Tattoo artist Remy painstakingly injects tiny dots of pigment into Koki Hatanaka’s bald scalp to mimic hair follicles, performing a grey-zone cosmetic procedure increasingly in the crosshairs of Japanese health authorities.
Japan bucks a global trend by viewing permanent make-up as the domain of medical professionals, and has ramped up threats of criminal prosecution against anyone else who practises it, including the 44-year-old Okinawan artist.
Industry insiders insist that their craft, from make-believe hair to filled-in eyebrows and lip tints, is an artistic pursuit more befitting tattooists and hairstylists and hairstylists. However, in a country where body art has long symbolised yakuza gangsters, these cosmetic tattooists’ safety and sanitary protocols are not enough to dispel scepticism.
“It’s a complete mystery to me why they keep saying this constitutes a medical practice,” Remy told the media while inking 28-year-old Hatanaka. He argues that scalp micropigmentation (SMP) is “hardly invasive” and “so painless that clients sometimes even fall asleep,” while requiring sophisticated aesthetic talent.
For Hatanaka, the procedure was life-changing. A sudden onset of alopecia had plunged the marine sports instructor into despair. “I didn’t even want to go outside,” he said. “If I hadn’t done this, I wouldn’t have become brave enough to strike up conversations with strangers. I’m more confident in myself now.”
A landmark 2020 Supreme Court ruling declared traditional decorative tattooing a non-medical act, providing relief to artists without clinical training. However, the health ministry maintains that SMP is different because it has “an established history of doctors’ involvement,” according to an official.
The ministry argues that using needles makes it a “risky enough practice that it can hurt human bodies if done without medical expertise.” They have repeatedly warned that criminal complaints can be filed against unlicensed practitioners, which healthcare law expert Akihiro Saotome describes as “essentially signalling arrest,” noting a “significant chilling effect” on the industry.
Despite these threats, unlicensed cosmetic tattooists continue to operate openly. Last month, they gathered at a convention hosted by Remy’s brand, Scalp Ink, in Okinawa. Specialists from South Korea, Vietnam, and Sweden demonstrated their techniques, arguing that permanent make-up is less invasive than decorative tattooing and follows identical hygiene safeguards.
“I’m doing nothing I should be ashamed of,” said Tatsuki Miyahira, an Okinawa tattooist who performs SMP without a medical licence. He noted that if raided, he would offer authorities a full tour of his workplace to demonstrate his safety precautions, adding that official recognition of SMP as art would allow him to “hold my head even higher.”
Japan and South Korea were long among the few nations penalising non-medical permanent make-up, though Seoul passed a law last year decriminalising the practice. “Why is it only Japan that still can’t do this?” asked hairstylist Michiko Shinmasu, who also performs eyebrow tattooing.
Shinmasu noted that the lack of legal endorsement makes clients feel they are doing something wrong. “They’re like, ‘this is grey-zone, right?'” she said. Some observers believe Japan’s complicated history with tattoos—historically associated with criminals and yakuza rebels—fuels official distrust.
While public attitudes are shifting and tattoos are becoming more common for fashion, they remain banned in many public spaces like hot springs. SMP business operator Yasuaki Sameshima, 41, campaigns for systematic accreditation for all tattooists. “Every country has some kind of licence specifically for doing tattoos, but Japan hasn’t created that,” Remy added. “I believe that’s the best way to protect clients and to ensure that tattoos are done under proper hygiene management.”
Otherwise, they said, both follow the same hygiene safeguards, use needles to insert pigment into human skin and are practically indistinguishable.
“Why is it only Japan that still can’t do this?” asked hairstylist Michiko Shinmasu, 50, who doubles as an eyebrow tattooist.
“Nowadays lots of people get their bodies inked just for fashion” in Japan, SMP business operator Yasuaki Sameshima, 41, told the media.
Dozens of beauty specialists, including from South Korea, Vietnam and Sweden, deftly inked the scalps, eyebrows and lips of their models, surrounded by towering banners depicting each participant as oceanic royalty in coral crowns.
I think their negative image is spilling over and shaping the way SMP is perceived today.”
Despite repudiating medical control on his profession, SMP guru Remy agrees it risks infections if done poorly, warning against a completely unregulated approach.
He founded the Japan Tattoo Hygiene Association, with the ultimate goal of making its programme mainstream and even mandatory for the opening of tattoo parlours.
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