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Permanent Makeup

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(Also known as semi-permanent makeup, micropigmentation, cosmetic tattooing and microblading) and medical tattooing are procedures where pigment is tattooed into the skin for a long lasting cosmetic effect.

It was Captain Cook, the British explorer (1796) who first coined the word ‘Tattoo’. He was describing the Polynesian practise of placing black pigments under the skin.

Queen Cleopatra in ancient Egypt and others in India and Africa sought permanent eye enhancements with various substances over the years. Plant extracts were used, as well as ground coals (carbon) and nut pigments. These substances were inserted with any implement they could find which was suitable to file or grind into a sharp point. This was where Permanent Makeup, as we know it today, originated. The procedure was introduced into Europe in 1983 by Dawn Cragg MBE. Being a makeup artist in the traditional sense, Dawn was teaching in Hong Kong when she came across someone having their eyebrows ‘tattooed’ by means of 1, 2 or 3 sewing needles attached to a wooden chopstick with white thread or cotton and dipped into a pigment of a suitable colour.

Thinking of her clients at home, in particular those with Alopecia or hair loss caused by drugs or surgical trauma Dawn quickly, after some practise, changed her makeup brushes for needles.

These days, and in most countries, sophisticated electrical machines are used and everything is disposable. All needles and cartridges used are placed immediately into sharps boxes for collection by a specialised company with licence to transport sharps and contaminated waste e.g. cotton buds, cotton wool, tissues etc.

Hormonal imbalance later in life can cause a loss of eyebrow hair and eyelashes, as can chemotherapy, also one’s eyesight is often not as good as one gets older. The client may have mobility problems, which may make the daily application of conventional cosmetics either very difficult or altogether impossible. Permanent cosmetic procedures can also disguise scars whilst enhancing the eyebrows.

Eyeliner is a very effective procedure, for all the reasons mentioned in the paragraph above, but also for those who partake in sporting activities, or who work in a hot or humid environment, such as kitchen staff.

Medical micropigmentation, or medical tattooing as it is more commonly known, is used to give the appearance of reconstructing lost features, Many of the public will have heard of having the ‘areolae’ tattooed in following breast surgery, but do not realise that any white scar is also suitable for consideration, providing that the patients expectations are not too high and that they are in a good state of mental health.

The patient in the above photograph was approximately 40 years old and had self-harmed as a teenager. Later in life, she sought medical help to improve the appearance of her arm and was offered dermabrasion, (ski-scrape to remove the scarring). Unfortunately her skin did not grow back as expected and the colour discrepancy made her even more self –conscious, resulting in having to wear long sleeves, even in hot weather. Medical tattooing, to give the appearance of freckles and various other irregularities of skin colour to match the surrounding skin had a dramatic and positive effect on the clients mental state, and she now feels able to wear short sleeves.

Medical tattooing offers a longer lasting alternative to the time-consuming and often daily chore of applying conventional camouflage products. It is most important to have the co-operation of the patient’s dermatologist, consultant or medical practitioner. In these days of increased medical litigation none us can afford to take any chances, and patients will sometimes only tell us what they think we want to know. In some cases a treatment prior to the tattooing may be recommended, such as laser, to remove erythema (superficial reddening of the skin.)

An increasing problem is there is not any legalisation at present in the UK, apart from local byelaws and terms and conditions as stipulated by the insurers which are not always adhered to. The worrying fact is that many technicians are insured to go mobile, working in a kitchen or bathroom, and with carpets instead of washable flooring, and often placing needles and contaminated waste in the kitchen bin, or in a wicker wastepaper basket.

Scalp Tattooing

This comes under the category of medical tattooing, and it‘s popularity is rapidly increasing. One of the effects is of a no.1 haircut on males who have lost either all their scalp hair, or who are balding. It is also very effective on thinning hair for both male and females. The problem is choosing the right colour and density to allow for greying hair.

Loss of Eyebrows

There are many reasons for the loss of hair on the eyebrows. Sometimes, especially in the more mature client, it can be over plucking. It can be alopecia and sometimes certain drugs can be the cause of hair loss. This can have great psychological implications, and so in order to distract the patient from thinking only of her brows. It is often advisable to work on another area, either lips or eyeliner, as seen in the following photograph.

For patients with skin-type 4 and above, any trauma of the skin is even more of an issue. As a society, we are sometimes too forthright with our questions to those whose skin shows any discrepancy in either texture or colour.

Advice to Technicans

There are many cases, often the eyebrows, where the permanent makeup does not meet with the client’s expectations in terms of colour or design. This sometimes results in an inadvisable or unrecognised method of tattoo removal, which then further results in scarring and the client taking legal action. This example is closely followed by eyeliner that has migrated too deeply into the skin and ‘bleeds’, sometimes lower than the zygomatic bone (cheek-bone). Often, the technician will claim that the permanent makeup was carried out according to the client’s wishes, but the final result is not likely to be what would be expected from a trained and competent technician.

It is inadvisable for any technician to attempt to correct someone else’s work as in a court of law it is usually the last person to touch a client who is held responsible for the final result. Also the skin, once worked on with needles, will never return to its original condition, and there may be some scarring which the patient has not previously noticed. Nobody would want to be blamed for the work of another technician, but this does happen. Medical tattooing however, where the cause is surgical or accident trauma or a skin defect noticeable at birth, (for example a cleft palate,) can be life changing. This therefore would be acceptable with medical referral if the practitioner does not have a medically recognised qualification. It would be nice to think that those who practise in permanent make-up would refrain from making claims regarding the quality of their work which are unjustifiable.

With the increasing public attraction to discount vouchers available through the internet, it seems that many people are only attracted to how cheaply they can get their permanent make-up procedures, and are not concerned at all about the expertise of the technician.

Advice therefore to anyone who is asked to correct the work of others is “if you want to keep out of court, don’t even think about it”.

Tattooed eyebrows and cosmetic bridal makeup, including her shoulders, by Dawn Cragg MBE

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