Permanent Cosmetics-Trendy Tattoos or Here to Stay?
Dr. Kristanne Matez
Dermascope, DEC 04, PG 81-84

Facial tattooing-sounds a little scary doesn't it? For some, it conjures up images of dingy tattoo parlors, or smoky opium dens where Japanese masters use bamboo to pierce flesh. While that's still being done in America today, most clients who desire to "wake up with make-up" will find the environment has become extremely friendly.

What is permanent make-up? This is a make-up for eye- brows, eyeliner and lips that is applied to the skin with a sterile needle. Colored pigments are implanted into the dermal layer where they remain for a few years. When first applied, the color is darker on the skin, just like a tattoo. But as the epidermis sloughs excess color over a span of three to seven days, what remains is a lighter, softer appearance in the dermis. Unlike a tattoo, the service does not last a lifetime. Fading elements like sun exposure, use of acids such as glycolic or alpha hydroxy, and microdermabrasion hasten the breakdown of color. Jacqui Folsom, aesthetician and practitioner in Bakersfield, CA, says, "Lighter colors exit the skin faster-a blonde eyebrow won't last as long as a brunette one. I tell my blondes they are more high maintenance because I'll see them sooner for a touch up:' Most permanent make-up procedures are performed by aestheticians, cosmetologists, manicurists, electrologists, registered nurses, make-up artists and dental hygienists. What was once a secret procedure available to the stars of television and big screen, is such a mainstream service that everyone has heard about it.

So, why choose the permanency of this service? Isn't the beauty of make-up the fact that you can change colors with the seasons, or opt for a more dramatic look in the evening hours versus the workplace? Won't choosing a permanent service make you a "slave" to that color? Far from it! Karin Downes, practitioner in Waterford, MI, believes, “A permanent make- up service is designed to enhance one's features-not totally overpower them. For a brow, I choose colors that are natural and blend with the hair. And, eyeliners are placed in the lash line to give the appearance of fullness. Regular make-up will completely cover the work I do if a change is needed.” For some, permanent cosmetics makes all the difference in their morning ritual and self-esteem.

Who are the best candidates for this service? Permanent make-up procedures really have two branches of the same tree-the cosmetic applications and the paramedical ones. The paramedical side of this procedure embraces the client with physical infirmity. Patients that have suffered a stroke and have paralysis on one side may find it difficult to apply make-up evenly. Crippling rheumatoid arthritis does just that-cripples. Those patients have trouble brushing their hair daily, let alone applying even brows or straight eyeliner. Patients that wheelchair bound-quadriplegics and paraplegics enjoy the benefit of make-up that is lasting and doesn’t have to be applied by others. Women suffering from alopecia, a form of baldness that can affect eyebrows and eyelashes, don’t feel so naked when they aren't made up. The list continues-from women have visual problems and can't see well to the completely blind patient who may be at the mercy of a husband who has no clue. Chemotherapy patients experiencing hair loss can have their eyebrows and lashes enhanced, making them feel less like “victims” of cancer. Cleft lip and palate patients can have color restored to the lip line and lips, creating a visual appearance that minimizes the scar tissue. The same can be said for burn survivors. Children who bite extension cords when toddlers, can have color applied at adulthood that restores the shape of the mouth without surgery. Most patients with facial burns have hair loss as well. Linda Dixon, MD, anesthesiologist and practioner in Hawaii concludes, "While the procedure cannot smooth the rippled texture of burned skin, the presence of eyebrows and lips return the face to a more normal appearance".

How about those without facial deformity? What can a service achieve for the average woman. Teresa Zamora of Upland, CA began tweezing her brows in high school. Six years later, her too thin brows needed help. “I hated the look of not having brows when I was sweating or rubbed my forehead. If I went clubbing with friends, my brows would be off by the end of the night. And, swimming in the summer meant no brows;' she admits. Teresa had her brows done approximately four years ago and loves the ease of make-up application in the morning. She's considering having her lips done. Color placed in the lips can accentuate the lip line and need only a gloss to look wet. Mothers with infants don't have to brand their babies with lip- stick anymore! Face it, everyone wants to look their best right out of bed or fresh from the shower.

Technicians employ many different types of equipment for this service. About 30 percent of practicing technicians use the time-tested method of manual placement. A machine is not used-instead, a small hand-held tool is fashioned with various configurations of needles and is "scratched" or "tapped" into the skin. For those who prefer a machine, there are two types-rotary and coil. A coil machine is traditionally considered a tattoo gun, works with a foot petal and is a little noisier than its cousin. Composed of stainless steel, it is the workhorse of the industry. However, only about 20 percent of technicians use this machine. The rotary pens are inexpensive and plastic. They tend to be quiet and feel more like using a make-up brush. They dominate the market, with approximately 40 percent of the technicians using these Asian-made devices. A few years ago, rotary pens went digital-now they can be programmed and a foot petal is optional. Only about 10 percent of the industry has invested in these machines. They're a little pricey but certainly making headway among technicians using machines. Regardless of the equipment used, permanent cosmetics must be implanted into the dermis. And, regardless of the equipment used, healed procedures look pretty much the same.

Most systems are totally disposable. While some parts of the machine can be sterilized, needles are always single use and disposed after the treatment into a Sharp’s container. This is a biohazardous waste container for the disposal of needles and lancets. It’s usually red, puncture proof and can hold thousands of needles before it needs to be replaced. Most technicians call their local waste department for directions about proper disable of their Sharp's. Topical anesthetics are usually applied for pain control. Because most technicians work in the salon environment, the of injectable products is not allowed. Instead, anesthetics applied to the skin for a designated period of time, then the technician begins working. Throughout the service, topical anesthetic is repeatedly rubbed into the skin, creating a reservoir of anesthesia. As the service continues, the skin becomes more numb. Heather Witmer, practitioner in York, PA says, "My clients get so numb in the lip area, they often feel as if they're drooling when I'm taking their after photograph. If my client has thin lips she's thrilled-the swelling makes them larger and plumper and they feel they have collagen lips for the day."

So, you can have "beauty without the bother" and "wake up with make-up". But nothing's perfect so what is there to watch out for? First and foremost, make certain that the equipment used is sterile. Transmission of disease is possible with dirty needles and a good technician shouldn't mind providing proof. Secondly, make sure he/she is covered-up that is! Gloves, safety goggles and masks are the required gear in this field. Technicians in the business for the long haul are concerned about their own health. While Hepatitis C and HN are the feared viruses, technicians treat all clients as though they are infected and practice universal precautions. And thirdly, check out the portfolio. If the work you see is attractive and the clients look like regular people, your results may be as pleasing. Most technicians require that you at least be a daily consumer of the product you are requesting. Karla Kwist, practitioner in Las Vegas, NV believes, "A woman who wants I her brows done should wear pencil or powder daily. This procedure wasn't designed for the woman who pencils her brows on Thanksgiving, Christmas Day and New Years' Eve. That's the job of conventional make-up. I want to put brows on the woman who is a slave to her pencil. She's going to love the result because she already wears it everyday."

A medical history is necessary for clients wanting any service. For example, accutane is a contraindicated drug, so patients taking that medication need to be cycled off for at least 60 days-maybe longer. Lip procedures can be performed on virtually anyone, even those with a history of herpes. However, although a breakout of fever blisters or cold sores may have occurred long ago, that client must still be pre-medicated with an anti viral prior to the procedure. This requires a phone call to the primary care physician and a prescription.

After-care protocols vary with each technician. In most cases, some form of an occlusive ointment is applied, providing a barrier of protection against infection. Vaseline and A&D ointment are very common, and the client avoids the use of soaps and cleansers, cosmetics and stays out of the sun. Post care regimens vary in the time requirements as well-some technicians prefer 24 hours while others prefer three to five days. A crust will appear in all the areas within a few days, eventually sloughing off by one week. The color that appeared too dark initially, heals to a lighter, softer shade. A follow up appointment is scheduled four to six weeks later so additional color can be placed if bald or missing spots appear.

Permanent make-up--what a concept! It frees women from the daily application of cosmetics, adding to their attractiveness which almost always promotes self-esteem. That’s the principal behind the “Look good, feel better” slogan of the American Cancer Society. When we look good, we feel good, and that’s a better way to go through life. With the number of practioners increasing every year, and the client base that continues to grow, this is definitely a procedure here to stay.