Natural Standard Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
Cosmetic tattooing, dermapigmentation, micropigmentation, permanent cosmetics.
Permanent makeup is a cosmetic procedure involving the permanent application of tattoo ink into the skin for cosmetic or aesthetic reasons. Permanent makeup alters the appearance of the skin in such a way that scars are concealed. Alternatively, the procedure is done so that a person appears to be wearing cosmetics, such as eyeliner, all the time.
Tattoo ink is injected approximately two millimeters into the skin into the dermis using a very fine needle. On areas of very thin skin, the ink is injected at a more shallow level.
Permanent makeup became more popular in the 1970s and 1980s, as technology to apply tattoo ink over sensitive areas of skin, such as the eyelids, became more popular. Improved technology in the tattoo industry has increased the precision and detail that may be achieved through permanent makeup.
Some individuals choose permanent makeup procedures to avoid the time consuming task of daily application. However, makeup also has a number of medically related applications. For instance, permanent makeup may be used to conceal the scar left by a skin graft or to alter the appearance of the areola after breast surgery to a more "natural" look. Individuals who experience vision or coordination difficulties may choose a permanent makeup procedure to bypass obstacles in the application of cosmetics.
According to the Federal Food, Drug, and Cosmetic Act, the ingredients of inks used to create tattoos are under the domain of the U.S. Food and Drug Administration (FDA). The regulations regarding the actual practice of putting ink into the skin for cosmetic purposes are controlled by local and state governments. In the June 28, 2007 edition of the New England Journal of Medicine, it was reported that the FDA has had over 150 adverse events associated with permanent makeup.
The appearance of permanent makeup may change over time. For instance, ink that is injected below the dermis may spread. Additionally, as the contours of the face change with age, permanent makeup may appear out of place. The dyes may also fade with time.
Before undergoing the tattooing process, the patient attends a consultation with a trained professional known as an aesthetic technician. The patient discusses the desired cosmetic result of the permanent makeup, and the technician discusses the procedure and ink possibilities. When application is agreed upon, the patient makes an appointment for the treatment.
Before undergoing the application of permanent makeup, the patient signs a waiver. This waiver usually acknowledges that the appearance of tattoos change over time and that the technician will not be held accountable for any adverse effects resulting from the treatment.
The first permanent makeup procedure typically lasts between one and three hours. During this time, the technician injects dye into the dermis layer of the skin. The technician may use one of several different tattooing machines. However, each of these procedures requires the use of a new, sterile needle for each client. Though some discomfort usually occurs, most people do not find the sensation unbearable. Some technicians apply anesthetic or desensitizing ointments. In some cases, a doctor or dentist may give the individual an anesthetic block to assist the patient in coping with the discomfort and pain that may occur during the tattooing process.
Aesthetic technicians usually perform the application of permanent makeup. However, more complicated procedures, called para-medical procedures, may be performed by a cosmetic surgeon at a doctor's office.
Following the initial application of permanent makeup, individuals may experience bruising, swelling and some discoloration at the site of the tattoo. However, these effects usually last no more than 72 hours. In general, it is advised that antibiotic cream is applied and that the patient avoids sun exposure during this time period.
Most people who undergo permanent makeup procedures attend one or two follow-up appointments. During this time, the color, density and border of the makeup is adjusted to further satisfy the client's specifications. This process involves further tattooing.
In many areas of the United States, there is no government licensing body to certify aesthetic technicians who perform permanent tattoos. For technicians in most states, this certification process is voluntary.
Permanent makeup cannot be washed off. However, a person may change the appearance of the area where the makeup was applied somewhat by wearing removable makeup over the tattooed area.
Permanent makeup usually fades to different shades a few years after the procedure. However, the pigment will always be visible to some extent.
Multiple cases of allergic reactions have been reported in individuals who have undergone permanent makeup procedures. The most common reactions are localized itching and swelling. Some individuals become allergic to the dyes in their tattoos years after they undergo the procedure.
Other potential adverse reactions to permanent makeup may include scar formation, keloids, granulomas, skin cracking, bleeding, and local infection.
Tattoos, especially those on the face, may be difficult to remove without discoloration and scarring. Red ink often turns black during laser removal surgery and may permanently discolor the skin.
Some individuals have reported searing pain at the location of permanent makeup, especially on the eyelids, during routine MRI procedures.
Needles must be sterile in order to avoid disease transmission.
Patients with bleeding disorders should consult a qualified healthcare provider before deciding to have permanent makeup applied.
Patients who are prone to scarring and keloids may develop undesired skin changes following the application of permanent makeup.
This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
American Society of Plastic Surgeons. www.plasticsurgery.org.
Food and Drug Administration. www.fda.gov.
Goossens A, Verhamme B. Contact allergy to permanent colorants used for tattooing a nipple after breast reconstruction. Contact Dermatitis. 2002 Oct;47(4):250. View Abstract
Klitscher D, Blum J, Kreitner KF, et al. MRT-induced burns in tattooed patients. Case report of an traumatic surgery patient. Unfallchirurg. 2005 May;108(5):410-4. View Abstract
No author. Adverse events associated with 'permanent makeup'. FDA Consum. 2004 Sep-Oct;38(5):4-5. View Abstract
Permanent Cosmetics Network. www.permanentcosmetics.net.
Ro YS, Lee CW. Granulomatous tissue reaction following cosmetic eyebrow tattooing. J Dermatol. 1991 Jun;18(6):352-5. View Abstract
Straetemans M, Katz LM, Belson M. Adverse reactions after permanent-makeup procedures. N Engl J Med. 2007 Jun 28;356(26):2753. View Abstract
Copyright © 2013 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.
March 22, 2017