Freehand Skin Pen
If you're into freehand work, then you'll need a freehand skin pen. We like to use markers [like these] to do a loose sketch of the tattoo on the skin first, then go over it with a Freehand Skin Pen to define the lines for the final design before tattooing. You can use them 'naked' just as they are, or grab a Freehand Pen Holder if you prefer something something with a better grip.
We also recommend checking out Electrum as well as Stencil Spray Stuff; both are products that will help keep your freehanded designs from wiping away.