The NHS guide to cosmetic procedures

Permanent make-up

Permanent make-up, also known as micropigmentation, is a cosmetic procedure to create long-lasting eyeliner, lipliner or eyebrow definition.

The technique can also be used medically ("medical micropigmentation") to recreate areas affected by a health condition or skin problem. For example, it can be used to:

  • create an image of a nipple for women who have had a mastectomy
  • give the illusion of hair for people with hair loss
  • camouflage scars or areas of skin affected by vitiligo

Before you go ahead…

It's important to be absolutely certain before you go ahead with permanent make-up or medical micropigmentation. Here are some things to weigh up:

Cost: In the UK, the cost of cosmetic micropigmentation varies from £75 for a beauty spot to £500 for lip liner. You could pay a few hundred pounds for nipple reconstruction and a few thousand pounds for scalp coverage.

Limitations:

  • It may fade a little every year (some people decide to pay extra to maintain the look).
  • There’s no guarantee you’ll achieve the desired effect.
  • Mistakes are hard to fix (you'll need to undergo laser or chemical tattoo removal).
  • Styles change – thick, well-defined eyebrows, for example, may not be so fashionable in five years time.

Safety: Providers of micropigmentation don't have to be registered with the Care Quality Commission (CQC), which is the independent regulator for health services in England. You should find a reputable practitioner who practises in a clean, safe and appropriate environment, with the processes in place to deal with any complications. Check their qualifications and training.

Medical micropigmentation requires specific training, so make sure the practitioner is properly qualified if you choose this, and check with your doctor that it won’t interfere with any planned treatment. You shouldn’t consider micropigmentation if you’re prone to keloid scarring.

What it involves

Consultation

You should have a thorough consultation beforehand to discuss what type of look you would like to achieve and to agree the colour, position and shape of the desired effect. Find out about the process that would be followed if something were to go wrong.

Take time to reflect on your decision.

A patch test should also be done, to make sure you're not allergic to the pigment.

On the day

A local anaesthetic cream would be applied to the skin to numb it. The skin would then be sketched with a surgical pen.

A sterile single-use needle would be inserted underneath the upper layers of skin to deposit pigmented granules. The pigment is usually iron oxide, which is least likely to cause allergic reactions and bleeding.

Each time the needle is inserted, a droplet of pigment is released into the tiny hole created. You may feel a slight stinging.

The procedure takes about one hour.

You'll usually need two applications spaced four to six weeks apart, and "maintenance" or "top-up" treatments after one to three years, which will cost extra.

Afterwards

Your practitioner will apply a barrier cream. You’ll be advised to apply this twice daily if you feel the area drying out and repeat this for up to 14 days, or until the area has fully healed.

The area may feel itchy or be quite dry while it is healing.

Initially, the colour may appear very intense. It takes about four weeks for the colour to fade to its permanent shade.

The surrounding area may be red and a little swollen immediately after treatment and (depending on the procedure) for a few days afterwards. There may be a few spots of blood on the first day.

You'll need to avoid direct jets from the shower or soaking in the bath for too long, as this may remove the pigment or increase the risk of infection. You'll also need to steer clear of chlorinated water (such as swimming pools) and exposure to sunlight until it has fully healed.

It can take about two weeks to fully heal, after which time you'd be able to carry out your usual routine and use beauty products.

Risks

Possible risks of micropigmentation are:

  • disappointing results (mistakes can be hard to fix)
  • infection
  • a skin reaction, such as swelling, cracking, peeling or blistering
  • granulomas – tiny lumps that form under the skin around the pigment
  • scarring, or overgrowths of scar tissue
  • an allergic reaction to the pigment – but this is rare, as the patch test would usually pick this up
  • MRI complications – rarely, some people have experienced swelling or burning in the tattooed area after having an MRI scan

What to do if you have problems

You should look out for problems with healing or skin pigmentation changes.

If you have any symptoms or complications that require medical attention, it is best that you go back to the practitioner who treated you. If this is not possible, you can go to your GP or local accident and emergency (A&E) department.


Page last reviewed: 19/05/2016

Next review due: 19/05/2019

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