 However a detailed review of the cases within the medical literature involving cosmetic tattoos indicates that poor quality pigments, pigments adulterated with heavy metals, and pigments with diamagnetic properties may have been the causative factors in most of those cases.Topical anesthetics are often used by technicians prior to cosmetic tattooing and there is the potential for adverse effects if topical anesthetics are not used safely.In 2013 the International Industry association CosmeticTattoo.org published a detailed position and general safety precautions for the entire industry.