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Plastic surgery practices have become more accepting of the implantation of permanent cosmetics over the last few years. Many plastic surgery practices have added the implantation of permanent cosmetics into their offered services. Many clients who would not have considered having permanent cosmetics implanted because of having to go to a tattoo parlor are now having the procedures performed. The most popular procedures being performed are the implantation of permanent eyeliner followed by eyebrows and lip liner. Other implantations of permanent cosmetics are the full-lip applications, eye shadow application, cheek blush, and a beauty mark implantation. Micro pigmentation can be used for nipple coloration following reconstruction or camouflaging skin pigmentation problems due to trauma, birthmarks, cancer, etc. This article focuses on the use of micro pigmentation for the use of permanent cosmetics (WebMD, 2009).
Cosmetics have been very important to women throughout history. In 2000 B.C., the Egyptians were the first women to create and use cosmetics. "Many cultures were using tattooing more than 2000 years ago. A few of the cultures identified as using tattooing were the Incas, Mayans, Aztecs, Greeks, Egyptians and the Nubians. The Egyptian women used lead and copper as cosmetics. Throughout history women have used berries, burnt matches, arsenic, lead, mercury and leeches. Women put themselves at risk to enhance their appearance" (Health Beginnings Magazine, 2012).
Today, cosmetics are a multibillion dollar industry because women are always looking for ways to enhance their appearance (WebMD, 2009).
Permanent cosmetics is also called permanent makeup, micro pigmentation, and cosmetic tattooing. Permanent cosmetics procedures include eyeliner, eyebrows, lip liner, eye shadow, and creation of pseudo birth marks (The American Society for Aesthetic Plastic Surgery, 2009). Permanent cosmetic applications may be used to give the effect of lifting, enhancing, making an area more of a focal point, minimizing or masking asymmetry, creating fullness, or minimizing an area (Zwerling, Dixon, Christensen, & Goldstein, 2010).
The application of permanent cosmetic eyeliner is used to enhance the eye. The application of eyeliner may also be used to give the appearance of lifting the eye by creating an upward angle on the tale of the outer aspect of the eyeliner. When a client is unsure of having permanent eyeliner applied, it is recommended that she apply removable eyeliner first for a few weeks to assist her in making a decision (Zwerling et al., 2010).
Eyebrows may be used to shorten, elongate, soften, or harden the look of the face. A subtle lift, shortening, elongation, lighten, darkening, or filling in may cause a major change to the face. Permanent cosmetics for the eyebrows are also used to help minimize asymmetry (Zwerling et al., 2010).
Lip liner may be used to give the lips more color, definition, or fullness, or to minimize the shape. As we age, the lips become smaller. The application of pigment into the lip with either a liner or full lip color gives the appearance of younger fuller lips. Application of permanent cosmetics in the lips also aids in minimizing asymmetry (Zwerling et al., 2010).
People have a variety of reasons for seeking out permanent cosmetics. Permanent cosmetics may be used to enhance an individual's natural appearance, especially for those who have a physical or visual impairment and/or when applying cosmetics has become a daily challenge. As women age, the eyesight begins to deteriorate and applying makeup becomes more difficult. Some women seek the convenience of not having to apply cosmetics. These women start to seek out options to assist with makeup application and that leads many women to permanent cosmetics. The application of permanent cosmetics is very beneficial for those who have an active lifestyle. Patients with permanent cosmetics no longer need to apply makeup or worry about it getting wet, running, or smudging (Zwerling et al., 2010).
When a patient is considering permanent cosmetics, the technician must be able to provide a thorough consultation using her assessment skills. This would involve gathering and reviewing the patient's medical history to rule out any contraindications to the procedure. Due to the possible risks of anesthetic effects to a fetus or baby, a patient who is pregnant or breastfeeding should not undergo tattooing until breastfeeding is finished. Accutane (isotretinoin) use within 12 months must be avoided as Accutane may cause changes in the skin, resulting in potential scarring. The use of steroids may impair healing and must not be used for 6 weeks prior to the treatment. If the patient reports any recent or up and coming surgical procedures, the micropigmentation should not be performed until the patient is completely healed to prevent risk of infection. Previous laser treatments near the area for pigmentation must be completely healed prior to application of pigment to improve retention of pigment and to prevent infection. Once the area has been pigmented, having laser treatments near or on the area may cause the pigment to change color or break down the pigment. Facial fillers should not be injected in the pigmented area until completely healed to decrease risk of infection. If facial fillers have previously been injected, be sure that all swelling has subsided prior to pigmentation to achieve best placement and result. If the client is on anticoagulant therapy, medical clearance must be obtained from the primary care physician (PCP) due to potential for bleeding, scarring, bruising, and swelling. Medical clearance from the PCP should be obtained by the client and printed on the physician's personal letterhead.
All clients who are insulin-dependent diabetic patients, are on chemotherapy treatments, or are immunosuppressed would also need written medical clearance because of potential for infection, healing issues, and scarring. For a client who has a history of herpes simplex and is having the lips treated, a prescription for an antiviral medication must be given, for example, valacyclovir (Valtrex) 500 mg twice a day for 6 days, to commence 2 days prior to the scheduled treatment. A client with a history of cardiac issues, valve replacements, stents, organ transplant recipient, or joint replacements must get medical clearance from the PCP because of the possibility of negatively affecting long-term health. All integumentary conditions, such as conjunctivitis, shingles, sunburn, or psoriasis, must be controlled and healed prior to the application of micropigmentation due to risk of infection, scarring, and optimal results of pigment applied. Clients with a history of keloid scars must be pigmented gently to minimize potential for keloid formation (Zwerling et al., 2010).
The technician must be aware that a procedure must not be performed on a patient who has had permanent cosmetics from the year 2000-2004 with Premier True Concentrates pigment. The pigments used may cause a severe allergic reaction that may disfigure the client. Previous tattoos on the body may be viewed to assess how the client reacted to past pigments and tattooing (Zwerling et al., 2010).
Patients need to be informed of possible adverse reactions and ensuring patient commitment to permanent change. These adverse reactions include bleeding, infection, swelling, discoloration, and potential for scarring. As with any aesthetic procedure, there is always a risk of an allergic reaction of the anesthetic cream or the dyes used. It is important to inform any client who is considering permanent cosmetics that he or she should not schedule the procedure within 2 weeks of a special occasion because of length of healing time. Interesting to note to patients is the potential for experiencing a warm or tingling sensation during a magnetic resonance imaging (MRI) due to the presence of iron oxide in the pigment. We are all unique individuals with different body chemistry. Depending upon the body's reaction, the body may try to exfoliate the pigment faster than another individual. It is impossible to tell a patient how long the pigment may last due to each individual body reaction/exfoliation.
Once the health history is complete, the patient's area of interest is determined and assessed in regard to location, color, and thickness. It is important to take enough time to properly educate patients so they are comfortable signing an informed consent. The following steps on the day of treatment are as follows:
* Before photo taken
* Topical anesthetic applied for 30 minutes
* Patient marked in a sitting position
* Informed consent reviewed, signed, dated, and timed
* Color chosen
* Patient positioned for procedure
* Outline followed for implantation of pigment
* Topical anesthetics applied throughout procedure
* Patient reviews the results prior to cleanup
* Vaseline/hydrocortisone applied
* Patient must be made aware that the initial pigment color will be darker than the healed pigment color.
* Touch up cannot be determined or performed for 6-8 weeks.
* Written discharge instructions reviewed
* 6 weeks' follow-up appointment
* Contact information for the provider (Zwerling et al., 2010).
Once the treatment is completed, the patient must receive written and oral instruction that includes the following information.
* Short term (until pigmented area is completely healed)
* Application of ointment
* Keeping the area clean
* Application of ice the day of procedure
* Sleep with the head elevated to decrease swelling and
* Avoid excess sodium to help minimize swelling
* The patient must be instructed not to pick at the scabbing or the pigment may be pulled out
* Avoidance of chlorine, hot moist environments, antibiotic ointment, ointment vitamin E, and direct sunlight
* Avoid cosmetics in pigmented area
* If all after-care instructions are not followed, optimal result may be sacrificed (Zwerling et al., 2010).
* Long term
* Direct sun and tanning beds
* Exfoliants on pigmented area
* Cosmetics that may affect pigment (Exfoliants, Latisse, etc.) (Zwerling et al., 2010).
A patient must have realistic expectations. If a patient's expectations cannot be met, it is best to inform him or her that you cannot meet the expectations or perform the procedure. As a provider, if you feel the patient is indecisive, it is best not to perform the procedure. In the case of the indecisive patient or a patient with unrealistic expectations, a procedure should not be performed, no matter how persistent the patient may be.
Many of our patients have self-esteem issues. When a patient comes in for a consultation, sometimes he or she feels guilty or vain. It is important to encourage patients to think about what is important to him or her and do what he or she wants to do to improve confidence. As a provider, I truly believe that if a cosmetic procedure helps the self-esteem, why not have it performed.
Permanent cosmetics can have such a positive effect in a patient's life. If the patient truly wants to have the procedures, he or she must understand that there are no perfect results. Nobody is perfectly symmetrical whether it is his or her eyes, ears, arms, legs, or any body part. When a patient applies makeup, it is not perfect. One side of the makeup may be slightly darker than the other. A patient must be prepared for the permanent makeup results. I have found that some patients will go home and study themselves looking for minute flaws. It is very important to prepare the patient for a natural looking result that will enhance his or her appearance, not change him/her into someone else. The keys for success are preparation, education, and realistic expectations.
Providing the service of permanent cosmetics can be a welcome addition to any practice. To be successful, the technician must be trained by a well-prepared and highly credentialed instructor of the art. Becoming a permanent cosmetic specialist is a challenging yet rewarding experience. Certified courses are available, but the requirements may differ between the different states. Some of the common requirements to apply for certification are completing an approved training program and completing an apprenticeship.
Once these training sessions are completed, the technician must send the following information to the certification board: a copy of the training certificate, letter of apprenticeship, copy of malpractice insurance and proof of professional membership, photo identification, and registration fee to pay for the certification examination (American Academy of Micropigmentation, n.d.).
Nurses who wish to expand their role may want to consider the very rewarding challenge of becoming permanent cosmetic specialists.
American Academy of Micropigmentation. (n.d.). Board certification exam. Retrieved May 22, 2012, from http://www.permanentmakeuptraining101.com/board_certification_exam.htm
The American Society for Aesthetic Plastic Surgery. (2009). Micropigmentation. Retrieved April 17, 2012, from E:/News Release-Skin, Hair & Veins Treatments-ASAPS Press Center-Micropigmentation.mht [Context Link]
Health Beginnings Magazine. (2012). The history of permanent make-up & paramedical procedures. Retrieved April 16, 2012, from mhtml:file://E:/The History of Permanent Make-up&Paramedical Procedures [Context Link]
WebMD. (2009). History of makeup. Retrieved April 16, 2012, from mhtml:file://E:/History of Makeup.mht [Context Link]
Zwerling C. S., Dixon L. H., Christensen F. F., Goldstein N. F. (2010). Micropigmentation millennium. Alpharetta, GA: Apex Book Manufacturing. [Context Link]
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