Q&A: Dermatologists can use power of permanent makeup to physically, mentally aid patients

Key takeaways:

• Walter Liszewski, MD, FAAD, discussed how permanent makeup can benefit dermatology patients.
• He also offered safety information and practical applications for dermatologists looking to implement this practice.

Makeup not only has cosmetic applications, but medical ones too.

While most think of lipstick, mascara and other products that individuals apply to their face daily as makeup, there are alternative definitions as well, one of which is permanent makeup — a type of tattoo that is commonly used in both the cosmetic and medical communities.

Healio spoke with Walter Liszewski, MD, FAAD, assistant professor of dermatology and preventative medicine at Northwestern Feinberg School of Medicine, about how permanent makeup can benefit patients with dermatological diseases, both physically and mentally.

Healio: What is permanent makeup?

Liszewski: Permanent makeup is where pigments can be placed into the skin to correct a perceived cosmetic problem or to help enhance the natural appearance. It can be used in lieu of standard makeup. For example, instead of having to apply eyeliner every day, someone can get permanent makeup done, which will allow them to have the pigment they would like in place every single day.

It can also be used for medical purposes. The one example that people think of most often is nipple reconstruction for breast cancer survivors after they’ve had full breast reconstruction. In this case, permanent makeup can be used to create a nipple that looks real.

It can also be used for other medical purposes such as permanent dyschromia, vitiligo or alopecia areata. So, there’s a variety of medical and cosmetic uses for permanent makeup.

Healio: How does permanent makeup benefit patients with chronic skin diseases and other conditions?

Liszewski: Our medications are limited in terms of what they can do. We can’t always regrow hair, regrow pigment or change permanent post-inflammatory hyperpigmentation. As a result, permanent makeup is very useful because it can fix chronic changes to the skin that medications are unable to fix.

For example, it can give the appearance of hair if someone doesn’t have hair; it can fill in pigment of some vitiligo; it can even fix or cover up post-inflammatory hyperpigmentation due to psoriasis or atopic dermatitis.

It can also be very helpful for people who either don’t want to apply makeup on a regular basis or have health reasons preventing them from doing it, such as physical disabilities or allergies to makeup products.

For example, permanent makeup can be life changing for patients with Parkinson’s disease, spinal cord injuries or inflammatory arthritis because it allows them to wear the makeup they would like to wear but are physically unable to apply on a daily basis.

Healio: Can the use of permanent makeup improve patients’ mental health?

Liszewski: Yes, one of the wonderful things about permanent makeup is its ability to achieve things that we as physicians cannot. We cannot always get the hair to come back and we can’t always get skin pigment to normalize. That’s where a very talented permanent makeup artist comes in because they are able to achieve these changes which can allow patients to move on with their lives and not be burdened by this disease that they have — the disease they have to look at every single day.

Healio: Are there any health risks from using permanent makeup?

Liszewski: One of the things consumers need to know about is that the permanent makeup industry is largely unregulated. Several states don’t even require permanent makeup artists to have a license, let alone wear gloves. Many people who practice permanent makeup have a background in cosmetology, but they don’t have the same background that a decorative tattoo artist does.

When I say decorative tattoo, I mean a tattoo you would get on your arm, for example. Decorative tattoo artists do apprenticeships and spend years training. However, for permanent makeup, the training is oftentimes only a few hours or a couple of days.

So, there’s tremendous variability in terms of the safety of how the tattoos are applied from a blood-borne pathogen standpoint. If a physician recommends permanent makeup, it is very important that they have a good idea of who in the community is doing it and doing it safely.

Healio: What should patients do when a complication from permanent makeup occurs?

Liszewski: Unfortunately, in many states, permanent makeup artists are not required to give aftercare instructions. As a result, consumers don’t always know what a complication is let alone who they should contact if a complication occurs. A complication may include redness, swelling or infection.

If a patient experiences complications, I would encourage them to contact their tattoo artist first. Dermatologists may be very surprised to learn that tattoo artists know a lot about skin complications. They don’t necessarily know it in the same detail that a dermatologist does or have a medical background, but the reality is, that much like a cosmetic dermatologist, a permanent makeup artist is only as good as the work they do. They want to do the best job possible and have the best cosmetic outcomes possible, because if they don’t, they won’t have clients.

So, there really is a tremendous interest amongst tattooists to learn more about tattoo safety, and there’s a great opportunity for the dermatology community to partner with tattoo artists. I think many physicians would be shocked to realize just how serious tattoo artists are about their job, how much they prioritize safety and how they really want to learn as much as possible. Even in the absence of government regulations, tattoo artists really do care about safety and they want to make sure that they’re doing their job right.

Healio: Any final advice for dermatologists?

Liszewski: I think any dermatologist and any physician can recognize that a tattoo artist who’s capable of creating a nipple for a survivor of breast cancer has tremendous ability to help patients. I don’t think anyone would doubt that. So, I think dermatologists should realize that there are very talented permanent makeup artists out there who, while being able to do great microblading or great eyeliner, which is a huge service to our patients, can also help patients with something like alopecia areata.

The best way to learn more about this is to just email these artists. Ask them what they do and ask them about their portfolio. Having a close connection with a permanent makeup artist can be great because, firstly, our patients trust us, and we want to give them a recommendation for someone we trust as well. Secondly, this is a tool in our toolbox that many dermatologists are not using. Many dermatologists don’t know that permanent makeup can be incredibly effective for calcifying vitiligo or correcting severe chronic alopecia areata.

I encourage dermatologists to learn more about who in their community is doing permanent makeup. I think they’ll be pleasantly surprised how much these artists are not only talented, but also how much they genuinely care about human disease and improving patient quality of life.