tattooing and hairstyling. However, in a nation where body art is synonymous with yakuza gangs, skepticism persists regarding the safety and sanitary protocols of these cosmetic tattooists. Remy, when asked why the authorities persist in labeling their work as medical, expressed confusion.

Scalp micropigmentation (SMP), a painless procedure requiring technical skill, aids clients who have lost hair due to alopecia, boosting their confidence. While the Japanese Supreme Court ruled decorative tattooing non-medical in 2020, the same does not apply to SMP, which has historical ties to medical involvement. The ministry has warned that criminal complaints can be filed against unlicensed practitioners, which has reportedly led to a chilling effect on the industry.

Nonetheless, unlicensed cosmetic tattooists continue to operate openly, often attending conventions hosted by Remy's SMP brand in Okinawa. These tattooists argue that permanent makeup is even less medical than artistic tattooing due to shallower penetration of the skin. Tatsuki Miyahira, an Okinawa tattooist who also performs SMP without a medical license, defended his practice and insisted he would demonstrate his safety measures if raided by authorities.

Despite the lack of legal endorsement, SMP business operator Yasuaki Sameshima believes official recognition could boost the industry's credibility. However, Remy advocates for standardizing licensing and training for all tattoo artists, both cosmetic and medical, to protect clients and ensure proper hygiene standards.