Permanent makeup

Editors-In-Chief: Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [mailto:Newmanm@ccf.org]; Michel C. Samson, M.D., FRCSC, FACS [mailto:samsonm1@ccf.org]

Overview
Permanent makeup is a cosmetic technique which employs tattoos (permanent pigmentation of the dermis) as a means of producing designs that resemble makeup, such as eyelining and other permanent enhancing colors to the skin of the face, lips, and eyelids. It is also used to produce artificial eyebrows, particularly in people who have lost it as a consequence of old age, disease, such as alopecia, chemotherapy, or a genetic disturbance, and to disguise scars and white spots in the skin such as in vitiligo. It is also used to restore or enhance the breast's areola, such as after breast surgery.

Most commonly called permanent cosmetics, other names include dermapigmentation, micropigmentation, and cosmetic tattooing (the latter being most appropriate since permanent makeup is, in fact, tattooing.) In the United States and other countries, the inks used in permanent makeup and the pigments in these inks are subject to FDA or similar agency regulation as cosmetics and color additives.

Regulations and oversight
Permanent makeup regulations vary from country to country: sometimes by state, province, county or even city to city. For instance, in the US, while in most areas it falls under the cognizance of the Department of Health, State Boards of Cosmetology are often the oversight agency. In fact, in some areas a cosmetology or esthetics license is required, while in other areas, cosmetologists are prohibited from conducting these procedures. Exclusive to Australia, practitioners are prohibited from advertising the procedures as "permanent" since it is commonly known that tattoos will fade over time & it is their opinion that the "…benefits of cosmetic tattooing are not permanent and will generally only last three to five years." The purpose of the ACCC action was to alert the consumer public to the fact that touch ups may be required to maintain optimal appearance. Some believe this position is not consistent with the fact that permanent makeup is tattooing and tattooing is a permanent process. .

Before you undergoing any form of cosmetic tattooing it is essential to ensure that a salon has appropriate approvals from their local health authorities for skin penetration procedures. It is important to note that just because a salon has local health approvals for general beauty therapy services does not necessarily mean that they have approval for cosmetic tattooing procedures, it is prudent to insist on seeing the certificate of registration.

Mobile tattooing (in home) services may be a breach of Health Guidelines in some locations, for example in Melbourne Australia they prohibit mobile tattooing services.

History
Permanent makeup dates back at least to the start of the 20th century, though its nature was often concealed in its early days. The tattooist George Burchett, a major developer of the technique when it become fashionable in the 1930s, described in his memoirs how beauty salons tattooed many women without their knowledge, offering it as a "complexion treatment ... of injecting vegetable dyes under the top layer of the skin."

Results
Results are usually good, and often mimic topically applied cosmetics, such as in complete alopecia of the eyebrows. The skill and the experience of the tattoo artist are fundamental. Before committing to permanent makeup, particularly if for convenience only, clients should be aware of the potential problems of later removal and complications that may ensue. As with tattooing, permanent makeup may take several sessions and may present some minor discomfort. (Although many technicians will use a topical anesthetic to help reduce any discomfort.) Result appear "harsh" just after application, but become somewhat more natural (as natural as makeup can be) after a few weeks.

Permanent makeup can be useful for women who wish to wear makeup, but cannot apply it easily because they have allergic reactions to makeup materials, have vision deficits, tremors or restrictions of precise movements of the fingers and hands (such as in arthritis, stroke, Parkinson's disease, multiple sclerosis, or other conditions). Permanent makeup may also be used to camouflage scarring on the face or other parts of the body.

The pigmentation of permanent makeup may fade over time, particularly under the effects of sunlight or when using colors like light brown tones for eyebrows. It usually lasts for a decade or more before fading significantly. Touching up the tattoos may be required to restore the original color as early as two years after the original procedure. Many procedures last a lifetime with little to no intervention.

Removal
As with tattoos, permanent makeup can be difficult to remove. Common techniques used for this are laser resurfacing, dermabrasion (physical or chemical exfoliation), and surgical removal. Camouflaging-- adding a new pigment which counteracts the tattoo color and attempts to emulate normal skin color is considered a poor choice by professionals. Removal is more painful and laborious than the tattooing itself.

Adverse effects and complications
As with tattoos, permanent makeup may have complications, such as allergies to the pigments, formation of scars, granulomas and keloids, skin cracking, peeling, blistering and local infection. The use of unsterilized tattooing instruments may infect the patient with serious diseases such as HIV and hepatitis. Removal problems may also ensue, due to patient dissatisfaction or regret, and they may be particularly difficult to remove in places such as eyelids and lips without leaving permanent sequelae.

On very rare occasion, people with permanent makeup have reported swelling or burning in the affected areas when they underwent magnetic resonance imaging (MRI).

Examples
This client had her eyebrows and top eyeliner permanently tattooed. The eyebrow tattooing is an example of a "powdery filled" technique as opposed to individual hairline strokes since the client already has eyebrow hair but simply wanted an enhancement and shaping. The top eyeliner represents a thin eyeliner tattoo and a "lash enhancement" procedure that is used to define the eye without making it look excessively made up.