- Ask about your professional's background and training
- Ask how long they have been doing micropigmentation (semi-permanent cosmetics)
- Ask if they have passed any examinations for Board Certification by the Academy
- Ask if they use disposable needles. This is so important to your safety and welfare.
- Ask if they were trained by an instructor who is Board Certified by the American Academy of Micropigmentation?
- Ask what pigments they use? Iron Oxides and titanium dioxide are the least likely to cause problems. Some synthetic organic pigments are okay but make sure there has never been an allergic reaction. If a technician states they use “vegetable-based” pigments or dyes that is a red flag because there is no such thing used for coloring the face. Note: You can have an MRI safely after permanent makeup. (J Magn Reson Imaging. 2002 Feb;15(2):180-4). Questions? go to: http://www.mrisafety.com
- Ask if your makeup is "permanent" or if it will fade? If they insist your makeup is permanent, and will not fade, then consider consulting a second professional. All colors soften and fade over time and need to be refreshed every year or two in most cases. Especially eyebrow colors with muted browns, golds and grays.
- Ask if your technician can offer you advanced procedures like color correction, hairstrokes for your brows, pleasing lip colors and eyeliner that won’t turn "tattoo" blue?
- Ask your technician if their eyeliner colors contain any ink (Pelikan Ink)? Inks are fine for traditional tattoos. However, if used for eyeliner, inks have been known to migrate or spread under the skin and look like a permanent bruise.
- Ask about pain control. Injections of local anesthetic should not be used for permanent makeup. Topicals work well, are safe and don’t need a doctor. Occasionally, a dental block may help control pain but rarely is required for lip procedures.
The American Academy of Micropigmentation continues to protect the public by offering information about the profession and professionals, sources for competent training, safety guidelines for products and a team of physicians with an unparalleled background in all aspects of permanent makeup. Dr. Charles S. Zwerling, MD, an ophthalmologist has authored “Micropigmentation: State of the Art”, a textbook on permanent makeup. The millennium edition will be edited by Dr. Zwerling, Dr. Linda H. Dixon, anesthesiologist, and Dr. Kristanne Matzek, PhD in education and pioneer permanent makeup instructor.
Many members of the Academy offer their services free to cancer survivors who’ve lost their eyelashes and brows to chemotherapy. Also, members know how to do medical tattooing of the breast after surgery. Patients with unsightly scars from accidents, burns, hair transplants or cleft lip repair benefit from the artistic skills of Academy members. Top permanent makeup professionals and members of the Academy undergo years of training and continuing education.
The Consumer Rights Statement of the American Academy of Micropigmentation members tells the consumers what service they can expect from the Permanent Cosmetic Professional. It also tells the consumers what they need to do in order to cooperate with the service provider to ensure quality service and outcome.
Right to know:
1. Consumers have a right to know.
1.1 The micropigmentation information for their procedure(s)
1.2 The usual and customary fees
1.3 The PC professional's credentials and standards of performance
1.4 The right to Privacy
1.5 The FDA Statement about cosmetic tattooing (www.fda.gov/ search tattoo).
1.6 The cooperation expected from the consumer
1.7 The importance of the informed consent and their signature on the form.
1.8 The commercial interest of the professional in services or products
1.9 The complaint handling procedure.
1.10 That all information presented by the professional is truthful.
1.1 Information about micropigmentation procedures. Explanation of the nature and risk of a permanent makeup procedure to the client is essential. Clients should understand the indications for the procedure, the risks involved, and the result that it is hoped to attain. Written informed consent must be obtained and the original is to be kept with the client's records.
1.2 The usual and customary fees
When a practitioner agrees to care for a client, a contract is established and should be in writing in the form of an informed consent. This relationship implies agreement that the practitioner will be compensated for services rendered to the client. Whether or not requested by the client, a practitioner should fully discuss the fee with the client. Fees are to be commensurate with services rendered and the client's rights. Practitioners have individual bases for their charges, and fees vary in different communities. The American Academy of Micropigmentation does not attempt to establish fee schedules for its members who are expected to make charges commensurate with what is considered to be reasonable.
1.3 The PC professional's credentials and standards of practice
The PC professional shall provide proof of training, education and experience, including AAM Board Certification and/or eligibility as requested by the consumer.
1.4 The right to privacy.
Every client's right to privacy must be respected. The practitioner should maintain the confidentiality of information from and about the client, except as such information must be communicated for the client's proper care or as is required by law. Photographs and/or videotaping of the client shall not be construed as a violation of their privacy. The informed consent should reflect if any such recordings may be used for educational purposes.
1.5 The FDA Statement about cosmetic tattooing (see attachment).
1.5 The cooperation expected from the consumer
Cooperation is required from the consumer in order to complete a satisfactory result for micropigmentation. Thus the consumer is required to comply with all requests of the professional for follow-up visits, physician release, needed consultation and/or prescribed medications to be taken (e.g. herpes, mitral valve prolapse), sensitivity testing of pigments for color and/or allergic reaction as needed, and meticulous attention to post-operative care of the tattooed site.
1.7 The significance of the informed consent and their signature on the form
Because cosmetic tattooing is an elective procedure, and not a medical necessity, the consumer must understand that any adverse events are preventable by simply electing to not have any micropigmentation performed. Further, that such procedures do have complications which are unforeseen and that their cooperation with the PC professional and/or medical professionals is vital to their well being. They must understand that their signature on the informed consent means that they are legally competent to sign the consent and have a full understanding of the procedure they elect to undergo by the PC professional.
1.8 The commercial interest of the professional in services or products
When appropriate, an Academy member should disclose any financial interest in a commercial enterprise so that other professionals or the public can accurately evaluate statements made by the Fellow about the products or services. Failure to disclose remuneration or financial interest may constitute grounds for disciplinary action by the Board of Directors of the American Academy of Micropigmentation.
1.9 The complaint handling procedure
In the event of a complaint, consumers shall present themselves for photographs and a meeting with the PC Professional. Any refunds for procedures shall be done at the discretion of the PC Professional. All other remedies as allowed by law are available to both parties. The consumer or practitioner (professional) may write to the American Academy of Micropigmentation and request that his/her complaint be reviewed and that a non-binding opinion be given by Academy Board Members. Such an opinion shall not be construed as a professional opinion for litigation purposes but is rather intended to handle a dispute prior to any legal remedies being sought by either party.
1.10 All materials presented to the consumer shall be truthful and free of alteration, falsification, deception by omission or commission. Specifically, all photographs in literature, websites or any promotional materials shall be unretouched in any manner. All materials shall be real representations of micropigmentation unless strictly ornamental in nature.
U. S. Food and Drug Administration
Center for Food Safety and Applied Nutrition
Office of Cosmetics and Colors Fact Sheet
November 29, 2000
TATTOOS and PERMANENT MAKEUP
The inks used in tattoos and permanent makeup (also known as micropigmentation) and the pigments in these inks are subject to FDA regulation as cosmetics and color additives. However, FDA has not attempted to regulate the use of tattoo inks and the pigments used in them and does not control the actual practice of tattooing. Rather, such matters have been handled through local laws and by local jurisdictions.
But with the growth in popularity of tattooing and permanent makeup, FDA has begun taking a closer look at related safety questions. Among the issues under consideration are tattoo removal, adverse reactions to tattoo colors, and infections that result from tattooing.
Another concern is the increasing variety of pigments and diluents being used in tattooing -- more than fifty different pigments and shades, and the list continues to grow. Although a number of color additives are approved for use in cosmetics, none is approved for injection into the skin. Using an unapproved color additive in a tattoo ink makes the ink adulterated. Many pigments used in tattoo inks are not approved for skin contact at all. Some are industrial grade colors that are suitable for printers' ink or automobile paint.
Nevertheless, many individuals choose to undergo tattooing in its various forms. For some, it is an aesthetic choice or an initiation rite. Some choose permanent makeup as a time saver or because they have physical difficulty applying regular, temporary makeup. For others, tattooing is an adjunct to reconstructive surgery, particularly of the face or breast,
to simulate natural pigmentation. People who have lost their eyebrows due to alopecia (a form of hair loss) may choose to have "eyebrows" tattooed on, while people with vitiligo (a lack of pigmentation in areas of the skin) may try tattooing to help camouflage the condition.
Whatever their reason, consumers should be aware of the risks involved in order to make an informed decision.
What Risks Are Involved in Tattooing?
The following are the primary complications that can result from tattooing:
Infection. Unsterile tattooing equipment and needles can transmit infectious diseases,such as hepatitis. The risk of infection is the reason the American Association of Blood Banks requires a one-year wait between getting a tattoo and donating blood.
It is extremely important to make sure that all tattooing equipment is clean and sterilized before use. Even if the needles are sterilized or never have been used, it is important to understand that in some cases the equipment that holds the needles cannot be sterilized reliably due to its design. In addition, the person who receives a tattoo must be sure to care for the tattooed area properly during the first week or so after the pigments are injected.
Removal problems. Despite advances in laser technology, removing a tattoo is a painstaking process, usually involving several treatments and considerable expense. Complete removal without scarring may be impossible. See "The Most Common Problem: Dissatisfaction" and "Removal Techniques," below.
Allergic reactions. Although allergic reactions to tattoo pigments are rare, when they happen they may be particularly troublesome because the pigments can be hard to remove. Occasionally, people may develop an allergic reaction to tattoos they have had for years.
Granulomas. These are nodules that may form around material that the body perceives as foreign, such as particles of tattoo pigment.
Keloid formation. If you are prone to developing keloids -- scars that grow beyond normal boundaries -- you are at risk of keloid formation from a tattoo. Keloids may form any time you injure or traumatize your skin, and according to Office of Cosmetics and Colors (OCAC) dermatologist Ella Toombs, M.D., tattooing or micropigmentation is a form of trauma. Micropigmentation: State of the Art, a book written by Charles Zwerling, M.D., Annette Walker, R.N., and Norman Goldstein, M.D., states that keloids occur more frequently as a consequence of tattoo removal.
MRI complications. There have been reports of people with tattoos or permanent makeup who experienced swelling or burning in the affected areas when they underwent magnetic resonance imaging (MRI). This seems to occur only rarely and apparently without lasting effects. There also have been reports of tattoo pigments interfering with the quality of the image. This seems to occur mainly when a person with permanent eyeliner undergoes MRI of the eyes. Mascara may produce a similar effect. The difference is that mascara is easily removable.
The cause of these complications is uncertain. Some have theorized that they result from an interaction with the metallic components of some pigments.
However, the risks of avoiding an MRI when your doctor has recommended one are likely to be much greater than the risks of complications from an interaction between the MRI and tattoo or permanent makeup. Instead of avoiding an MRI, individuals who have tattoos or permanent makeup should inform the radiologist or technician if this fact in order to take appropriate precautions, avoid complications, and assure the best results.
The Most Common Problem: Dissatisfaction
According to Dr. Toombs, the most common problem that develops with tattoos is the desire to remove them. Removing tattoos and permanent makeup can be very difficult. Skill levels vary widely among people who perform tattooing. According to an article by J.K. Chiang, S. Barsky, and D.M. Bronson in the June 1999 issue of the Journal of the American Academy of Dermatology, the main complication with eyelid tattooing is improperly placed pigment. You may want to ask the person performing the procedure for references and ask yourself how willing you are to risk permanently wearing someone else's mistake.
Although tattoos may be satisfactory at first, they sometimes fade. Also, if the tattooist injects the pigments too deeply into the skin, the pigments may migrate beyond the original sites, resulting in a blurred appearance.
Another cause of dissatisfaction is that the human body changes over time, and styles change with the season. The permanent makeup that may have looked flattering when first injected may later clash with changing skin tones and facial or body contours. People who plan to have facial cosmetic surgery are advised that the appearance of their permanent makeup may become distorted. The tattoo that seemed stylish at first may become dated and embarrassing. And changing tattoos or permanent makeup is not as easy as changing your mind.
Methods for removing tattoos include laser treatments, abrasion, scarification, and surgery. Some people attempt to camouflage an objectionable tattoo with a new one. Each approach has drawbacks:
Laser treatments can lighten many tattoos, some more easily and effectively than others. Generally, several visits are necessary over a span or weeks or months, and the treatments can be expensive. Some individuals experience hypopigmentation -- a lightening of the natural skin coloring -- in the affected area. Laser treatments also can cause some tattoo pigments to change to a less desirable shade.
Unfortunately, knowing what pigments are in your tattoo or permanent makeup has always been difficult and has become more so as the variety of tattoo inks has multiplied. Inks are often sold by brand name only, not by chemical composition. Because the pigments are sold to tattoo parlors and salons, not on a retail basis to consumers, manufacturers are not required by law to list the ingredients on the labels. Furthermore, because manufacturers may consider the identity and grade of their pigments "proprietary," neither the tattooist nor the customer may be able to obtain this information.
There also have been reports of individuals suffering allergic reactions after laser treatments to remove tattoos, apparently because the laser caused allergenic substances in the tattoo ink to be released into the body.
Dermabrasion involves abrading layers of skin with a wire brush or diamond fraise (a type of sanding disc). This process itself may leave a scar.
Salabrasion, in which a salt solution is used to remove the pigment, is sometimes used in conjunction with dermabrasion, but has become less common.
Scarification involves removing the tattoo with an acid solution and creating a scar in its place. Surgical removal sometimes involves the use of tissue expanders (balloons inserted under the skin, so that when the tattoo is cut away, there is less scarring). Larger tattoos may require repeated surgery for complete removal.
Camouflaging a tattoo entails the injection of new pigments either to form a new pattern or cover a tattoo with skin-toned pigments. Dr. Toombs notes, however, that injected pigments tend not to look natural because they lack the skin's natural translucence.
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