Skin cells are regularly and continuously lost and replaced. What does the permanency of
tattoos indicate about the tattooing process?

Tattoos are made by injecting indelible ink through the upper layer of the skin (epidermis) into the underlying dermis. So initially there is pigment deposition in the epidermis as well as the dermis.  However, the damaged epidermis overlying the deposits of tattoo ink sloughs off and is replaced by new epidermal cells, which are free of pigment.

The dermis is primarily composed of collagen fibers, elastin and extrafibrillary matrix (previously called ground substance, composed of large molecules, called glycosaminoglycans, whose function is to attract and hold onto water molecules). Although components of the dermis are continually remodeled, damaged collagen fibers removed and new ones deposited (except under certain conditions, like chronic sun damage, where collagen degradation is increased and new collagen deposition is decreased), for the most part, the dermis remains intact.

In addition to the connective tissue components, there are also some skin cells present in the dermis, such as the fibroblasts (cells that make collagen and other connective tissue elements), macrophages (the clean up cells of the immune system) and a few inflammatory cells, such as lymphocytes.

The tattoo ink is injected into the collagen part of the dermis.  There is a following immune reaction, where the macrophages come to pick up the tattoo ink as it is foreign material for the skin.  Some of the tattoo ink is carried away by the macrophages into the lymph nodes, draining the area, but most remains trapped within the macrophages in the dermis. Usually these macrophages are located near the dermal blood vessels. That is the resultant pigment that is seen from the outside.  Because the macrophages don't have a mechanism of dissolving and disposing of the pigment, it remains in the dermis.

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