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. Nothing, it seems, will phase these cosmetic tattoos.
In the hands 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 (lack of natural pigmentation in the skin), are similar procedures. "They're the same procedures but used for different purposes," says ophthalmologist Charles S. Zwerling, MD, who coined the term micropigmentation.
Permanent makeup for eyeliner is the most popular cosmetic enhancement, followed by eyebrows and lip color. Some practitioners offer blush and eye shadow, but Zwerling, chairman of the American Academy of Micropigmentation (AAM) in Goldsboro, N.C., says he's totally opposed. "What I've seen has been very poorly done. You can't be sure what the color is going to do, and if you get an allergic reaction, you're dealing with a large surface area. You're talking about major reconstructive face surgery."
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. Before you rush to the Yellow Pages to find a practitioner, experts advise doing your homework.
"Allergic reactions to pigments are reasonably rare, but it's difficult to remove the irritant," says FDA spokesman Stanley Milstein, PhD, in Washington, D. C. "Anytime you implant 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. Keloids 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 micropigmentation procedures. The adverse events are associated with certain ink shades of the Premier Pigment brand of permanent makeup inks, which are manufactured by the American Institute of Intradermal Cosmetics, doing business as Premier Products, in Arlington, Texas.
As of July, the FDA had been made aware of more than 50 adverse events and is investigating additional reports sent to the manufacturer. Reactions that have been reported include swelling, cracking, peeling, blistering, and scarring as well as formation of granulomas in the areas of the eyes and lips. In some cases, the effects reported caused serious disfigurement, resulting in difficulty in eating and talking.