Not So Permanent Make-Up

Permanent makeup is a form of tattooing used to enhance the natural appearance of facial characteristics such as the eyebrows, eyelids, and lips. In recent years, the scope of PMU has expanded to include various medical applications. These include: (a) reconstruction of the areola and the nipple following breast surgery, (b) coverage of skin scars, (c) imitation of hair follicles in cases of hair loss of any (medical) reason, and (d) correction of vitiligo. These medical applications have gained popularity and are now considered famous and widely implemented in clinical settings, significantly improving recipients’ quality of life. While the primary motivation for cosmetic PMU is typically beauty and self-esteem, medical tattoos aim to restore a sense of normalcy for recipients.

Cosmetic tattooing includes both the creation of the permanent makeup effect and the camouflage of injuries or surgical scars. PMU is also known as semi-permanent makeup, micropigmentation, derma-pigmentation, or aesthetic tattoo. The use of tattoos for medical purposes dates back thousands of years. Tattoo marks that have been found on preserved mummies show that, among other significances, it was believed that tattoos had healing properties, such as arthritis pain relief, because some appear to be close to traditional acupuncture points. Historically, cosmetic tattooing served various purposes, including tribal rituals and gender-independent decoration, as evidenced by findings in Egypt, Asia, Africa, Europe, and the Americas which demonstrate the significant role in the life of ancient civilizations. Early tattoos were created using primitive tools and natural colorants, such as soot and colourful powders from plants and rocks.

Today, body tattooing is primarily decorative and performed with electric devices. The past few years have seen significant advancements in tattooing apparatuses, inks, techniques, and services. Tattooing is increasingly popular, with many celebrities covering their bodies with various designs, influencing their fans and especially young people to get inked. Many individuals obtain their first tattoo during their teenage years or early adulthood, and the number of tattoos often increases over time. Concurrently, PMU has become one of the fastest-growing sectors in the beauty industry, with thousands of women undergoing this procedure daily to enhance their facial features and follow the trends.

Both procedures are the same. All pigments are inserted superficially in the papillary layer of the dermis. Due to the puncturing of the skin, an inflammation is initiated. Macrophage cells try to remove the foreign body pigment particles by engulfing them with the phagocytosis procedure. Some macrophages will take up more than one pigment particle and will reach a diameter that will not allow the macrophage and the pigment to enter the lymphatic system. As a result, the macrophages containing the pigments remain in place between the collagen bundles of the connective tissue of the dermis and form a visible and permanent or semi-permanent tattoo. After the macrophages have undergone cell death, new macrophages move in and engulf the same pigment agglomerates. This process of phagocytosis and apoptosis is repeated constantly during the lifetime of a tattoo and is described as the pigment capture-release-recapture cycle of dermal macrophages. The permanent character of tattoos and PMU is based on these cellular processes, and, progressively, it fades and blurs.

In PMU applications, the depth at which pigments are inserted significantly affects the perceived colour of the final result. When pigments are placed deeper in the skin, shorter wavelength colours, such as blue, are reflected more intensely than longer wavelength colours, like red. This phenomenon often results in a cooler, bluish tint in applications like eyebrow tattoos. For example, if the pigment is placed too deep, the final appearance can be more bluish rather than the intended colour. This depth-dependent colour shift contrasts with decorative tattoos, where variations in colour depth typically have a less noticeable impact on the overall design. Black tattoos, for instance, may appear differently from the original ink colour due to the interaction of light with the skin but remain consistent in the design.

Both PMU and tattoo pigments interact with light, absorbing and reflecting wavelengths within the visible spectrum based on their colour. The appearance of PMU can vary depending on a person’s skin tone, which differs in translucency based on ethnicity, anatomical site, and thickness.

For PMU and tattoo application, it is important not to mix inks and colorants from different brands or product lines because their carrier liquids and chemical compounds can differ. These different substances may lead to the destabilization of the application or cause adverse reactions. Furthermore, the particle size of the pigments may differ due to different raw materials and different processes of milling, which can result in discordance between pigment fractions. Pigment particles from different ink manufacturers can agglomerate during mixing and lose their dispersible properties. Different pigment clusters may cause migration of some fraction of pigment from the insertion site to a different depth or position in the dermis, resulting in visible blowout to the surrounding skin near the application of the tattoo or permanent makeup.

The rising popularity of tattooing and PMU has also led to an increased demand for complete or partial tattoo removal. Laser tattoo removal is the most common method for eliminating unwanted tattoos, whether for complete removal or correction of a poor PMU application. Often, a new tattoo can be applied in the same area a few months after removal.

Tattoo inks, primarily composed of organic pigments, are characterized by smaller particle sizes and greater pigment stability, contributing to their lifelong permanence. In contrast, PMU colorants, which predominantly use inorganic pigments, exhibit a semi-permanent nature due to their larger particle sizes and gradual fading. This necessitates multiple applications of PMU, unlike the typically single-application requirement for tattoos.

The use of inorganic pigments in PMU offers a potential advantage: easier removal for recipients who change their preferences. However, this characteristic also warrants further research into the safety and efficacy of inorganic pigments, particularly when used on sensitive facial areas. Future studies should aim to identify the specific compounds influencing the duration and safety of PMU colorants, thereby ensuring safer application practices and protecting public health.

In summary, while PMU and tattoo procedures may appear similar, the choice of colorants significantly impacts the longevity and maintenance requirements of the applications. Understanding these differences is crucial for practitioners and manufacturers, emphasizing the need for careful selection of colorants and consideration of their long-term behaviour in the skin to achieve the best possible results for both permanent makeup and tattoo applications.

NOT MY OWN WORK. Taken from:

Andreou, E.; Hatziantoniou, S.; Rallis, E.; Kefala, V. Why Permanent Makeup (PMU) Is Not a Lifetime Application. Cosmetics 2024, 11, 160. https://doi.org/10.3390/cosmetics11050160

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