So it's time to simplify the beauty routine. You know, shorten your time in front of the mirror each day.

Wouldn't it be great to wake up looking like you did the evening beforefresh eye liner, lip color, blushwithout lifting a finger? It's easier than you think. Just head to your nearest tattoo parlor.

Tattoo? Yes, you read that correctly. Permanent makeup, a form of tattooing, is an innovative way to have that ready-to-go face all the time. But don't be fooled. Sure, it's called "makeup," or "cosmetics," but the process involved is nothing more than tattooing.

A permanent makeup technician injects a small amount of pigment into the skin, causing an instant color change and providing a look similar to makeup. Let's say, for example, you'd like to have permanent eyeliner. The technician injects the desired color into the eyelid, creating the specific "line" you like. No more fussing with eye pencils or liquid liner. It's there. Forever.

And that's the key with permanent makeup. It really is permanent. Of course, as with traditional tattooing, there has been some success in removing the tattoo with laser and other types of treatment. "There is no permanent way to remove a tattoo," says Charles S. Zwerling, M.D., F.A.C.S. "Anytime you try to remove a tattoo you will have permanent alteration of the tissue, a scar." And after many years, the color can fade. Experts caution: Before going ahead with a permanent makeup procedure, make sure it's something you are willing to live with for the rest of your life.

"This is not like changing hair color," says Kathleen Ciampi, executive director of the Society of Permanent Cosmetics Professionals. Ciampi, who has been a permanent makeup technician since 1991, says that people need to be very sure about what they want before sitting down in the technician's chair.

In addition to knowing what you want, you should be sure of what you're going to get. Zwerling, an ophthalmologist, founded the American Academy of Microgpigmentation in 1992 to help encourage board certification and continuing education for practitioners of permanent makeup. The Academy also closely monitors regulations and laws governing the practice of permanent makeup (laws and regulations vary from state to state).

So how does an ophthalmologist get involved in cosmetic tattooing? Interestingly enough, Zwerling says, it was ophthalmologists who first were permitted to do the procedure on the eyelids. Later, Zwerling says, ear, nose and throat specialists and plastic surgeons were given the green light to provide permanent makeup services. More recently, estheticians, cosmetologists, electrologists and others beauty professionals have come into the field.

But it was his wife's interest in the eyeliner procedure some 20 years ago that got Zwerling into the industry. "My first reaction was: You have lost your mind. You want your eyelids tattooed?" Zwerling called a Las Vegas-based ophthalmologist who was considered a pioneer in the field. After speaking with the doctor, he decided to visit him to see how the procedure was done. "It amazed me," Zwerling says, "it was so simple."

Once he began performing the procedure, Zwerling says he had trouble finding any good scientific research on the subject. "Research was very limited, and didn't use a reasonable scientific standard." He decided to get into the research business and eventually wrote two textbooks on the subject.

In the Trenches

Ciampi says that permanent makeup is not appropriate for everyone. "Those who expect miracles, those who think you will make them perfect, and, of course, those who typically should not expose themselves to tattoo procedures, like pregnant women, diabetics or those on anticoagulants," Ciampi says.

She says that her clients are a mixed group of women. "Typically one would think [permanent makeup] would only be for vain women, but women now have little time and want to do things for themselves. It is most common with women who are starting to notice changes. Maybe less-than-perfect lip definition and pale lips, brow hair that is thinning, or overall 'washed out look' as so may state," Ciampi says.

Even if a client thinks she knows what she wants, a good technician will give her a reality check. "A blue-based lip cannot have a brown permanent lip color," says John Hashey, a traditional tattooist-turned permanent makeup technician. "It will turn blue." Hashey says that he uses his understanding of how the color, or pigment, will look once it's injected under the skin in assessing what he can and cannot do for a client. He says that some technicians know how color works on the outside of the body, but in order to produce the desired result, one must understand how the color will work inside the body. "People new to the industry don't understand color theoryyou have to understand what the color will do," he says.

Finding Your Perfect Match

When it comes to selecting a technician, Zwerling, Ciampi and Hashey all say that clients need to do their homework. Zwerling says that technicians should be certified by his academy (for more on certification, visit www.micropigmentation.org). He says the lack of consistency in training within the industry prompted him to start the academy. "You [technicians] just can't go out there and do these things that are permanent to somebody's face and not have credentials."

Hashey, who is on the board of the AAM, agrees: "The real deal is that in the industry as a whole, a good portion of [practitioners] don't even know what they're doing." Hashey, a self-proclaimed bad boy of the industry, teaches prospective technicians from his Oldsmar, Florida (near Tampa), school. He blames the abundance of "one-day seminars" and the like for producing substandard technicians. "It really aggravates me that these schools do a one-day course. My average beginner takes two to six months before they are out on the street doing work," Hashey says. "You can't learn this in a week. You can't do it. There is no way."

What To Expect

The procedures actually are quite straightforward. Ciampi says the first thing she does is take a complete history of the patient. This serves two purposes: It allows the technician to rule out any possible contraindications and helps determine what results the client is hoping to achieve.

Permanent makeup procedures are available for lip color (liner and full lip color), blush, eyeliner, eyebrows and other areas, including camouflage and reconstruction.

For lip color, Ciampi says, "I use single-use, fine-tipped, nontoxic red markers to shape the lips after the client has been sitting with a topical anesthetic on her lips for about 15 minutes (some technicians prefer to have the client go for injected anesthetics). Then, using whatever device is selected, whether it is a machine or a hand device, the line is followed with the pigment selected to achieve the desired color, increasing the thickness as the client wishes. The client will also be participating by checking the shape and color from time to time."

After the lip procedure, the lips are typically swollen, though the degree of swelling varies from client to client. Overall, experts say, the healing process is quite fast and requires little more than application of a gentle salve, such as A&D ointment or petroleum jelly.

Hashey says that clients need to be aware of the experience of their technician. In the case of one woman, Hashey says the technician "tattooed black ink into someone's lip liner. It destroyed the woman's face." The client sought out Hashey to correct the problem. "I fix a lot of major cases," he says. "They call me the janitor because I clean up so many messes."

More Than Just Vanity

Permanent makeup has uses far beyond the obvious. Many technicians with advanced training work with clients who have vitiligo, a progressive loss of pigmentation of the skin (commonly know as "that condition that Michael Jackson has"), as well as women who have had mastectomies (areola reconstruction). For conditions such as vitiligo, Zwerling cautions: "I would urge anyone who is considering having this done to be very skeptical. It's not an easy thing to do. There is almost always a delayed color change later on. Check the credentials of the technician, see their work. See people who [the technician worked on] a year ago," Zwerling says. "The results for this type of work are very controversial. Only do a small test area, then wait six months to a year [for the rest of the procedure]," he says.

Hashey says he has done a great deal of camouflage work for cancer patients, people with port wine stains and others. He says he usually does this type of work for free. "I want to give back to people," he says.

If It Walks Like a Duck

If it's pigment injected into the skin using needles, it's a tattoo. Perhaps it's the connotations surrounding tattoos that prompts many permanent makeup technicians from admitting the true nature of their craft. Ciampi says that the main difference between a regular tattoo and permanent makeup is that regular tattoos typically are not on the face. "Plain and simple. They are the same thing. Needles putting color in the skin."

Zwerling agrees and says that the purpose of the procedure is different. "The training is different. Many of the best permanent makeup technicians have their roots in [traditional] tattooing. If you're going to do this, you're going to require different training."

Hashey, a former United States Marine who began his career as a traditional tattooist, says permanent makeup is nothing more than a tattoo. "The techniques are slightly different," he says. "The tissue you are working with is different. But it is a tattoo. You have to learn to tattoo [before you can do permanent makeup well]."

Risks

When done correctly, permanent makeup is a very safe procedure. Reputable technicians follow universal precautions with respect to sanitation and safety. However, even under the best circumstances, there is a risk of hepatitis C. transmission. "There have been a number of cases," Zwerling says, "but very few people want to admit it. I personally know of two cases. One in which the technician contracted hepatitis C from a client. It's not always the risk of the tech giving it to the clientAnytime you have an exposed needle, you have a risk. There is no way to get around it."

Zwerling also has heard anecdotal evidence of transmission of HIV from a practitioner to a client.

Additionally, some people with permanent makeup, Zwerling says, have experienced a mild reaction after having an MRI. The pigments contain iron oxide, which may react to the magnetic field. "You can get a mild itching to a full-blown swelling," he says. The reaction is transitory, "within 24 hours it is gone." Patients can use Benydryl, a steroid cream or other over-the-counter creams to make the reaction disappear.

Bottom Line

Permanent makeup doesn't come cheap. Ciampi says clients can expect to pay $300 on the low end for eyebrows and $800 on the high end for lips.

All of the experts advise that price should not be the deciding factor in choosing a technician. Hashey says that he charges $750 for lip color, which he guarantees for five years. "Some technicians will charge $600 for lips, but then two weeks later the color is gone and the client needs to spend $200 for touch-up. Touch-ups may be necessary, but the client shouldn't have to pay for them."

Just like the guy who goes into a tattoo parlor and has the name of his latest girlfriend emblazoned on his shoulder, only to regret it years later when his wife's name doesn't match, many permanent makeup clients have probably wished that they had thought twice about that deep red permanent lip color. Or those really high-arched eye brows. Or even that thick, black eyeliner.

Before you seek out permanent makeup, take a good, long look in the mirror and decide if the choice you make today will still make you happy 10 years down the road. If you're ready, do your homework and thoroughly research your technician. Ask for referrals and pictures of past work.

If you're going to let someone permanently mark your face, be sure it's someone you can trust.

For more information on permanent makeup, visit the following Web sites:

• Society of Permanent Cosmetics Professionals (For general information and technician listings)
• American Academy of Micropigmentation (For general information, legislation updates, state regulations and searches of AAM certified technicians)
• John Hashey's Advanced School of Permanent Cosmetics (For general information and technician training)

Robin Heinz Bratslavsky
DERMAdoctor Staff Writer

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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