Background: Medical tattooing is often applied in the context of plastic, aesthetic, and reconstructive surgery to help achieve the best cosmetic outcome.

Objectives: This article reviews various conditions that medical tattooing has been empirically studied in terms of patient satisfaction outcomes, makes practice recommendations, and suggests future directions for research.

Methods: This review was performed following the PRISMA guidelines. Studies were included if the tattooing application was associated with a medical condition and if outcome data were provided using at least a case series methodology. Where no cohort or clinical series exist, case examples are used from the literature and the author's practice to illustrate emerging medical tattooing applications that need further evaluation.

Results: Eighteen studies met the inclusion criteria and addressed the following conditions: baldness, vitiligo, scars from incisions, lacerations or burns, and nipple-areola complex reconstruction.

Conclusions: The application of medical tattooing has shown high levels of patient satisfaction across conditions. The practice recommendation grade is "B" or recommend since the level of evidence for these interventions ranged from III to IV according to the American Society of Plastic Surgeons guidelines. This means clinicians can consider this treatment alternative, but they should be alert to new information and be sensitive to patient preferences. Recommendations are made for reporting future research including clearly describing procedural details, identifying the professional performing the procedure, increased use of standardized outcome measures, and that satisfaction ratings be assessed by someone independent of the health service provider. Further research using randomized controlled trial methodology with waitlist controls is needed.