MEDICAL CONSIDERATIONS FOR PERMANENT MAKEUP, PERMANENT MAKEUP PROBLEMS, PERMANENT MAKEUP TATTOO RISKS, PERMANENT MAKEUP TATTOO REMOVAL
The following medical conditions require special consideration before permanent makeup procedures. Clients with any of these conditions should contact their physician to determine if it will be safe to have a permanent cosmetic procedure. In some cases the cosmetic tattoo artist will ask for a physicians release.
* Diabetes. Healing could be compromised, higher risk of infection.
* Glaucoma. Increased intraocular pressure combined with pressure placed on the eye to apply eyeliner could be damaging.
* Bleeding disorders. Blood disorders that affect clotting such as hemophilia, sickle cell anemia, platelet disorders.
* Mitral Valve Prolapse, Artificial Heart Valves, Artificial Joints. Any condition that requires prophylactic antibiotics before dental or other procedures will need to take them before micropigmentation also.
* Herpes Simplex. People who get fever blisters / cold sores may experience an outbreak after lip procedures. Antiviral prescription should be taken.
* Pregnancy. Procedure should be postponed. Some medications are not to be used while pregnant. If you were to have a problem, this is not a good time to have it. Skin tones are also a little different while pregnant.
* Keloid or Hypertrophic Scarring. Persons with tendencies for this type of scarring have that risk with tattooing also.
* Use of certain Medications. Accutane / Retin-A, topical steroids can make skin fragile. Physician strength meds / treatments that affect the dermal layer of the skin can affect the permanent make-up. OTC meds / treatments that only affect the epidermis and are not much concern. Anticoagulants (blood thinners), long-term use of aspirin, ibuprofen, and some herbs reduce clotting time resulting in increased bleeding and bruising.
* Heart conditions, Uncontrolled High Blood Pressure, Poor general health.
* Any treatment, medication, or illness that compromises the immune system / healing would make you NOT a good candidate for micropigmentation procedures.
* Lips that have been injected with fillers may not hold color well. Restylane injected superficially near the lip edge has caused migration or feathering to occur along the lipline if the Restylane was placed within months before lip permanent makeup application. There has not been a problem if the lips permanent makeup is healed first, then the lip filler injected second. However, the person that injects the lip filler might cause the lip edges to become uneven if even a tiny bit more is shot into one side. You would have to compensate with topical lip liner. Lips that have been injected with liquid silicone risk disruption of the capsular formation holding the micro droplets in place due to stretching and pressure applied for the permanent lip color procedure. Loss of liquid injectable silicone may occur, and all risks associated with free silicone applies if this happens. Lip implants may become infected if the lips aquire an infection. The mouth is full of germs and saliva will contact all the open holes made by the tattooing.
Please take risks seriously. Every possible complication does not happen every time. Just because it did not happen to your friend does not mean it will not happen to you. Just because it did not happen to you last time does not mean it will not happen to you this time. On the bright side, just because it happened last time doesn't mean it will happen next time. Hopefully you will choose a well-trained professional for your permanent makeup procedure who is knowledgeable and can identify complications in their early stages to direct you to the appropriate treatment.
Keloid Scarring – occurs when a wound scar grows excessively producing fibrous protein (collagen) after the wound has healed, beyond normal boundaries. Although keloid scarring is more likely with deeper wounds, persons with this tendency may have problems with tattooing also. Kelocote Mederma Scar Guard Kenelog Copper PeptidesCertain body areas have higher risk for developing keloids. Breast and lip tissue is delicate and higher risk. Some women have developed keloids after breast surgery who had no problems with abdominal incisions (c-section, etc). Treatment may include both topical products and local injection of a steroid. Hypertrophic Scar - is raised but remains within the boundaries of the original wound and will usually regress in 12-18 months.
Cold Sores/Fever Blisters & Canker Sores- trauma around the mouth area may cause an occurance of cold sores. It is usually a few days after the injury or procedure that cold sore pain begins. People who get cold sores will need to take preventative medication. Clients with permanent lip color have noticed reduced occurance of cold sores on the lips. It is thought that the pigment may offer a layer of protection to lip tissue. It does not affect occurance of cold sores around the mouth or nose. Various preventions and treatments include Zovirax/Acyclovir Valtrex/Valacyclovir Famvir/Famciclovir L-lysine
Post-inflammatory hyperpigmentation (PIH) – dark skinned individuals have a higher predisposition for this, and permanent makeup lip procedures are higher risk (larger area, more swelling, longer healing time) than permanent eyeliner or permanent eyebrows. If your acne or other scars stay dark for a long time, you have PIH concerns. Hyperpigmentation is a broad term meaning darkening of the skin, and refers to everything from freckles to pregnancy mask. Generalized hyperpigmentation in the superficial epidermal layer is more easily treated with skin lightening products and exfoliation / resurfacing methods. Localized post-inflammatory hyperpigmentation (PIH) that occurs after injury or inflammation (acne, insect bites, tattoo) tends to be in the deeper dermal layer. PIH is not so quickly or easily resolved with the products and services, but tends to fade on its own over many months. A dermatologist can determine the type of hyperpigmentation and recommend treatments to speed recovery. Emedicine Article
Foreign Body Granulomas – nodules that form around material that the body perceives as foreign. This is rare (don't know anyone who has seen it), but is possible with tattoo pigment, body piercing jewelry, splinters, or any foreign material that is too large to be ingested and removed by macrophages.
Epidermal inclusion cyst (EIC) - a subcutaneous, well-circumscribed, firm, and often movable, fluctuant nodule. They slowly enlarge and are generally not painful unless ruptured, which elicits an inflammatory reaction. EIC can form from epidermal cells which have been forced into deeper dermal tissues by some sort of trauma or puncture wound. The epithelium forms a cyst under the skin as it continues to make keratin and grow. Rare incidence, and easily removed in a physician’s office. 1, 2
Milia – the tiny white bump that looks like a whitehead, but doesn’t act like one. It is formed when dead, normally sloughed off cells become trapped under the skin. Hard like a grain of sand, and will not squeeze out like a pimple. Most people will encounter at least one in their lifetime. A few people have lifelong battles with multiple clusters. It is not uncommon to get one or two milia in the healing area after tattooing, eyelid surgery, deep peels, dermabrasion, or other services that present opportunity for a few dead cells to become trapped under the healing skin. Milia will sometimes go away as the skin exfoliates. Other times it needs help, or we just don’t want to wait on it. For an occasional one or two, the top of the skin can be lanced with a needle. A dermatologist or esthetician can do this, although most people do it themselves at home – taking it out like a splinter. For those who get chronic clusters on the face or neck, routine exfoliation products and services are a must. Article 1
MRI - Magnetic resonance imaging uses magnetism and radio waves to produce pictures of inside the body without using dyes or x-rays. Reports of adverse reactions of tattoo pigments during MRIs involve iron oxide pigments that contain large amounts of ferromagnetic metals. How “strong” or “weakly ferromagnetic” a pigment is varies among manufacturers, and varies with colors. Premier pigments are non-iron oxide “non-ferromagnetic”. The electromagnetic fields and temperature elevations produced during MR procedures may cause temporary discomfort in an iron oxide tattoo. A few patients reported a pulling and burning sensation in a tattoo during an MRI. Many others have had no problem. The size of the tattoo contributes to the total amount of magnetic pull, as does the number of tattoos- some people have entire body parts covered. Additionally, a metallic tattoo may interfere with the MRI image. Pre-MR procedure screening includes identification of surgical implants, medical devices, tattoos, and body piercing jewelry. If a patient has surgical staples or a small tattoo, a cold compress is placed over the area during the MRI. mri safety
Allergies – could be triggered by numbing medicine, antibiotic ointment, latex gloves, powder in gloves, nickel metal of tattoo needles or nickel metal in iron oxide pigments 1(Premier pigments do not contain iron-oxide), pigments, or preservative in any of the products. Allergic reaction to pigments is rare. Stats were first estimated to be one in 100,000. Next it was reported to be one in 250,000. Now it is thought to be even less because there is no way to keep an accurate head count on how many people have some type of tattoo (body or permanent cosmetics). Little butterflies and dolphins have become popular with women, increasing the tattooed population. Most families have at least one member with some type of tattoo. There have been a few cases reported of an allergic reaction at the time of laser tattoo removal for body art tattoos, even though the person had the tattoo for several years with no previous problems. If there is a reaction to a pigment, treatment choices include use of steroids, overtattooing with Kenalog, or pigment removal. Premier pigments original formula had been on the market for over 15 years with no problems. In 2001, an additional line called True Color Concentrates which contained a new ingredient (benzimidazolone orange) was put out. The new line was recalled in 2003 after some allergic reactions to that ingredient, and use of that ingredient was discontinued.1. There are many companies manufacturing tattoo pigments, and the ingredients vary. If there is a reaction to a topical product (like neosporin ointment), the reaction should stop after discontinuing the product. Allergic Contact Rash
Skin / Wound Infections – could result from use of unclean equipment and supplies, or contracted elsewhere during the healing period. Sometimes this is the result of client failure to protect tattooed area from unclean environment (don't spend the rest of the day handling fertilizer and cleaning the litter box), touching area with fingers, failure to apply antibiotic ointment, or bacteria in facial products used at home. Bacteria live harmlessly on the skin and in the nose and mouth, but when it gets into the body through a cut, puncture, or medical incision it can cause an infection. Lips are triple risk for infection because of 1) mouth germs, 2) skin germs, 3) nose and throat germs breathing down on the lips. Some physicians prefer to give the client antibiotics for a few days as a preventative measure with lip procedures, others don't because many women easily get a Candida Albicans/yeast imbalance. If you have a couple days of pain-free normal healing after a lip procedure, then on the third or fourth day burning pain begins, you may have an infection and need oral antibiotics. There are some similarities and differences to look for to determine the difference between the bacterial and fungal infection on the lips in the early stages. A culture can be taken but is not always conclusive because Candida is sneaky and test results often return false negatives. The lips special problems page has more information.
An overpopulation of demodex face mites can increase the risk of infection. Bacterial, viral, and rickettsial elements are found on electron micrographs of the mite surface. The microcopic mite lives in facial pores (clogging them up) and is associated with some cases of acne, enlarged pores, rosacea, blepharitis and chalazion, persistant eye irritation and redness, epidermal and sebaceous hyperplasia, and loss of brow hairs and eyelashes (aka eyelash creatures). In addition to the germs around the mite, the demodex feeds off the sebum and cytoplasm, stealing the nutrients and impairing the structure and function of healthy cells, which may contribute to delayed cellular turnover / rejuvenation. Ref 1, 2, 3
Infectious Diseases – preventable by use of clean and sterile equipment, supplies, gloves, and noncontamination of pigment bottles.
We hear the most talk about tattoo needles and Hepatitis. Tattooists ease consumer’s fear with the fact that needles are now single use disposable. That is true, but any surgical nurse knows there is more than one way to contaminate, and it’s not just the needles that become contaminated. Most legitimate and licensed facilities have a healthy fear and respect for microorganisms (some can live hours to months on surfaces), educating themselves and taking all precautions. They properly dispose of other disposable parts and supplies, and properly disinfect surfaces and sterilize equipment. No cutting corners to save a dime – their business and reputation depend on it. Of greater concern are the sneaky backroom jobs where someone comes in from out-of-town and does a group of people for amazingly low prices. This out-of-towner has the luxury of leaving behind any problems or unhappy clients. An experienced, quality tattoo artist has enough customers to remain firmly planted in one spot and hasn’t the time or desire to travel around doing illegal jobs.
Since some diseases can be carried for a long time without symptoms, and can be contracted multiple ways, pinpointing a tattoo as the cause can be difficult. Yearly blood donors can place infection into a certain time frame if one year their blood donation tested fine, and the next year did not. Hmmm, not a bad idea to give blood before booking a tattoo appointment. By the way, some states require a one year wait after a tattoo before donating blood because some diseases will not test positive until the body has had a little time to build the antibodies to it. Other states do not require the one year waiting period if a licensed practitioner performed the tattoo, piercing, acupuncture, or electrolysis procedure in a licensed facility. Red Cross OBI Oklahoma Blood Institute offers donor benefits by providing cholesterol testing for each blood donor at no charge. OBI also offers prostate Specific Antigen (PSA) testing and a new testing and information package, Heart Check, designed to identify risk factors for heart disease at a nominal charge.
Corneal Abrasion – is a painful injury that usually heals in 1-2 days. It may result from a scratch or poke, or irritation from meds. Frequent eye rinses with saline, collyrium, and celluvisc prevent irritation during the procedure. I have not heard of anyone poking a client in the eye with tattoo needles, but it is possible. If the tattoo needles did poke the cornea, color could be implanted – see corneal tattoo. I have heard of gauze rubbing across the eye when wiping off excess pigment, and have heard of a client poking herself in the eye with her long fingernail when attempting to apply ointment at home (should have used Qtips). Persons with dry eyes, or whose eyes do not completely close while they sleep should apply lubricating ointment or drops before sleeping the evening after the procedure.
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