Permanent Cosmetics Christine L

Aesthetics Department

Permanent Cosmetics Christine L. Wetzel , BSN, RN, CPSN

lastic surgery practices have Cosmetics have been very impor- enhance the eye. The application Pbecome more accepting of the tant to women throughout history. of eyeliner may also be used to give implantation of permanent cosmetics In 2000 B.C., the Egyptians were the appearance of lifting the eye over the last few years. Many plastic the first women to create and use by creating an upward angle on surgery practices have added the cosmetics. “Many cultures were the tale of the outer aspect of the implantation of permanent cosmetics using tattooing more than 2000 eyeliner. When a client is unsure of years ago. A few of the cultures having permanent eyeliner applied, into their offered services. Many cli- identified as using tattooing were it is recommended that she apply ents who would not have considered the Incas, Mayans, Aztecs, Greeks, removable eyeliner first for a few having permanent cosmetics implant- Egyptians and the Nubians. The weeks to assist her in making a ed because of having to go to a tattoo Egyptian women used lead and decision (Zwerling et al., 2010). parlor are now having the procedures copper as cosmetics. Throughout Eyebrows may be used to short- performed. The most popular pro- history women have used ber- en, elongate, soften, or harden the cedures being performed are the ries, burnt matches, arsenic, lead, look of the face. A subtle lift, short- implantation of permanent eyeliner mercury and leeches. Women put ening, elongation, lighten, darken- followed by eyebrows and lip liner. themselves at risk to enhance their ing, or filling in may cause a major Other implantations of permanent appearance” (Health Beginnings change to the face. Permanent cos- cosmetics are the full-lip applications, Magazine, 2012). metics for the eyebrows are also eye shadow application, cheek blush, Today, cosmetics are a mul- used to help minimize asymmetry tibillion dollar industry because (Zwerling et al., 2010). and a beauty mark implantation. women are always looking for Lip liner may be used to give Micro pigmentation can be used for ways to enhance their appearance the lips more color, definition, nipple coloration following reconstruc- (WebMD, 2009). or fullness, or to minimize the tion or camouflaging skin pigmenta- Permanent cosmetics is also shape. As we age, the lips become tion problems due to trauma, birth- called permanent makeup, micro smaller. The application of pig- marks, cancer, etc. This article focuses pigmentation, and cosmetic tat- ment into the lip with either a on the use of micro pigmentation tooing. Permanent cosmetics liner or full lip color gives the for the use of permanent cosmetics procedures include eyeliner, eye- appearance of younger fuller lips. (WebMD, 2009). brows, lip liner, eye shadow, and Application of permanent cos- creation of pseudo birth marks metics in the lips also aids in (The American Society for Aes- minimizing asymmetry (Zwerling Christine L. Wetzel, BSN, RN, CPSN, is thetic Plastic Surgery, 2009). Per- et al., 2010). the Clinic Nurse Supervisor, Skin Care Con- manent cosmetic applications People have a variety of rea- sultant and Permanent Cosmetic Specialist for the Plastic Surgery Clinic at Geisinger may be used to give the effect sons for seeking out permanent Medical Center. of lifting, enhancing, making an cosmetics. Permanent cosmet- The author has received no financial assis- area more of a focal point, mini- ics may be used to enhance an tance in writing this article. mizing or masking asymmetry, individual’s natural appearance, The author has no conflict of interest. creating fullness, or minimizing especially for those who have a Address correspondence to Christine L. an area (Zwerling, Dixon, Chris- physical or visual impairment Wetzel, BSN, RN, CPSN, 100 North Acad- emy Ave, Danville, PA 17822 (e-mail: tensen, & Goldstein, 2010). and/or when applying cosmetics [email protected]). The application of perma- has become a daily challenge. As DOI: 10.1097/PSN.0b013e31826929c6 nent cosmetic eyeliner is used to women age, the eyesight begins

PPSN200219.inddSN200219.indd 117117 88/16/12/16/12 5:385:38 PMPM to deteriorate and applying make- facial fillers have previously been how the client reacted to past pig- up becomes more difficult. Some injected, be sure that all swelling ments and tattooing (Zwerling et women seek the convenience of has subsided prior to pigmenta- al., 2010). not having to apply cosmetics. tion to achieve best placement Patients need to be informed These women start to seek out and result. If the client is on of possible adverse reactions and options to assist with makeup anticoagulant therapy, medical ensuring patient commitment to application and that leads many clearance must be obtained from permanent change. These adverse women to permanent cosmetics. the primary care physician (PCP) reactions include bleeding, infec- The application of permanent due to potential for bleeding, tion, swelling, discoloration, and cosmetics is very beneficial for scarring, bruising, and swelling. potential for scarring. As with those who have an active lifestyle. Medical clearance from the PCP any aesthetic procedure, there is Patients with permanent cosmet- should be obtained by the client always a risk of an allergic reac- ics no longer need to apply make- and printed on the physician’s tion of the anesthetic cream or up or worry about it getting wet, personal letterhead. the dyes used. It is important to running, or smudging (Zwerling All clients who are insulin- inform any client who is consid- et al., 2010). dependent diabetic patients, are ering permanent cosmetics that When a patient is considering on chemotherapy treatments, or he or she should not schedule permanent cosmetics, the tech- are immunosuppressed would the procedure within 2 weeks nician must be able to provide also need written medical clear- of a special occasion because of a thorough consultation using ance because of potential for length of healing time. Interesting her assessment skills. This would infection, healing issues, and scar- to note to patients is the poten- involve gathering and reviewing ring. For a client who has a his- tial for experiencing a warm or the patient’s medical history to tory of herpes simplex and is hav- tingling sensation during a mag- rule out any contraindications to ing the lips treated, a prescription netic resonance imaging (MRI) the procedure. Due to the pos- for an antiviral medication must due to the presence of iron oxide sible risks of anesthetic effects be given, for example, valacyclo- in the pigment. We are all unique to a fetus or baby, a patient vir (Valtrex) 500 mg twice a day individuals with different body who is pregnant or breastfeed- for 6 days, to commence 2 days chemistry. Depending upon the ing should not undergo tattooing prior to the scheduled treatment. body’s reaction, the body may until breastfeeding is finished. A client with a history of cardiac try to exfoliate the pigment fast- Accutane (isotretinoin) use with- issues, valve replacements, stents, er than another individual. It is in 12 months must be avoided organ transplant recipient, or joint impossible to tell a patient how as Accutane may cause changes replacements must get medical long the pigment may last due in the skin, resulting in poten- clearance from the PCP because of to each individual body reaction/ tial scarring. The use of steroids the possibility of negatively affect- exfoliation. may impair healing and must ing long-term health. All integu- Once the health history is com- not be used for 6 weeks prior mentary conditions, such as con- plete, the patient’s area of inter- to the treatment. If the patient junctivitis, shingles, sunburn, or est is determined and assessed reports any recent or up and psoriasis, must be controlled and in regard to location, color, and coming surgical procedures, the healed prior to the application of thickness. It is important to take micropigmentation should not be micropigmentation due to risk of enough time to properly educate performed until the patient is infection, scarring, and optimal patients so they are comfortable completely healed to prevent risk results of pigment applied. Clients signing an informed consent. The of infection. Previous laser treat- with a history of keloid scars must following steps on the day of ments near the area for pigmen- be pigmented gently to minimize treatment are as follows: tation must be completely healed potential for keloid formation ⅙ Before photo taken prior to application of pigment (Zwerling et al., 2010). ⅙ Topical anesthetic applied to improve retention of pigment The technician must be aware for 30 minutes and to prevent infection. Once the that a procedure must not be per- ⅙ Patient marked in a sitting area has been pigmented, hav- formed on a patient who has had position ing laser treatments near or on permanent cosmetics from the ⅙ Informed consent reviewed, the area may cause the pigment year 2000–2004 with Premier True signed, dated, and timed to change color or break down Concentrates pigment. The pig- ⅙ Color chosen the pigment. Facial fillers should ments used may cause a severe ⅙ Patient positioned for pro- not be injected in the pigment- allergic reaction that may disfig- cedure ed area until completely healed ure the client. Previous tattoos on ⅙ Outline followed for implan- to decrease risk of infection. If the body may be viewed to assess tation of pigment

PPSN200219.inddSN200219.indd 118118 88/16/12/16/12 5:385:38 PMPM ⅙ Topical anesthetics applied A patient must have realistic well-prepared and highly cre- throughout procedure expectations. If a patient’s expec- dentialed instructor of the art. ⅙ Patient reviews the results tations cannot be met, it is best Becoming a permanent cos- prior to cleanup to inform him or her that you metic specialist is a challeng- ⅙ Vaseline/hydrocortisone cannot meet the expectations or ing yet rewarding experience. applied perform the procedure. As a pro- Certified courses are available, ⅙ Patient must be made aware vider, if you feel the patient is but the requirements may dif- that the initial pigment indecisive, it is best not to per- fer between the different states. color will be darker than the form the procedure. In the case of Some of the common require- healed pigment color. the indecisive patient or a patient ments to apply for certification ⅙ Touch up cannot be deter- with unrealistic expectations, are completing an approved mined or performed for 6–8 a procedure should not be per- training program and complet- weeks. formed, no matter how persistent ing an apprenticeship. ⅙ Written discharge instruc- the patient may be. Once these training sessions tions reviewed Many of our patients have self- are completed, the technician ⅙ 6 weeks’ follow-up appoint- esteem issues. When a patient must send the following informa- ment comes in for a consultation, some- tion to the certification board: a ⅙ Contact information for the times he or she feels guilty or copy of the training certificate, let- provider (Zwerling et al., vain. It is important to encour- ter of apprenticeship, copy of mal- 2010). age patients to think about what practice insurance and proof of Once the treatment is complet- is important to him or her and professional membership, photo ed, the patient must receive written do what he or she wants to do to identification, and registration and oral instruction that includes improve confidence. As a provider, fee to pay for the certification the following information. I truly believe that if a cosmetic examination (American Academy procedure helps the self-esteem, of Micropigmentation, n.d.). • Short term (until pigmented why not have it performed. Nurses who wish to expand area is completely healed) Permanent cosmetics can their role may want to consider ⅙ Application of ointment have such a positive effect in a the very rewarding challenge of ⅙ Keeping the area clean patient’s life. If the patient truly becoming permanent cosmetic ⅙ Application of ice the day of wants to have the procedures, specialists. procedure he or she must understand that ⅙ Sleep with the head elevated there are no perfect results. to decrease swelling and Nobody is perfectly symmetrical REFERENCES ⅙ Avoid excess sodium to help whether it is his or her eyes, ears, American Academy of Micropigmen- minimize swelling arms, legs, or any body part. tation . (n.d. ). Board certification ⅙ The patient must be instruct- When a patient applies makeup, exam. Retrieved May 22, 2012, from ed not to pick at the scab- it is not perfect. One side of the http://www.permanentmakeuptrain- bing or the pigment may be makeup may be slightly darker ing101.com/board_certification_ pulled out than the other. A patient must exam.htm ⅙ Avoidance of chlorine, hot The American Society for Aesthetic be prepared for the permanent moist environments, anti- Plastic Surgery . ( 2009 ). Micropig- makeup results. I have found biotic ointment, ointment mentation . Retrieved April 17, 2012, that some patients will go home vitamin E, and direct sun- from E:/News Release-Skin, Hair & and study themselves looking for light Veins Treatments-ASAPS Press Cen- minute flaws. It is very impor- ⅙ Avoid cosmetics in pigment- ter-Micropigmentation.mht tant to prepare the patient for a Health Beginnings Magazine . (2012 ). ed area natural looking result that will The history of permanent make-up ⅙ If all after-care instructions enhance his or her appearance, & paramedical procedures . Retrieved are not followed, optimal not change him/her into some- April 16, 2012, from mhtml:file://E:/ result may be sacrificed one else. The keys for success The History of Permanent Make- (Zwerling et al., 2010). are preparation, education, and up&Paramedical Procedures WebMD . ( 2009). History of make- • Long term realistic expectations. ⅙ up . Retrieved April 16, 2012, from Direct sun and tanning beds Providing the service of per- mhtml: file://E:/History of Makeup.mht ⅙ Exfoliants on pigmented area manent cosmetics can be a Zwerling C. S. , Dixon L. H. , Christensen ⅙ Cosmetics that may affect welcome addition to any prac- F. F. , Goldstein N. F. (2010 ). Micropig- pigment (Exfoliants, Latisse, tice. To be successful, the tech- mentation millennium . Alpharetta, etc.) (Zwerling et al., 2010). nician must be trained by a GA: Apex Book Manufacturing.

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