You’ve had the surgery, the swelling’s gone, and your results are settling in, but there’s one final detail that can really complete the transformation.
Vanessa Dougherty is a tattoo artist who specializes in scar camouflage and restorative micropigmentation. She works closely with plastic surgeons to help patients take their results to the next level using color, care, and craft.
Vanessa shares how she got into medical tattooing, why technique and color matching matter so much, and how every procedure has to be tailored to the individual. It’s not just about hiding scars; it’s about understanding skin tone, selecting the right pigments, and applying them with expert precision.
Timing is important. You’ll usually want to wait about a year post-surgery before starting, and expect at least two sessions, plus a possible touch-up later. Results can last anywhere from two to five years.
Aftercare is also a big deal. You can’t get a tattoo and head straight to the beach! Proper healing makes all the difference in how the pigment holds up.
From recreating nipples after mastectomy to blending facelift or breast lift scars, Vanessa sees how this final step transforms not just the body, but how people carry themselves.
Find out what to expect in terms of pain, cost, and results—plus how to find a truly qualified medical tattoo artist, and why she believes this should be part of the standard aftercare plan for surgical patients.
Links
Learn more about Restorative Permanent Makeup
Follow Vanessa on Instagram @restorativepmu and TikTok @restorativepmu
Subscribe to Vanessa’s YouTube channel @restorativepermanentmakeup
Learn from the talented plastic surgeons inside La Jolla Cosmetic Surgery Centre, the 12x winner of the Best of San Diego and global winner of the 2020 MyFaceMyBody Best Cosmetic/Plastic Surgery Practice.
Join hostess Monique Ramsey as she takes you inside LJCSC, where dreams become real. Featuring the unique expertise of San Diego’s most loved plastic surgeons, this podcast covers the latest trends in aesthetic surgery, including breast augmentation, breast implant removal, tummy tuck, mommy makeover, labiaplasty, facelifts and rhinoplasty.
La Jolla Cosmetic Surgery Centre is located just off the I-5 San Diego Freeway at 9850 Genesee Ave, Suite 130 in the Ximed building on the Scripps Memorial Hospital campus.
To learn more, go to LJCSC.com or follow the team on Instagram @LJCSC
Watch the LJCSC Dream Team on YouTube @LaJollaCosmeticSurgeryCentre
The La Jolla Cosmetic Surgery Podcast is a production of The Axis: theaxis.io
Monique Ramsey (00:03):
So you've had the surgery, the swelling's gone down and your results are settling in. But there's one final detail that can make all the difference. Enter Vanessa Dougherty, a tattoo artist who specializes in scar camouflage and restorative micro-pigmentation. Today she's sharing how color care and craft come together to help people truly complete their transformation. Welcome, Vanessa.
Vanessa Dougherty (00:27):
Thank you so much. I'm so glad to be here.
Monique Ramsey (00:29):
Well, I'm so glad to have you here because this is a topic that a lot of people want to know about. None of us can predict maybe how perfectly we're going to scar after a surgery or even what's the world of permanent makeup and medical tattooing. A lot of us don't know a lot about it. I think we know it when we see badly done work.
Vanessa Dougherty (00:53):
Yes. You know when it's not it. Yeah.
Monique Ramsey (00:55):
Right. When you're seeing a bad facelift or where it's just too much, something's wrong. But I think beautiful work what you do. I saw the pictures and we're going to talk about it. It's really special. And I mean, you are an artist, so how did you first get into the world of medical permanent makeup and tattooing?
Vanessa Dougherty (01:17):
It's so interesting because it wasn't like I, as a little girl was like, I want to do medical tattoo and I grow up. You know what I mean? But I've always been artistic. I've always been an artist. And even in high school I was always bringing my friends home and doing their makeup, and I would get in trouble in class because I'd be tweezing eyebrows and doing makeup in school when I wasn't supposed to be. I did get some scholarships for art in high school, and so I did a little bit of art school, but I ended up getting a job while I was in school, at a makeup counter and fell in love with the way I made women feel about themselves. Being able to take somebody and just turn their day around by just helping them with their makeup. I loved it.
(01:58):
So I actually dropped out of school and I just became a professional makeup artist, and that's when I started to notice permanent makeup on people. And my initial reaction was like, this is hideous. Who would do this? This is so ugly because 25 years ago it was mostly hideous and artificial looking and unnatural. And I thought, who would do this to their face? Oh my God. But I realized that there was a need for it because time after time my clients would say, oh God, I just wish you can come over every morning and put my eyebrows on for me. I wish you could do my makeup for me every day. You do such a great job. And I excelled at makeup because of the artistic ability that was innate, that I'm just naturally talented. And so I was like, okay, well maybe I do want to learn how to do that.
(02:46):
And so I ended up, my first husband, when I dated him, he ended up living across the street from a woman who did permanent makeup. And she was actually kind of a pioneer because she actually did a bit of medical tattoo. Well, and this is when nobody was doing anything like that. And so I took her class and then after her class I was like, I'm not ready to take clients. So she's like, go ahead and you can work with me, you can be my assistant. And so I was her assistant for about a year.
(03:15):
So I watched her work on clients and then she very quickly threw me in and was like, I don't want to do any touch-ups. I really don't want to work on people. I just want to market to people and let you do it all. So I was like, it was the best practice probably a person could have. But I realized that what I was learning from her was a very limited and just sort of scratching the surface on what tattooing really is. At that time, she just had one little machine and one little needle, and that was it. There was no real in depth knowledge of tattooing. So I decided, well, I need to learn how to be a tattoo artist because I want to get realistic results. I just kind of set an intention. I need to learn how to tattoo, but I knew nothing about how to getting into that field.
(04:01):
And then a friend of mine, we were out and she said, Hey, I want you to meet somebody. And she pulled me across the bar and sat me down with this guy covered head to toe with tattoos, and he turned out he managed a tattoo shop and he said, she told me that you do permanent makeup. And I was like, yeah. He said, people call the shop all the time wanting it. Would you come do it for us? And I was like, well, yeah, I'll do that for you, but I'd also really like to learn how to do body art and learn how to do tattoos. And so he said, well, yeah, totally. Come on in and we'll do it. So I ended up becoming a body art tattooist alongside being a permanent makeup artist. And I really think that helped me understand the tools, understand the technicalities of tattooing.
(04:46):
And then shortly after that I got an opportunity to work in a plastic surgery office, and they were just wanting a permanent makeup artist, I think. But the surgeon started to come to me and say, Hey Vanessa, do you think you can add a little color back into this areola that didn't heal very good? Or, Hey, Vanessa, I got this patient who has a bad scar. Can you mix some skin tone and put it in there? And so that was really powerful for me because I had this surgeon who would just give me, it was experimental at that point because I hadn't really had anyone teach me how to do that. It was a lot of trial and error at that time. But I'm always grateful for that opportunity that I had.
Monique Ramsey (05:32):
That moment where you kind of were able to say, oh yeah, I want to do this and make people pretty, but also making people pretty in a restorative way or scar camouflage and other things. So you've been working with plastic surgeons for 15 years, that collaboration, I'm sure you probably do to how good you are at what you do get a lot of word of mouth referrals.
Vanessa Dougherty (05:57):
Yes.
Monique Ramsey (05:59):
And how has that evolved over time when you started doing this more restorative work to now?
Vanessa Dougherty (06:07):
It's evolved so much, and I think that also because I'm an artist, I'm always striving for perfection and I'm always trying to be better and better and better. And there was a lot of trial and error in the beginning where I pulled from my makeup artistry background to be able to see skin tones. And then I pulled from my tattooing background and being able to know how to use my equipment and knowing how to implant pigment into skin. But there was trial and error in the beginning with sometimes it would come back and the color had changed or it didn't blend as well as it needed to. So I tried a lot of things and I really fine tuned what I do to where now I really have it on lock. I really know how to get those results, like diluting pigment, knowing how to neutralize pigment, knowing what needles to select.
(06:57):
And I think a lot of what a lot of people don't realize is that just like any skillset, there's all these little details that you kind of have to know so that you can see a scar or situation and know, okay, I'm going to use this needle because of this reason and I'm going to use this color because of this reason. And so I really think that's something that just came with years and years of doing it over and over again and never quitting on. I had a couple situations early on that were so life-changing for people, and I have the before and after photo of one of 'em that I sent you guys, but this gal came for lip blush and she had had over 20 surgeries on her mouth. She was born with a cleft lip and palette and with makeup on, she passed as normal, you know what I mean, with makeup on, she was like, I can get it by. But without makeup on her skin, it was just so uneven. I think that on the bottom it was grafted.
Monique Ramsey (07:58):
Beautiful.
Vanessa Dougherty (08:01):
And she was getting married, and even her fiance had never seen her without her makeup on. She went to bed with the lipstick and had it on the bedside table and put the lipstick on before he woke up. He had never even seen her without her lipstick on. So I was like, that was the first time I'd ever had somebody like that. And this is years ago, I said, well, lemme give it a shot. And this is after one session, and she came in for her follow-up appointment and she said to me, Vanessa, you changed my life. At that moment, I was like, wow, this is more than just putting makeup on people. This can be more powerful than that for her to just have the freedom to get out of the shower in front of her fiance and not be like, where's my lipstick? I can't leave the house without my lipstick. Or I can't, someone as close as somebody you're getting married to, he still had not seen her. It just was so life-changing for her and that really made me want to focus on that kind of tattooing.
Monique Ramsey (09:01):
Yeah. Well, and so anybody who's in the audience, if you're listening, you need to come check out either on Spotify or on YouTube, you'll have the video. We have some the before and after on the screen for you. And that would be such an emotional moment to see that like, oh my gosh, and every day just to have that freedom of not having to worry about coming up with a way to present yourself to the world. And so is medical this restorative, permanent makeup, is it different than traditional cosmetic tatooing? Are there different techniques or tools?
Vanessa Dougherty (09:44):
I would say yes, it is a little bit different in the sense that you really do need to have a thorough knowledge of your equipment and your tools and your pigments because scar tissue behaves a little bit differently than normal skin. And let's say you are someone who just does lip blush and you went to a lip blush course, for example, and they just showed you one technique. And I hear this all the time from students where they're like, I've already taken classes, but they don't really have needle knowledge. They don't really, for example, a tattoo needle, there's three different measurements of a tattoo needle. You have the configuration, which is how many needles and how they're configured. And then you also have the needle gauge, which is how thick each individual needle is in the configuration. And then you also have the taper, which is how polished to a point that needle is. And so these are technical details that are barely starting to come to light in the permanent makeup world, but have been common knowledge in the body art world. You know what I'm saying, so it is getting better in permanent makeup, artists are starting to go like, oh, maybe I should use a different needle than this one needle that I use for everything. Because when I first trained in permanent makeup, yeah, she didn't teach us any needle knowledge. It was like you use one needle for literally everything.
Monique Ramsey (11:04):
Oh gosh.
Vanessa Dougherty (11:05):
And sometimes it would go well and you'd get a beautiful result, and then sometimes you'd be frustrated, but you really didn't know what was the problem. And you thought maybe it was the pigment, the pigment wasn't dark enough, I'm going to go darker. Or maybe you just didn't really know how to pivot and to change things and customize. I just started probably three years ago, I started working on my curriculums because I really saw a need for good education out there. Artists weren't able to get good education, and it's hard to get into body art. It's typically done through apprenticeship, and those apprenticeships are really hard to get and hard to find. And a lot of times they require people to work there as an intern almost full time. And a lot of times, even paying the artist who's giving you the apprenticeship or paying the mentors. A lot of people, they want to get into this business, but it's really difficult to get those body art apprenticeships. And in permanent makeup, it's sort of like the other spectrum where it's all just one day classes, a two day classes.
(12:08):
And so you have artists where they've got all these certificates, they've collected all these one and two day classes, and they're still going, I still don't know what I'm doing. I still am frustrated. I still need help. I still don't know why I get inconsistent results. So there's definitely, I'm trying to bridge that gap using my body art experience to kind of help artists who want to learn how to do this work but can't necessarily get a body art apprenticeship. So one of the things that is, it's good and it's bad at the same time because five years ago when I told people that I did medical tattoo, nobody knew what that meant. Nobody knew that you could camouflage a scar or that you could tattoo a 3D areola. And I will definitely say in this past year, it's definitely more and more people are like, oh yeah, I see reels about that.
(12:56):
Oh yeah, I've heard about that, which is amazing and awesome. But because of that also you have a lot of people who are thinking it's going to be easy to learn. And there's a lot of marketing out there for classes that are like, start making a thousand dollars a day. You only need to take this two day class. It's easy to learn and sort of gives you almost like it's promising you're going to be super successful right away. So a lot of people are seeing it as like, oh, I can just get rich doing this, or I want to make a lot of money. It's like a lot of promises. But then they get into it and they realize, oh, this actually takes work. I mean, it's like anything, 10,000 hours right before you're master anything.
(13:43):
What I would say is if you're looking for someone who knows how to do this, you definitely want to see before and after pictures that are theirs that aren't from a marketing company. That's not like we're all using these same before and after pictures that it's like they're genuine before and after pictures. Having a background in body art is awesome if they have that, and having some years of experience is essential because it's not easy to do it. I'm an artist and I've been doing it forever, and it's still not, I don't think of it as easy work because it has to be customized for each person. So you have to really know what you're doing to be able to customize every procedure.
Monique Ramsey (14:22):
Well, and I would think the skin on your face is different than the skin of a scar on your face. This breast, if you're trying to camouflage a breast lift scar or post mastectomy, recreate a whole areola and nipple complex. I mean that tissue is different.
Vanessa Dougherty (14:45):
It is different. It's compromised tissue. Sometimes we're working on breasts that have had radiation, totally different working on that than normal skin scars that are like contracture scarred from infections or necrosis. That's a completely different type of skin than a hypertrophic scar. And I have to use different tools to treat each one and even different pigment strength. So I might dilute for this type of scar, but I might use full strength for this type of one. And so that only really comes from doing it a lot of times and having gone through seeing the healed results and knowing how to adjust the results. And yeah, it is a specialty for sure. There is a company, I don't know if they call 'em a company. It's a nonprofit organization, and they basically vet medical tattoo artists so that the public can know that if they are certified through this particular nonprofit, that they are, I just got my board certification from them. So I'm really excited. And a lot of the artists that I respect that are doing beautiful work are board certified through them.
Monique Ramsey (16:04):
I think that's really important because it's going to set, just like for surgeons, it's going to set a certain amount of training, a certain amount of time and practice before you can get board certified and a certain amount of cases that you're going to have done and that there is some overarching guidelines for quality and for training. So yeah. Now tell me, let's say in the plastic surgery world for patients, what are the common types of medical tattoo that you would do? And then we can kind of talk about each one.
Vanessa Dougherty (16:43):
Yeah, so I do a ton of facelift scars, a ton of breast lift scars, tummy tuck scars, and I do a lot of hypopigmentation, so people that have been damaged by laser. So yeah, this is a good example of a hypopigmentation. So we were able to color match her skin really well and get great results with that. I think that's two sessions. So yeah, she was thrilled.
Monique Ramsey (17:10):
That's amazing.
Vanessa Dougherty (17:10):
And then even just the tattooing process is kind of like microneedling, so her skin even looks like smoother after the treatment, which I thought was a cool side effect.
Monique Ramsey (17:18):
Rejuvenation. That's a cool side effect. That's beautiful. That's beautiful. And then when she goes, let's say she's out in the sun, she gets tan, what happens?
Vanessa Dougherty (17:27):
So the area that has been camouflaged, it doesn't have melanocytes, so it's not going to tan.
Monique Ramsey (17:33):
It's going to stay.
Vanessa Dougherty (17:34):
It's going to stay the same color, but we always just tell people it's still better than paper white. It's still less of a contrast than it was if you hadn't had the pigmentation added. And I always say put sunscreen on anyways. It's a good practice to put sunscreen on, and it also, it's going to extend the longevity of the tattoo if you protect it with sunscreen.
Monique Ramsey (18:01):
And do you have people, let's say you have a consultation with somebody like this person here with hypopigmentation where that area is white. Do you plan ahead like, okay, are you tan most of the year? Are you not tan most of the year? Do you ever talk about a baseline of tan, I guess?
Vanessa Dougherty (18:22):
Yes. That's a really good question. So we always tell people you want to be your typical skin tone, so you don't want to be coming in right after vacation to Hawaii. So we just always say, what are your next couple months going to look like? Are you planning or did you go? We always just at the consult, we really talk about everything and we ask those questions.
Monique Ramsey (18:45):
Planning for, yeah, when is the right time to do this. Now walk us through if you could, let's say we're in the process of camouflaging a facelift scar. Where are those scars that people want camouflage?
Vanessa Dougherty (18:58):
So typically people want to be able to wear their hair up with confidence. They're like, I just want to be able to put my ponytail on when I go to the gym and not be self-conscious. And this is a pretty classic scar right here where it kind of goes along the hairline in the back. It kind of comes across to the ear and then it wraps around the bottom of the ear and then it goes across the front of the ear and then up into the temple area. So that's real classic. Her scar isn't bad when I look at her scar. I think you had a good surgeon. You know what I mean? This is pretty typical. Obviously no scar would be ideal, but I wouldn't consider this a bad case of scarring. Any area that is hypo pigmented that doesn't match the rest of the skin, those are the areas we're going to treat.
(19:45):
I do have a process of matching the skin tone, and so I have a skin tone, I have lots of skin tone pigments, and then I also have pigments that are sort of for neutralizing and adjusting those pigments. Typically mix two to three pigments together. Don't usually go more than that. Occasionally a fourth pigment, but usually it can get it with two to three pigments. And the machine movement that I use is a very specific type of movement, and the needle that I use is a very specific type of needle. And then there's dilution involved. So the pigments that I'm using are like body art grade pigments, which means they have a really super high pigment load and they are meant to last. They're not semi-permanent. Like a lot of times you might hear with permanent makeup this is semi-permanent. So the pigments that I'm using are more permanent.
(20:40):
And so because of that, we want to be very careful with them. You don't want to put too much in, you don't want to saturate that scar. You don't want to end up with a brown line. So I dilute them into a watercolor kind of texture, and I stipple the pigment in so that it doesn't look solid because if you have just solid color, that also looks unnatural. So it's a process of layering these stippling, this pigment in kind of a blotchy way, but it looks more human looking than if you were to just try to color it all in a coloring book. So it's a process that I developed over years of doing this so that I find that it works the best. Also, scar tissue doesn't take the pigment as easily as normal skin, so we have to use a certain process to make sure that it holds.
(21:28):
And I'd always rather err on the light side. A scar like this, I usually have them come in twice. So the first time I'm doing the color matching and I'm matching it as perfectly as I can, and I'm using shear pigment and I'm stippling the pigment in, but I'm going on the lighter side because I want to see how that scar handles the color. Sometimes people come back and they're like, oh my god, it's amazing. I can't even see it. It's perfect. And sometimes people come back and they're like, I still see it a little bit. I'd much rather have to add a little bit more than have to try to remove pigment because I went overboard.
Monique Ramsey (22:05):
Now what is the healing in terms of what does that look like? So let's say the lady that we saw with a facelift scar, she'll come in, she'll have you treat that scar. Is she having a lot of, I don't know, home care type things that she needs to do? And if so, for how long?
Vanessa Dougherty (22:27):
It's pretty minor. We are breaking the skin with the tattoo needles, so you do want to not expose it to bacteria, things like that. You don't want to get sweaty and you don't want to go swimming in the ocean or go surfing or something immediately after because you don't want to introduce any bacteria to the area. But scar tissue especially does tend to swell and puff up a bit for the first few hours. So I always tell people you might not want to make social plans immediately after, if it's in an area that really shows. Now, if it's around the ear, you can just wear your hair down, it's fine, but it is going to puff up a little bit and it is going to get some redness in it a little bit, and that's all totally perfectly normal. And then after that, it's pretty minor care.
(23:12):
I give them an ointment to apply. I tell them that they can wash the hair the following day, but the day of to just kind of leave it alone. And usually it's like maybe get a little bit crusty, a little bit dry after a couple days, but most people find that it's super easy healing. You do want to keep it clean though. Just like any wound, you want to wash it every day and the ointment is just going to make it so it doesn't itch and you don't end up scratching at it. So it takes about, I would say five to seven days for the skin to turn over and about two weeks before you can put it in the sun and stuff like that.
Monique Ramsey (23:49):
Now, if they're going to have two sessions, when is session number two?
Vanessa Dougherty (23:55):
So I like six weeks. There's a reason why the skin has to turn over, but then also the pigment molecule itself. So we actually are injecting pigment into the top layers of skin. So it is a particle that we're implanting and we want to give that particle all the time. It needs to settle where it's going to be permanently. So if you try to treat a scar, and this goes with permanent makeup as well, if you try to treat it too early, sometimes you can end up too saturated down the line because the pigment really, that particle really needs a minute to find its place in your skin and to make its home there. And you also, you want that skin to be fully recovered. You don't want it to be sensitive or tender or painful if you go into it before, it has had a chance to not just heal on the surface, but the deeper layers to finish healing. And then with the needling at all, I mean, I'm sure you guys do microneedling in your practice, but
Monique Ramsey (24:54):
In the med spa, yeah.
Vanessa Dougherty (24:54):
Yeah. So microneedling is wonderful for smoothing skin out and promoting collagen production and all these things. We want to give it the skin a chance to have that process as well. So a lot of times when we're working on scar tissue, just the needles alone can help to relax and smooth and flatten the scar. Or if the scar is a little bit depressed, it might puff up a little bit. So we want to give the skin all the time. It needs to have that full process happen before adding more color.
Monique Ramsey (25:22):
Now in the same case, let's talk about the patient who's had a facelift or even a breast lift or breast reduction or tummy tuck. I'm sure doctors, maybe they're not happy with their scar, the patient, but the doctor's not going to want them to do anything until it's fully healed. And so when about if they're thinking about having a little revision with the medical tattooing, how long do they need to wait before they treat it? Maybe it'll fix itself?
Vanessa Dougherty (25:53):
Yeah, 100%. Yeah, this is a really great question because people will come in too soon a lot for consults and we'll be like, it's not ready yet. So you want that scar to have settled. So if there's red or purple tones in the scar, it's still healing. We generally tell people one year is a good time to have the scar treated or if their plastic surgeon gives them the, okay.
Monique Ramsey (26:23):
Now, in terms of, you're talking about matching the pigment precisely to the skin, do you see that as more of an art or a science to getting that perfect color for that patient?
Vanessa Dougherty (26:36):
I feel like tattooing especially, I mean I think all tattooing is art and science mixed together, but especially restorative tattooing, it is so technical and there is so much chemistry involved and technical aspects involved, but it is also an art in that you have to be able to see color and the more you look at pigments and matching pigments, the more you can see it. So practice really does make perfect in this case, because if I was to hold up some skin tones, people would be like, they all look beige, but I can see this one has a purple, this one has a green, this one has a yellow, this one has. You know what I'm saying? And that just is a trained eye that looks at it and looks at it and looks at it all the time. But I would say it's a real mix of both.
(27:24):
I mean, obviously different pigments behave differently. So when you really break down what a tattoo ink is, is it's like a powder pigment mixed with a carrier fluid. So that's why we shake the bottles up. So it disperses the powder pigment evenly throughout the pigment, but it's definitely science, like some pigments, like titanium white for example, it's going to be a larger molecule. It's going to last a really long time in the skin. It's almost like the body's never going to get rid of it. Black is your body's never going to get rid of black, but all the other colors in between have different shelf life, I guess you could say in the skin. Some are going to fade really quick and some are going to last a lot longer. So when you are creating a pigment for someone, you want to make sure that it ages well, that doesn't just look good immediately after, but that it ages well and that you're not left with yellow tones or gray tone, or orange.
Monique Ramsey (28:23):
I've seen some scary things.
Vanessa Dougherty (28:24):
Yeah, exactly.
Monique Ramsey (28:26):
Yeah, over time. Yeah. So that's where, to me, it's not just knowing somebody who's technically proficient at making it look good, putting it in the lines, the coloring in the lines the right way, but it's also the color that in three years, is it going to be this weird orangey mess that that's like, no, I don't want that. Then you're almost in worst spot that you were beginning.
Vanessa Dougherty (28:52):
100%. And when I was first taking this on 15 years ago, I had a couple situations where I was like, I don't want to do this. It's too hard. The stakes are too high, the stakes are too high. If it doesn't go right, then you just made a scar uglier.
Monique Ramsey (29:10):
Okay. I don't even remember what it was that I read. I read all kinds of crazy stuff all the time. But there was something, they were talking about these different pigments that might have toxic properties, like metals in them or other things that we wouldn't want. So how is that true, first of all? And I guess how do you prevent?
Vanessa Dougherty (29:34):
I think when tattooing first became popular, I mean, tattooing is kind of relatively new stuff. Permanent makeup is kind of new. Not very many people heard of permanent makeup 20 years ago even. And body art too, it's mainstream now and it's a lot more popular than it was 30 years ago. But essentially tattoo artists used to, in the seventies or whatever, sixties, fifties, they used to have to make their own pigments. And so they would order pigment powders from the same suppliers that order pigments for ink, for whatever newspapers. They're all sort of going to these same pigment suppliers and buying pigments and hand mixing. So at that time, the pigments came from the earth. They came from minerals in the earth and things like that, and there probably was some toxicity to that. But nowadays it's so streamlined and everything's so controlled when it comes to body art pigments, most pigments that I use are all made in America, and they have a medical grade testing process and everything's made in the laboratory, so they're not going and getting pigments necessarily from mines and things like that like they used to. So it's very, very, very unlikely that there's anything toxic or any heavy metals in the pigments.
Monique Ramsey (30:57):
Yeah. Well, it's funny, cuz we think about what we put in our mouth for food, and it's like in the same way you're putting something in your body, and if that's something you care about
Vanessa Dougherty (31:08):
100%,
Monique Ramsey (31:09):
You want to make sure that, okay, I'm going to have this in my body and for how long and is that safe? And so I think that's a fair question.
Vanessa Dougherty (31:17):
It's such a fair question. And the answer is that modern pigments do not contain heavy metals, and we're also diluting the pigments for medical tattoo. So it's such a tiny amount of particle that's actually even going into your skin. I think you probably get more poison eating almonds.
Monique Ramsey (31:41):
You heard a hair first people,
Vanessa Dougherty (31:42):
I was like, would they have arsenic or cyanide or something? And I'm like,
Monique Ramsey (31:46):
Right, yeah, no,
Vanessa Dougherty (31:47):
Almond milk is more toxic than this probably.
Monique Ramsey (31:51):
So switching over to the emotional aspect, what kinds of emotions do clients bring into your space after surgery and where are they? And then how does that scar camouflage that you're doing help their self-esteem after?
Vanessa Dougherty (32:06):
Oh, honestly, it's amazing to see people. We've actually had people where their personality changed after working with them where they had a, I don't know how to explain it, but the shoulders were hunched and they were a little bit more like this. And then after we restore their areolas or fix the scars, they're just confident and standing up straight and emanating like a whole nother energy, which is really cool to see. We get tears all in the chair, people see their results and we're all crying. That's really common. That happens daily. I would say a lot of times when it comes to mastectomy work that we do a lot of mastectomy work. I would say people just want to put it all behind them. It's a traumatic experience going through something like breast cancer and mastectomy, and a lot of times they've had multiple surgeries and they're just so done with it all, but every time they get out of the shower and pass the mirror, it's a reminder constantly that they went through that. It's like an open wound that never can heal. And so when we put their areolas back on, they're like, I can just move on from this now. I can finally be complete. I can finally put this behind me.
Monique Ramsey (33:27):
Wow.
Vanessa Dougherty (33:27):
Yeah, so that's really powerful.
Monique Ramsey (33:29):
If you're listening, you got to switch over. But yeah. Wow, beautiful.
Vanessa Dougherty (33:33):
Thank you.
Monique Ramsey (33:33):
Absolutely beautiful. And I can't believe that what I'm looking at is flat. It's flat, right?
Vanessa Dougherty (33:40):
Yeah.
Monique Ramsey (33:40):
That's insane. Oh my gosh, incredible.
Vanessa Dougherty (33:45):
Thank you.
Monique Ramsey (33:46):
Yeah, and would totally. I think there's no way that that person isn't completely changed after that
Vanessa Dougherty (33:56):
100%.
Monique Ramsey (33:58):
That's incredible. So if you were to give advice to a patient who's thinking about whether it's just lip blush or some eyebrows or that they're looking at some medical tattooing for post-surgery, how would you give them advice for what to look for, how to approach it, what mindset even to come into it with?
Vanessa Dougherty (34:26):
Well, I would want that they were at least a year healed from whatever surgery they had, obviously. But if they're looking, I mean, if they don't want to come to me, then if they're not in my area or whatever, I would say, I would ask their plastic surgeons. And I know a lot more plastic surgeons need to find good people in their area that they can refer to. So that's something that we've been really working hard to become in the minds of all the plastic surgeons. They know we exist because how do you refer to someone good if you don't even know they exist?
(34:59):
And for a lot of patients too, they're like, it was hard to find you. And I'm like, what do you mean? They're like, nobody knows about that. They couldn't get a referral from anyone. Nobody really knew. Yeah, we know that that can be done, but we just dunno who's good at it. And so they just had to Google and ask chat gpt. And luckily our SEO is getting a lot better than it used to be. So people are finding us. But I would say if you're looking for an artist looking for board certification is awesome. That's going to be mean that somebody vetted them and made sure that their work was good and authentic and that they had the experience needed. So that's one way. I would also, you want to see before and after pictures that are theirs not reused. And that's been something that we've had to put our watermark on all of our photos because that is something that happens a lot where people see good before and after pictures and they try to pass 'em off as their own. So make sure you're seeing authentic before and after pictures and then that the person has a background of some sort and artistry that they have an artistic ability. I think that's really important because it is an art and you should have artistic ability, I think to be good at, to excel at it. I really do think that is important as well.
Monique Ramsey (36:14):
And you're really looking at, there's before and after in plastic surgery and patients always want to see before and afters and yours is like the after an the after. Right. And then I would assume that at the consultation you can help explain the process to people and maybe show some before and afters or even a progression here. She was after the first treatment here, she was after the second. Because that's the other thing, I think when patients can know what to expect.
Vanessa Dougherty (36:47):
Having a realistic expectations is important too. And that this is a sessions thing that you're going to have to at least commit to two sessions that is not just going to be a one and done situation. And I think a lot of people think too that tattooing is just putting makeup on. They don't realize that there's aftercare involved that they're going to have to avoid swimming. You'd be surprised at how many people book treatments online with us and they're like, I thought it'd be great to get my lips done right before I go on vacation, so I don't have to put my makeup on. We're like, are you going to be in the sauna? Are you going to be swimming? Are you going to be drinking? You can't do any of that when you're healing, so let's reschedule.
Monique Ramsey (37:25):
Right.
Vanessa Dougherty (37:26):
So I think understanding that it is a procedure, it's not just makeup. It is a procedure and you are going to have, your skin is going to be broken and there's going to be some healing and there might be a little swelling. And results you really have to trust the process because sometimes results you need to wait and see a little bit. In our lobby, we have binders full of before and after pictures for each thing we do. So we like a permanent makeup before and after, breast reconstruction before and afters, and then scar camouflage before and afters. We have binders full of before and afters in the office, and then we also have a gallery on our website. And then we obviously on Instagram and YouTube and TikTok, we're posting all the time or before and after. So we really want people to understand the process. We show the process. We have videos where we show a time lapse video of the process, but it's not painful if you're wondering if it's painful, we use.
Monique Ramsey (38:21):
Yeah, that was one of my questions. Everybody, I don't know, I have no tattoos, but I have thought about having some things fixed a little bit and altered or emphasized, and it is kind of like, how much pain am I going to be in? If you've never had that done before, what do you do to make people comfortable?
Vanessa Dougherty (38:41):
So we do use a prescription topical numbing cream, and it works great and no one is really in major pain when we work on them. The lips I would say, and lips are a little bit more sensitive, and we're right next to Dr. Norland, so we could always get a dental block from them.
Monique Ramsey (39:01):
Oh, that's nice. If the person really is having kind of,
Vanessa Dougherty (39:04):
If somebody's like, listen, I know I'm sensitive, I know I'm a big baby, I don't want to feel a thing. Then we'll say, alright, we'll schedule a dental block and then a
Monique Ramsey (39:13):
Smart idea.
Vanessa Dougherty (39:14):
We also have a nurse practitioner who can come and give a dental block, and so we can arrange that sort of thing for you if you're worried about pain. But eyebrows, eyeliner, scars and areola work pretty painless. People do not complain about being in pain at all. They're like, this was easy. And people are always shocked. They're like, I thought this was going to hurt so bad. And we're like, no, it doesn't have to hurt.
Monique Ramsey (39:38):
Yeah, that's nice. Now how much can somebody expect to pay for any of the services that you offer?
Vanessa Dougherty (39:46):
Yeah, so I would say probably anywhere from 500 to a thousand per treatment depending on what we're treating. And then sometimes if it's something that I've done a lot of, I mean I've done a lot of everything, but if it's a scar that I see a ton, like facelift scars, I usually can get most of it in the first session. And then I just like the second session for a follow-up. And so the first session might be a thousand and the second session might be like 500 follow-up. So usually around that kind of pricing, so anywhere from 500 to a thousand per treatment is pretty standard.
Monique Ramsey (40:21):
Now let's say the person is 35 and they had a breast lift and their scars are a little bit white or just not perfect, and you do your two sessions. Let's pretend in 10 years or 15, no, she's 35, so now she's 45, 55. Will she need a touchup and/or when?
Vanessa Dougherty (40:42):
I would say it's going to last two to five years, and so within about two to five, but it'll never go back to being sheet white again. It's just going to be starting to break up the pigment. When it ages, it just starts to break up a little bit. So you might just start noticing little holes in this camouflage that we just need to address. So I would say two to five years probably. And everybody's different. I've had facelift scars where they're like, it's lasted five years and they don't hardly need a touchup the whole time. And then I've had people where after two years they're thinking I need a little touchup. And it really depends on the person and everybody's body is different, and some people metabolize pigment faster. And it's also like your lifestyle if you're in the sun a lot, UV breaks down pigment faster. So if you are always tanning and you're always in the sun, chances are you might need to touch up more often. I would say definitely at least a minimum of two years is pretty standard.
Monique Ramsey (41:38):
That's nice. That's a long time. And when they need it touchup, is it sometimes the whole treatment again or is it literally a touchup?
Vanessa Dougherty (41:48):
It really just depends. Sometimes the whole thing needs to be done again, and sometimes it is just a matter of adding just a little bit and we price accordingly. If it's a whole treatment, again, we might charge you close to what a new treatment is, but a lot of times we just kind of charge you based on how much work needs to be done. So I would say a yearly touchup for eyebrows for example, is usually like 600, but the initial service might be anywhere from 800 to a thousand depending on what technique and what artists. So I am the expert at medical tattoo, and I do own my business, but I have trained a couple girls to work with me and under me. And so our pricing might differ just because they don't have the 25 years experience. They have three years experience. You know what I mean? If somebody is budget conscious, we have an option for you. We also do classes and we need models all the time for people that really, really can't afford treatments. We offer free treatments for people who are modeling for us, you just have to be okay with four students watching and possibly filming and pictures being taken and all that sort of thing. But if you're somebody who's like, I can't afford anything, but I really need this, still come and reach out because we can always use you as a model.
Monique Ramsey (43:12):
That's good to know. Now, if you were going to tell a plastic surgeon out there or a patient one thing about medical tattooing and scar camouflage, what would it be?
Vanessa Dougherty (43:23):
That their patients need it. That we exist. We exist, we want to help. I feel like it should be part of the aftercare protocol. I feel like our brochure or our cards should be in the bag that goes with you home. I feel like it could be even brought up during consults when someone's really worried about scarring. You can say, it's all right, we can fix that too. We have a great referral. We know someone that can handle that. So I think that for a lot of people, they might hesitate having surgery, so worried about scarring, and so having us in your back pocket is really going to help you put your patient's mind at ease. When it comes to scarring, I work with a lot of plastic surgeons, and it doesn't matter if you're the best plastic surgeon, people are people and some people are going to scar and you're going to have those situations where it'd be nice to just say, Hey, we know someone who can handle that for you.
Monique Ramsey (44:23):
Exactly. Exactly. Where do you see the future of restorative tattooing heading in the next five or 10 years?
Vanessa Dougherty (44:32):
Actually, I just got the chills because this has been one of those things for so long where no one has ever heard of it. If I tell people I do this work, they're like, what is that? And I really, it's coming to the surface now. It's getting into the mainstream consciousness. You're just going to see more and more and more of it. I really think eventually it'll be incorporated into just part of the patient care, especially with any kind of reconstructive stuff. I see a lot of people that have had car accidents, been bit in the mouth by dogs. I have surgeons that do a lot of mouth reconstruction, facial reconstruction, and then so the lip is uneven or the whatever they're sending 'em to, the eyebrows missing in one part. I think that this industry is just going to grow and grow and that the mainstream is going to be knowing what it is. Just like everybody knows what microblading is now everyone's going to know what this is eventually.
Monique Ramsey (45:37):
And is there anybody who's not a candidate for this? I mean, obviously they have to have a scar or something they want to improve, but is there anybody medically that you would say that's maybe you're not the best candidate.
Vanessa Dougherty (45:52):
You really do need skin that can handle the treatment, that can absorb the pigment? So I have had people with skin that just is too damaged to work on because if you even put a needle on it, it instantly starts to bleed. So I obviously can't treat someone's skin if it's not healthy enough. So that could be ages could be a factor. Medical conditions could be a factor. If someone's on Accutane, we definitely cannot tattoo their skin. So I would say anything that if somebody's maybe really bad diabetes and they don't heal properly, we don't want to tattoo them. And I'm pretty honest and straightforward with people. And if they're not a good candidate, I'll tell me this isn't for you. Probably not, but most people are candidates.
Monique Ramsey (46:40):
Well, that's good to know. And so Vanessa, thank you so much for this. This is very enlightening and it gives, I think for me, there's such a hopeful aspect so that you went into the surgery, maybe your scars just your body doesn't do what you thought it would do, and you want a little something tweaked. It's nice to know that you exist and that you're close by. You're right on Prospect Street in La Jolla and that they can come to you for sound advice and have talk about it and look at the before and afters and really understand what the process is. Because you don't have to live with subpar scars, right?
Vanessa Dougherty (47:27):
100%. Oh, it happens all the time where people are like, oh my gosh, I've been living with this for this long and I could have had it done this much time. How did I not? It is a really amazing, and when it's done properly, it really doesn't look like it's ever been done. So it's just like good plastic surgery, right? Good plastic surgery, good Botox, good filler. If it's good, no one would know. Nobody knows.
Monique Ramsey (47:50):
Right.
Vanessa Dougherty (47:51):
And that's how I feel about this. When it's done properly, no one will know. It looks natural. It looks really natural.
Monique Ramsey (48:00):
Well, like I say, I am going to be trotting down the street. Come see you.
Vanessa Dougherty (48:04):
Come see me, please. Come see me.
Monique Ramsey (48:06):
Yeah, so well, for everybody listening or watching, we're going to put her links in the show notes, and while putting in all your social media links and your YouTube channel, you can learn a whole bunch more about what Vanessa and her team do to help people. But it's one of those things that I remember when we first moved into the Ximed building in 1996. We had an aesthetician who worked for us, and she was doing medical tattooing, and she was then teaching. She ended up leaving because she went to go do that.
(48:41):
She did really nice work, but that was a long time ago. That's 30 something years ago. And really looking at your before and afters, it's like, wow, we have come a long way in terms of the techniques, and it's nice for people to know that they have this option. Well, thanks Vanessa.
Vanessa Dougherty (49:04):
Thank you.
Monique Ramsey (49:04):
We'll put everything in the show notes for everyone, and so if you have any questions, just shoot her a message because we'll have all her links and you can get into her DMs and send her a message and set up an appointment.
Vanessa Dougherty (49:17):
Thank you so much. I've really enjoyed this. I really appreciate you taking the time. Thank you.
Monique Ramsey (49:23):
Likewise. Likewise. Okay, thanks.
Vanessa Dougherty (49:25):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment, or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego Freeway in the Ximed Building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com or follow the team on Instagram @ljcsc. The La Jolla Cosmetic Podcast is a production of The Axis, theaxis.io.

Vanessa Dougherty
Medical Tattoo Artist
Vanessa is a tattoo artist who specializes in scar camouflage and restorative micropigmentation. She works closely with plastic surgeons to help patients take their results to the next level using color, care, and craft.