Everything you need to know about Permanent Makeup

Lovely red lips, perfectly shaped eyebrows, and flattering eyeliner. Permanent makeup holds the promise you’ll work all day, go to the gym, dance all night, and wake up in the morning with makeup in place.

In the hand of a skilled person, the procedures are generally safe. But state regulatory agencies haven’t kept pace with the growth of the permanent makeup industry, and there are lots of unqualified people wielding needles.

Permanent makeup is considered micropigmentation, similar to tattoos. It involves using a needle to place pigmented granules beneath the upper layers of the skin. Tattooing and medical restoration, which corrects imperfections from scars and vitiligo, are similar procedures. “They’re the same procedures but used for different purposes,” says ophthalmologist Charles S. Zwerling, MD, who coined the term micropigmentation.

Most procedures are done after applying an anesthetic to the skin. Zwerling says after the initial procedure, touch-up might be required but no sooner than one month and as much as three months later. Practitioners include dermatologists, cosmetologists, aestheticians, nurses, and tattooists.

“Allergic reactions to pigment are reasonably rare, but it’s difficult to remove the irritant,” says FDA spokesman Stanley Milstein, PhD. “Anytime you want a foreign body into the skin; it has the potential for results not anticipated. The reaction could occur years later as a rash or an immune system allergic reaction.”

Zwerling says pigments, like iron oxide, rarely cause allergic reactions. “Iron oxide has been shown to be the safest pigment,” he says. “Anything that is vegetable based, organic, or natural is the most risky. It’s the natural products in vegetables and herbs that can cause horrible allergic reactions.”

Two more possible adverse reactions are granulomas, which are masses that form inside tissue around a foreign substance, and keloids, which are overgrowths of scar tissue or a raised scar. Keloid appear more often with removal of permanent makeup than with its application.

In July 2004, the FDA alerted the public to a number of reported adverse events in individuals who had undergone certain pigmentation procedures. The adverse events are associated with certain ink shades of the permanent makeup inks, which are manufactured by the American Institute of Intradermal Cosmetics.

Don’t be lured by ads claiming a practitioner uses FDA-approved colors. “Stay away,” says Zwerling. “They’re misrepresenting themselves and the profession.” FDA approves colors only for specified end uses. When someone says “FDA-approved colors,” you have no way of knowing whether te approval applies to cosmetics, food, or automotive paint, but one thing is certain: no color additive has ever been FDA-approved for injecting under the skin.

“FDA is certainly looking at some health and safety consequences,” says Milstein. Complicating the issue is the fact that some pigments are mixtures of materials and are not required to have ingredients labeled because they’re not sold to consumers. “These mixtures can be so complex it is very difficult for tattooists to know what they’re using,” he says.

MRI Complications

“An issue you should be most concerned about is what happens some years down the road and you have an MRI,” says Milstein. “There will be swelling or burning in the pigmented area due to interactions between the magnetic field and the pigment, and it may interfere with the quality of the MRI image.”

Zwerling acknowledges that people will experience redness or inflammation following an MRI but says it’s not a reason to avoid permanent makeup. “There’s a magnetic reaction with the iron oxide in the pigment. It vibrates and sets up a mild inflammatory action that can be controlled by a topical steroid cream.” He adds that the reaction from the permanent make up won’t compromise the quality of the imaging as long as the radiologist is aware of the permanent makeup.

How Permanent is Permanent?

Over time, some colors can migrate, and the result can be pretty creepy. Zwerling says this is most likely to happen if a practitioner uses black India ink, which should not be used in micropigmentation. “It has a very small particle size, so it’s almost like staining the skin,” he says. “Iron oxide pigments are inert, meaning they don’t react metabolically. They’re just a miniscule amount of migration with iron oxide.”

What you should be looking out for before considering the operation:

• Make sure the salon has a business license and a certificate showing it’s been inspected by the local board of health.
• Find out if the practitioner has been tested and found competent. The AAM is an accrediting body that requires a written, oral, and practical exam for certification. “Some states have chosen us as their certifying body,” says Zwerling. “We try to be sure practitioners are at least competent in knowing the right procedures, how to sterilize, etc.”
• How many procedures has the practitioner performed and how long have they been doing it?
• Ask to meet people the practitioner has performed procedures on. “Don’t rely on a bunch of testimonials or pictures,” says Zwerling. “Anybody can create a portfolio by stealing pictures from a web site.”
• Consider aesthetics, safety, and comfort. “Physicians may not be the best practitioners,” says Zwerling. “They may know the science but not the artistry.” The best choice might be a practice in which a nurse or cosmetologist works under the auspices of a physician. And if comfort is high on your agenda, be aware that the topical anesthetics a cosmetologist or tattooist uses are not as effective as injections in the hands of a medical professional.
• To avoid infection, make sure you see the practitioner remove a fresh needle from a package and open a fresh bottle of pigment. And follow instructions for caring for the treated area in the days and weeks following the procedure.