Micropigmentation boom could signal future removal demand

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Micropigmentation boom could signal future removal demand
Oct 1, 2006
Cheryl Guttman
Modern Medicine

Micropigmentation procedures to create permanent eyeliner or enhance the appearance of the eyebrows are increasing in popularity. However, as the number of persons who undergo those tattooing procedures grows, it is likely that so, too, will the number seeking correction or removal.

Dominic Brandy, M.D., cosmetic dermatology fellowship instructor for the University of Pittsburgh, directs three skin centers in Pennsylvania and Ohio at which micropigmentation procedures are performed by trained estheticians.

"There seems to be a definite increase in demand for permanent eye makeup in recent years," Dr. Brandy tells Cosmetic Surgery Times. "That trend can be attributed in part to the growing size of the aged population, as older persons, who find it difficult to apply makeup because of their deteriorating vision or fine motor skills, seek micropigmentation as an alternative. However, the growth in these procedures extends across all age groups, as more younger women want to look their personal best at all times," he says.

Jeffrey S. Dover, M.D., associate clinical professor of dermatology, Yale University School of Medicine, New Haven, Conn., and a dermatologic surgeon in Boston, does not offer micropigmentation in his private group practice. However, among patients who come to see him for other reasons, he has noted that permanent makeup is becoming more and more common.

"When I ask patients about their experience, the majority seem to be very pleased with the results. However, micropigmentation is an art form, and the key to consumer satisfaction is to have it performed by a trained expert who is likely to achieve a result that is even and natural-looking. Unfortunately, not all persons who perform these procedures are as skilled as they should be," Dr. Dover says.

Motivations for removal

Disappointment with the end result and the development of complications are two reasons why persons might seek cosmetic tattoo removal. In addition, individuals who have been pleased with their permanent makeup for years may grow dissatisfied over time as a result of changing anatomy or personal preferences. Tattooed brows that have dropped over time secondary to facial sagging may cause a person to look very heavy-eyed, or the "look" conferred by the permanent makeup may no longer correspond to the individual's lifestyle, Dr. Dover notes.

"One of the problems with permanent makeup, and particularly eyeliner, is that it presents a fixed appearance that is not always appropriate for all social occasions. Over time, women who have had these procedures may find that they do not want to look like they are always ready to attend a formal event," Dr. Dover says.

Laser best option

A number of methods have been described for removing cosmetic tattoos, including microdermabrasion, excision, and bleaching by filling the tattoo instrument with alcohol or glycolic acid and running it over the previously tattooed skin. However, surgical and mechanical techniques carry risks that include scarring, pigmentary abnormalities and alopecia. Laser treatment in the hands of an expert seems to offer the safest and most effective approach for cosmetic tattoo removal, say Dr. Brandy and Dr. Dover.

Nevertheless, doctors should be aware of certain caveats relating to the need for eye protection and the color of the pigment that has been used.

Dr. Dover has vast experience with laser surgery, including for tattoo removal. When removing eyebrow tattoos, the eyes are covered with gauze or metal goggles, whereas additional safety precautions are needed for removing permanent eyeliner, including the use of a metal eyeshield and anesthesia (topical ophthalmic and local infiltration) to prevent facial movement that could result in inadvertent ocular exposure to the laser. Use of a small spot size (2 mm) is also desirable for optimizing targeted energy delivery and avoiding damage to the eye and eyelashes.

If the tattoo contains only black pigment, it can be removed using a Q-switched ruby (694 nm), Q-switched alexandrite (755 nm) or Q-switched Nd:YAG (1064 nm) laser. Complete clearance is often possible, although patients should be prepared to undergo multiple treatments, Dr. Dover says.

However, cosmetic tattoos containing any cream or skin color tones present a greater challenge, because the pigment usually contains iron oxide or some other metallic oxide.

"If the tattoo color has a brown or gray tone, be aware that the pigment may have been blended with a metallic oxide that will turn immediately black by the laser," Dr. Dover explains.

That type of reaction can usually be predicted based on the color that is present, although the patient may be asked first to find out exactly what pigments were used. Dr. Dover suggests avoiding getting started if there is any suspicion that there is iron or some other metal oxide in the pigment.

"There are reports of these oxidized pigments being cleared with repeated laser treatments, and so you can inform the patient that the tattoo will darken right away and may then be removed with return visits," Dr. Dover says. "However, most patients are not too happy if the micropigmentation they are seeking to remove is made more visible, and an acceptable result may require 20 or more laser sessions, which is very expensive and can take months to years. Therefore, my advice is to tell the patient you are sorry, but there is nothing you can do."

Touch-ups and corrections

Depending on the problem, correction of cosmetic tattoos may or may not be a viable option. Dr. Brandy notes that his estheticians frequently do touch-ups because the tattoo pigment has faded over time, and those procedures are as straightforward as initial placement. In addition, his skilled estheticians may try to address some irregularities from a less-than-expert job done elsewhere, but the chance of achieving a good cosmetic outcome relates to the nature of the problem.

"Eyebrows and eyeliner tattoos need to be well-placed and not too heavy, so that they appear natural, and the tattoo should form a continuous line or curve, because the observer's eye is quickly attracted to any break or step. Adding pigment may correct some irregularities, but would not be an option for permanent makeup that is too thick or poorly placed," Dr. Dover says.

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