Permanent makeup removal options

When beauty goes awry

Last updated: October 2010

Orly Avitzur, M.D.
A board-certified neurologist, is medical adviser to Consumers Union.

Permanent makeup-aka micropigmentation, dermal pigmentation, permanent cosmetics, cosmetic tattooing-has steadily gained popularity in recent years. Women seeking to wake up made up, swim and shower without reapplication, or enhance sparse eyebrows or thin lips are prime targets for the service promoted at some doctors' offices, beauty parlors, day spas, and nail salons. But just like a tattoo, if you have an unwanted result or simply a change of heart, permanent makeup is neither easy, nor inexpensive to remove. And as it turns out, it's quite risky too.

"There are a number of problems that can occur after micropigmentation," said Suzanne L. Kilmer, M.D., Director of the Laser and Skin Surgery Center of Northern California and Associate Clinical Professor at UC Davis Medical Center, who has seen hundreds of patients requesting tattoo removal after disappointing results. These include complaints that colors are "off" or too harsh, shapes that are wrong (goofy-looking or irregular eyebrows, lip liner that is too high), and eyeliner that looks smudged. More serious complications include infection, granulomas (growths around the treated tissues) and allergic reactions. Other sobering consequences described in the medical literature recently include magnetic resonance imaging (MRI) complications (the magnet can affect the metallic inks, causing eye pain, irritation and inflammation), and reports of needle penetration of the eye. There have also been numerous accounts of skin cancer at the site of application.

Yet, few states regulate cosmetic tattoos, and even those that do, require a variable (and often insufficient) number of hours for certification. A 2009 survey by the Society of Permanent Cosmetic Professionals found that only 40 percent of their member respondents were certified. Because the industry is unregulated, the number of people receiving permanent makeup is unknown, but by 2003 the FDA had identified so many patients with negative reactions that it advised "the application of permanent makeup can result in serious, long-term, disfiguring reactions" and recalled one product line. It also advised that although a number of color additives are approved for use in cosmetics, none are approved for injection into the skin and many pigments are not approved for skin contact at all. Some the FDA reports are industrial grade colors such as those used in printers' ink or automobile paint!

Since permanent makeup typically uses a mixture of metallic pigments, when one individual color degrades over time, the overall color can change. Indeed, the most common reason women come to Dr. Kilmer's laser center is because the color has transformed. She explains that inks can undergo an oxidation reduction reaction (yes, like rust), a process that is not unusual as people age. Sun exposure can also lead to decomposition and photoallergic reactions.

Permanent makeup: Options for removal

YAG (yttrium aluminum garnet) laser is the initial laser choice for permanent makeup removal; typically several treatments are required. Those areas that don't respond to treatment with the YAG laser will require treatment with a more invasive (ablative) laser, or in extreme cases, reconstructive surgery.

Often, there is lightening of the skin in the areas treated and there's always the potential for scarring or keloid formation. In addition, YAG lasers can cause paradoxical darkening of tattoo pigments, worsening the situation. Nearby areas can also react to the laser. When removing a cosmetic tattoo near the eye, for example, "the iris can be damaged, because the laser's wavelength may be absorbed by the pigments in the iris, which are similar to that of tattoo ink colors," Dr. Kilmer cautioned. "Likewise, laser applied to black eyeliner or eyebrow tattoos can destroy the nearby hair bulb, resulting in permanent loss of eyelashes or eyebrows."

So what should you do if you've undergone permanent makeup application and dislike the results?

  • Don't be talked into more permanent makeup for color or shape "correction"; this can make removal even more difficult
  • Be sure to go to a board-certified dermatologist, plastic surgeon, or ophthalmologist (in the case of eye region tattoos) experienced in laser removal
  • Ask how many similar procedures the doctor has performed and for how many years
  • Make certain that the doctor performs a test patch treatment before applying laser to the entire site
  • Don't rely on testimonials; ask to speak to patients who've had treatments

For more information on permanent makeup, see Vanity Insanity.

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