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Is Permanent Makeup Safe?

Updated: Dec 27, 2023

Permanent makeup, a form of cosmetic tattooing, offers the allure of lasting beauty. Picture immaculate red lips, impeccably shaped eyebrows, and charming eyeliner resistant to sweat, sleep, and time. Sounds tempting. However, like any invasive procedure, there are potential risks.


Despite the captivating appeal of cosmetic tattoos that promise true beauty, it's important to remember that the permanent makeup industry's growth has outpaced regulation. This leaves room for unqualified individuals to perform such procedures, adding to the potential risks.


Permanent makeup is a form of micro pigmentation akin to tattooing. It involves inserting pigmented particles beneath the upper layers of skin using a needle. Procedures like tattooing and medical restoration, used to correct imperfections such as scars or vitiligo (loss of skin pigmentation), are similar. "These are identical procedures employed for varied purposes," according to ophthalmologist Charles S. Zwerling, MD, who is credited with coining the term 'micro pigmentation.'


The most sought-after permanent makeup enhancement is eyeliner, eyebrows, and lip color. Some practitioners also offer blush and eye shadow. However, Zwerling, chairman of the American Academy of Micropigmentation (AAM) in Goldsboro, N.C., strictly opposes this practice. He warns of uncertain color results and large-scale allergic reactions, potentially leading to major facial reconstructive surgery.


The procedures are usually performed after applying a skin anesthetic. According to Zwerling, touch-ups may be needed post-procedure but not before one to three months. Practitioners range from dermatologists and cosmetologists to aestheticians, nurses, and tattoo artists. Hence, it's vital to thoroughly research before choosing a practitioner.


Potential Negative Reactions


FDA spokesperson Stanley Milstein, Ph.D., warns, "Allergic reactions to pigments, while relatively uncommon, can be difficult to eradicate. Implanting a foreign body into the skin can result in unanticipated reactions, such as rashes or allergic responses, even years later."

However, Zwerling notes that pigments like iron oxide seldom cause allergic reactions, deeming it the safest pigment. Conversely, he cautions that vegetable-based, organic, or natural pigments are the most hazardous.


Additional adverse reactions include granulomas (masses forming around foreign substances inside the tissue) and keloids (scar tissue overgrowths). Interestingly, keloids appear more frequently with removing permanent makeup than with its application.


2004 the FDA warned the public about reported adverse events from certain micropigmentation procedures. These incidents were linked to specific ink shades from the Premier Pigment brand, produced by the American Institute of Intradermal Cosmetics. Reported reactions included swelling, cracking, peeling, blistering, scarring, and granuloma formation around the eyes and lips. In severe cases, these reactions led to significant disfigurement, causing difficulties in eating and speaking.


Risk of Infection


In 2003, a permanent makeup salon owner in San Antonio was found guilty of infecting a woman with hepatitis C during multiple lip color touch-ups. She was awarded over half a million dollars in compensation.


Zwerling cites multiple hepatitis transmission cases from permanent makeup and even an AIDS case in Canada. Unsterilized tattooing equipment and needles can spread infectious diseases like hepatitis.


Concerns Over 'FDA-Approved Colors'


Advertisements claiming practitioners use 'FDA-approved colors' should raise alarm bells, warns Zwerling. He stresses that FDA-approved colors are specified for certain end uses, but none have been approved for subcutaneous injection.


Milstein points out that pigment mixtures may not need ingredient labels since they're not sold to consumers, making it hard for tattoo artists to know what they're using.


Through its Cosmetics Adverse Reaction Monitoring Program (CARM), the FDA encourages consumers and healthcare providers to report adverse reactions to tattoos, permanent makeup, and removal problems.


MRI Complications


Milstein highlights potential issues with MRI scans in individuals with permanent makeup due to interactions between the magnetic field and the pigment. These can cause swelling or burning in pigmented areas and may affect the MRI image quality.


Zwerling acknowledges such reactions but suggests they can be managed with topical steroid creams or antihistamines like Benadryl. He stresses the importance of informing the radiologist about permanent makeup to avoid misinterpretation.


The Permanency of Permanent Makeup


Zwerling emphasizes the long-term nature of permanent makeup, cautioning clients to be certain before proceeding. Everyone's body responds differently, with fading varying greatly from person to person.


Additionally, some colors can migrate over time, leading to undesirable results. Zwerling warns against using black India ink, as its tiny particle size almost stains the skin. Instead, he recommends inert iron oxide pigments that seldom migrate.


Interestingly, Zwerling notes that permanent makeup may have an unexpected benefit. It helps with wrinkle reduction and can also help break down scar bands, flattening scars to some extent.


Dealing with Disappointing Outcomes


The biggest risk in any cosmetic procedure is not achieving the desired results, warns Zwerling. He advises getting it right the first time as rectification becomes progressively more complicated with each subsequent attempt.


"Many believe laser treatments can eliminate tattoos or permanent makeup, but they can also cause side effects, such as skin lightening," says Milstein. Other removal techniques include dermabrasion, surgical removal, and sometimes further tattooing to disguise the issue. "Some methods will leave a scar where the makeup was," he warns.


Making an Informed Decision


Consumers need to vet potential practitioners thoroughly, given the legal permissibility for individuals to perform these procedures after minimal or no training.

To safeguard yourself:


  1. Ensure that the salon has a business license and has been inspected by the local health board.

  2. Find out if the practitioner is certified and competent, has sufficient experience, and meets past clients.

  3. Always prioritize aesthetics, safety, and comfort over anything else.

Ensure a fresh needle and pigment bottle are opened for your procedure to avoid infection. Follow post-procedure care instructions diligently.


Finally, remember that cosmetic trends change over time. What's fashionable today may look outdated in a few years. So, before proceeding, ask yourself how prepared you are to live with a potential mistake. Milstein aptly concludes, "Transforming tattoos or permanent makeup is not as easy as changing your mind."



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