The lack of regulation in the permanent makeup industry has resulted in the injury of several trusting clients. This topic is something Dr. Cesiro is passionate about and I hope this presentation has laid down the fundamental issues that are embedded in the industry. It is up to us as pharmacists to point out its flaws for the safety of our patients.
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The Unregulated Permanent Cosmetics Industry
The Unregulated Permanent Cosmetics Industry
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Tattoos are a popular form of body art, with approximately 30% of the United States population reporting at least one tattoo. Permanent cosmetics, also known as micropigmentation, refers to the aesthetic use of tattooing in dermatology. Micropigmentation has witnessed a surge in popularity, driven by a growing desire for long-lasting solutions to enhance physical features. Micropigmentation involves the deposition of pigments into the dermis using electrically driven needles. The pigments are permanently fixed within dermal cells, among collagen fibers, blood vessels, and hair follicles. The most common types of permanent cosmetics include microblading, eyeliner tattooing, and lip pigmentation. Other noteworthy applications include nipple-areola tattooing for patients undergoing breast reconstruction following mastectomy; and camouflage for patients with stable vitiligo or burns/surgical defects.
Microblading is a form of superficial micropigmentation for eyebrow restoration. Microblading is a helpful procedure for patients seeking cosmetic enhancement, especially patients with complete alopecia, trichotillomania, and madarosis (in thyroid disorders). The technique utilizes “microblades” to form strokes resembling hair follicles, creating a defined eyebrow, or enhancing the fullness of existing brows. Eyeliner tattooing is popular among patients who want a defined eyeliner (to enhance the shape of the eyes) without daily application of makeup. Eyeliner tattooing uses a digital pen to fill gaps in the eyelash line or create a uniform line above/below the eyes. Finally, lip pigmentation is used to enhance the color and shape of the lips. Lip pigmentation is primarily used by patients with pale/uneven lip tones, and those seeking a more defined appearance. A digital pen, similar to eyeliner tattooing, is utilized to deposit the desired shade/color and, in some cases, make the lips appear fuller (extending beyond the existing margin and shape of the lips). The pigments typically last for 2 years (except microblading which requires yearly touch-ups), allowing patients freedom to change with the latest trends, etc.
Tattooing and micropigmentation are considered safe when performed by professionals in a sterile environment, but complications can still occur. The eyebrows and lips require meticulous measurements in order to avoid an unnatural, asymmetrical appearance, while the proximity of the eyes to the site of eyeliner tattooing increases the risk of injury and infection. Permanent cosmetic removal is common and uses laser treatment, requiring expertise to avoid scarring and post-inflammatory hypo/hyperpigmentation. In the case of microblading removal, it is important to note natural hair follicles present may become depigmented or permanently damaged by the lasers used. As with any tattoo, infections are common, as punctured skin may provide a pathway for bacteria. Bacterial infections may be transmitted via contaminated tattoo needles, ink, gloves, or improper aftercare; most infections are superficial but can lead to cellulitis, bacterial endocarditis, or necrotizing fasciitis. Allergic reactions are also possible, especially in patients with a history of allergies. Tattoo reactions are considered delayed type IV hypersensitivities causing chronic itch and pain with urticaria or ulcerations. The exact cause is unknown; however, red tattoo pigments are suspected to affect a majority of allergic patients, with blue, green, and yellow to a lesser extent. Proper training and adherence to hygiene protocols are crucial to ensure patient safety and satisfaction. Additionally, patients considering micropigmentation should be well-informed about potential risks, allowing them to make informed decisions about their beauty enhancement journey.
References
Kerure AS, Marwah M, Wagh ND, Udare S. Micropigmentation. Indian Dermatol Online J. 2023 Oct;14(5):605-10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10506827/
Marwah MK, Kerure AS, Marwah GS. Microblading and the science behind it. Indian Dermatol Online J. 2021 Feb;12(1):6-11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982014/
van der Bent SAS, Rauwerdink D, Oyen EMM, et al. Complications of tattoos and permanent makeup: overview and analysis of 308 cases. J Cosmet Dermatol. 2021 Nov;20(11):3630-41. https://onlinelibrary.wiley.com/doi/10.1111/jocd.14498