Abstract / Summary
Background and objective. Demand for permanent freckles by micropigmentation has grown, driven by social media, alongside risky home practices. Because it looks simple, the procedure tends to be perceived as minor. We aimed to review its general and specific risks and to propose safety, selection and dermatology referral criteria. Methods. Narrative review (SANRA) of PubMed and Google Scholar up to October 2026, with every scientific reference verified by DOI. Grey literature on the trend is identified as such, and recommendations without specific evidence are labelled as the authors' proposal. Results. No clinical series on freckle micropigmentation was identified. General risks, infrequent and mostly mild, come from the tattoo and permanent makeup literature: hypersensitivity, infection, granulomas and sarcoidal reactions. Four specific risks emerge: interference with surveillance of melanocytic lesions, as pigment over a naevus may delay or mimic a diagnosis of malignancy; laser-induced pigment darkening; infrequent transient discomfort on MRI due to iron oxides; and harm from home techniques. Regulations impose the same hygiene requirements as for any micropigmentation. Conclusions. Freckle micropigmentation requires the same preparation, hygiene and traceability as restorative micropigmentation, plus a specific requirement: a prior map of pigmented lesions. Selection criteria, an algorithm and a patient information sheet are proposed. Preprint, not peer reviewed. Conflict of interest: both authors hold management positions at the Instituto Nacional de Micropigmentación, a centre that performs the procedure described and provides training in it. Spanish version: https://doi.org/10.5281/zenodo.23122191