I recently considered having my eyebrows enhanced with permanent makeup, enticed by beautiful before and after pictures. Overplucking and age have turned my once bushy brows into spotty, straggly strands. Since I usually don’t leap before I look, I researched the pros and cons of permanent makeup. And, ladies, it’s not pretty.
Permanent makeup or micropigmentation is essentially tattooing; colored inks are injected below the epidermis.  In addition to eyebrows, colored inks are commonly applied to eyelids, lips and cheeks. Micropigmentation also is used for non-makeup applications related to medical conditions, such as reconstructing the areola (nipple) on women who have undergone breast reconstruction after a mastectomy.

What’s in that ink, anyway?

More than 50 different pigments and shades are in use, and although a number of color additives are approved by the Food and Drug Administration (FDA) for use in cosmetics, none is approved for injection into the skin. According to the FDA, many pigments used in tattoo inks are not approved for skin contact at all. Get this: Some are industrial grade colors that are suitable for printers’ ink or automobile paint!

Some cosmeticians tout inks without preservatives. Made with sterilized distilled water, the inks are not alcohol-based. It may sound good, but removing the alcohol and not adding any other preservative allows bacteria to grow. Infection is a common complication not only from nonalcohol-based inks but unsterile equipment and needles, which can transmit hepatitis, Staphylococcus aureus (“staph”) and HIV.

Adverse reactions

Reports of allergic reactions are rare, but adverse reactions can include swelling, cracking, blistering, peeling and scarring of the skin—even disfigurement. In some cases granulomas (nodules) or keloids (firm, rubbery raised lesions) may form. The latter can form as a result of laser removal of the micropigmentation as well. There also have been reports of photosensitivity and swelling or burning in the affected area when the person undergoes an MRI.

The most common problem, however, appears to be dissatisfaction with the results. Skill levels of practitioners vary widely. It seems when permanent makeup is good, it’s very, very good; but when it’s bad, it’s horrid. A Web search finds an overwhelming number of unhappy customers. Many feel they look unnatural or clownish (think Michael Jackson). The FDA reports the top four complaints are “too dark,” “wrong color,” “uneven” and “too big.” Colors do fade over time, however.

Yet another problem may not become apparent until years later—the effects of gravity. As skin sags, so do tattoos. Distortion may also occur if you subsequently undergo facial cosmetic surgery.

Costs

According to a 2009 survey, the average cost for a permanent makeup procedure runs about $400 for lip liner or eyebrows to nearly $600 for full lip color. But costs vary widely by region.

Laser removal of permanent makeup, however, will cost a lot more if you aren’t happy, and it isn’t covered by insurance. The painstaking process involves several treatments and a variety of risks. Removal from the lips can cause them to turn black; ink used on the eyebrows can turn yellow. Some colors may not be able to be removed completely and, the FDA warns, full removal without scarring may be impossible.

Do your homework

If you do decide to try permanent makeup, find out what the licensing requirements are in your state. They can vary from requiring that a licensed medical professional perform the procedure to no license needed at all. Experts in the field suggest the following:

• Check credentials. Go to a board-certified doctor; the procedure should be performed under medical supervision.
• Inquire about the practitioner’s experience in performing the type of procedure you want. For example, how many have been performed in the last year?
• Ask about possible risks and side effects and how often they have occurred in the practice.
• Ask to see before and after pictures, and get references.
• Get details about the procedure—how long it will take, where it will be performed and the expected recovery time.
• Provide your complete medical history, including any existing medical conditions and prescription medications you are taking.