Permanent Makeup Pre and Post Care
When scheduling an appointment date for a permanent makeup procedure, keep in mind the healing time of the procedure. You will need a few days afterward without social plans or strenuous activity. You will not look your best (swelling, oozing, & looks like wet paint) so plan activities around the house. Plan a shopping trip ahead of time for items you will need: ointments, straws, napkins for blotting, Q-tips, OTC pain reliever, prescriptions, a good book or movies. Get ahead on your dirty work - no lawn mowing or chores that will get dirt/ bacteria on the healing area. Do not have a procedure right before going on vacation because 1) you need healing time – you will not look like you had a makeover at the mall, 2) you may not be able to avoid sun, wind, or other items listed in post-care instructions, 3) if you had a question or permanent makeup problem it would be best to be near your permanent makeup artist and local physician. Do not wear your good clothes for the procedure because pigment might splatter on them. Pigment washes out of most clothes, but not your favorite ones. Wear something comfortable. We have heated throw blankets if you get cold easily.
At our office the supervising physician prescribes pain pill and valium for sedation. Permanent eyebrow procedures do not need sedation. The brow area numbs easily and the procedure doesn't take long. Permanent eyeliner procedures benefit most from relaxation because some people cannot control the squeeze & flinch protective reflexes for the eyes and might cause an error or injury. Permanent eyeliner and lip procedures take longer (if you want enough pigment in there to last) and the sedation also helps keep you comfortable lying still in one spot.
Most states do not restrict permanent makeup procedures to doctors offices, so may not have the benefit of prescription strength numbing meds and sedation. Alternative herbal products being used include Valerian, Kava, Hops, Melatonin, St John’s Wort, Passion Flower, Chamomile, Willow Bark, and Theanine. If I were to pick one supplement from the list it would be Melatonin. In addition to the drowsy effect, it is good for skin healing and rejuvination. The anti-oxidant properties of Melatonin contribute to its anti-aging effect. Some herbs may increase or decrease the actions of other herbs or prescription medications. Patients on prescription medications should check with their doctor regarding interactions, especially those on heart meds or blood thinners. Some medications and herbs can increase swelling and bleeding. Never discontinue a medication your doctor has recommended for you without consulting him or her.
Antihistamines like Benedryl taken before the procedure may reduce swelling and help you relax. Benedryl also helps eyes not be so watery during eyeliner procedures. Watery eyes can dilute the pigment that is being implanted. Permanent eyebrow swelling is mild and barely noticeable. Permanent eyeliner swelling is moderate. Permanent lip color swelling is severe. Arnica Montana and Bromelain may reduce swelling. It is rare to have a healing problem with permanent makeup eyebrows or eyeliner. If there is going to be a permanent makeup problem, it will be with the lips. Two unpleasant lip complications are Candida infections and hyper-pigmentation. These two permanent makeup problems can fool permanent makeup artists and doctors, resulting in not getting the best treatment for the type of problem that it is.
* Do not wear contact lens during the procedure or for 24 hrs after.
* Bring sunglasses to wear home. Eyes may be light sensitive.
* Do not dye or perm lashes for 2 days prior.
* Do not use eyelash curler the day of the procedure.
* If you have had any type of eye surgery, consult with the physician about how long you should wait before having a permanent eyeliner procedure. Most physicians are giving a 2 month ok after cataract, lasik, and blepharoplasty.
* Do not tweeze, wax, or dye brows for 2 days prior.
* Electrolysis should not be done for a week prior.
* If you get cold sores you will need an antiviral prescription. Physician usually instructs to begin taking it 3 days before procedure, for a 7-10 day course.
* If you have had any type of lip surgery, consult with the physician about how long you should wait before having a permanent makeup procedure on the lips. Most physicians are giving a 3 week ok after lip filler injections like collagen or Restylane. Permanent makeup artists have noticed poor color retention in lips that have received collagen injections within the previous 6 months, longer for restylane. There has even been a little pigment migration along lip edges with Restylane. It may be best not to have lip filler injections and permanent lip color within the same year. If the lip surgery involves an incision (like a lip implant), the incision needs to mature about 6 months before tattooing on top of it.
* Oral prosthesis dentures/ partials/ braces and tongue piercing bars may increase risk of getting bacterial and/or fungal infection from the mouth to the lips. Frequent or recent sinus infection puts lips at risk of infection. Denture wearers generally carry a higher candida/ yeast count. Cutaneous candidiasis/ candidosis is more common in older women (angular stomatitis - perlèche, angular cheilitis). Recent antiobiotic therapy can be responsible for a high candida count. Steroid medications and antacid drugs can allow candida to overpopulate. Smokers tend to have a high count also. Just because you can’t see it doesn’t mean it isn’t there. The bacteria-yeast balance in the mouth can get out of whack, and the oral saliva will get in the holes made by tattooing lips. Lips can get infected easily. Bacterial infections clear up more quickly than Candida Albicans infections. It is possible to have a co-infection when both bacteria and fungus are involved. It is possible to get a candida infection right after clearing up a bacterial infection. More lip infection information will be on the lips special problems page.
GENERAL PERMANENT MAKEUP POST-PROCEDURE AFTER-CARE INSTRUCTIONS
Cold packs have not shown to make a noticeable difference in reducing permanent makeup swelling, but they feel good on the skin and are a comfort measure. Cooling a skin wound is beneficial; freezing it is not. Using refrigerator temperature cold packs is safer for damaged dermis than freezer temperature cold packs. The traumatized tissue is already in a delicate condition and can get frost damage. Slight cooling of the skin a few times after a permanent makeup procedure can be done by applying wet tea bags, cloths, or gel compresses that were placed in the refrigerator (not freezer) in a ziplock bag. If you like to use bags of frozen peas, place a wet washcloth between your skin and the bag. Clients that leave it alone and let nature take its course heal better than the ones that frantically try to help the process. Cold packs are contraindicated for anyone with poor skin circulation, Raynaud’s, cold allergy/ cold urticaria, and other skin/ vascular/ blood disorders that react to cold temperatures.
Inappropriate/overuse use of ice packs on fragile facial skin may cause cryotherapy complications. The freezing can cause ice crystals to form in the skin cells and damage them. Additional swelling can rush in after removal of the ice pack as skin warms. In short, your efforts to reduce swelling with repeat freeze-warm cycles can have the opposite effect and increase swelling. The ice pack initiates primary constriction of blood vessels, then in response, vessels dilate and the area swells (reactive hyperemia of skin microcirculation). Oxygen is needed to heal wounds. Prolonged application of extreme cold reduces the blood flow that brings oxygen to the skin cells and may cause wound hypoxia and acidosis. A certain amount of skin perfusion pressure (SPP) is needed to maintain transcutaneous oxygen tension (TcPO2) for healing. Hypothermia increases risk of infection by reducing tissue oxygenation in hypoperfused tissues. Oxidative killing by neutrophils is a defense against pathogens, and rate of bacterial killing depends on sufficient tissue oxygenation.
* A permanent makeup procedure is the equivalent of a skin-deep wound - like a scratch you might get around the house. Expect it to ooze a little, scab a little, and heal in a similar time frame.
* May cool the skin a few times after permanent makeup procedure with cold pack (or wet and chill chamomile tea bags) for 10 min. every couple of hours the first day. Don’t overdo it. May switch to warm moist pack (or tea bags) after the second day.
* Keep moist with healing ointment at all times while outer healing occurs (3-5 days eyes, 7-10 days lips). Recommendation: GenTeal PM Ointment, Shoshanna EDEN SALVE, and Dr Dan's CORTIBALM lip balm. GenTeal PM makes a great healing ointment after permanent eyeliner because it is ophthalmic / safe for eyes - you can also put some of it in your eyes if they feel dry and irritated. GenTeal is preservative free. Sometimes it is the preservative in a product that people are allergic to. Make sure the box says PM because the other GenTeal formulas are not thick enough to use as a vaseline. Use healing ointment continuously throughout the day until outer healing is complete. Apply antibiotic ointment twice a day for 2-3 days. The antibiotic ointment is more likely to cause a red itchy reaction with prolonged or continuous use. The antibiotic ointment can be whichever brand you like to use at home (bacitracin, polysporin etc). You may use your favorite moisturizers, serums, or healing ointments that have vitamins in it. Clients do best with water soluble or non comedogenic / pore clogging products that let the skin breathe - especially for the prolonged use of ointment for lip tattoo. If a product stings or burns when you apply it do not use it.
* Notify permanent makeup artist or physician at first sign of allergic reaction or infection. If you suspect a problem is developing, the first thing to do is switch the type of ointment you are using. The ointment is often causing the problem. An occasional slight healing itch is normal. Constant intense itching, abnormal thick yellow discharge, yellow crust, hot burning pain, lumps, bumps, and blisters are not normal.
* Avoid strenuous activity for 2 days. Increased blood pressure and dilated blood vessels increases swelling and oozing. Also, sweat running into a wound stings.
* No Scrubbing. Do not rub, wipe, or scratch area. Use patting motions only.
* Keep area clean. Blot or rinse off oozing. Soap/ cleansers may be used as long as they are not alcohol based and do not have anti-aging acids or acne acids in it. Some cleansing chemicals might burn or bleach. If you wouldn’t use a product on any other type of injury, don’t use it on the healing permanent makeup. Rinse and pat dry.
* Do not expose the area to full pressure of the shower. You don’t want the water to beat on it, but water will not erase the tattoo despite the myths being told. Not keeping it clean sets it up for infection. Germs love the extra warmth generated by inflamed tissue, and they like the moistness provided by the oozing and ointment. Germs will be breeding in it. Clean it and keep ointment on it. Scabs that dry out take longer to heal off.
* Do not smash your face in a pillow while sleeping, especially the first couple of days. The skin is drilled full of holes and can tear or kink. The compressed tissue does not get adequate flow of blood and oxygen. The dependent side swells more, can ooze more, and have more color loss.
* Do not peel or pick at crust, this could cause pigment loss, scarring, and delayed healing.
* Do not expose to sun or tanning bed while outer healing progresses. Use of sunblock after healing is completed will help prevent premature fading.
* Do not swim in fresh, salt, or chlorinated water for 2 weeks.
* Avoid environments that would cause dirt or germs to contact area while healing.
* Do not apply topical cosmetics over area while healing.
* Ibuprofen or your favorite pain reliever may be used to reduce swelling and discomfort.
* Final healed result is at about 2 months. If a touchup is needed, it is not done any sooner than 2 months after the first procedure. Performing a touchup too early could cause scarring. Some colors (especially eyebrow colors) take that long or longer to see how they are going to settle in and look. Free touchup period is within 1 year. Brows may need additional fill-in strokes. Eyeliner should not need a touchup.
* Many anti-aging products and services containing acids, lighteners, and exfoliates cause premature fading of pigment. Avoid pigmented area. Stay about 1/4 inch away from permanent makeup.
* Do not use laser hair removal or foto-facial too close to pigmented area to avoid an accidental hit. Most laser operators know how protect a permanent makeup tattoo from the light by placing a tongue blade perpendicular/ 90° right angle against the edge of the brow or lip.
Specifics For EYELINER
* Do not wear contact lenses during the procedure or for 24 hours after.
* Have sunglasses available. Eyes may be light sensitive or even dilated immediately after. The sunglasses are also handy for hiding puffy eyes.
* Do not dye, perm, or use eyelash curler for 2 weeks.
* Do not use mascara until outer healing is complete (3-5 days). Most clients are returning to work in 2 days and are noncompliant about this, so at least begin with a new tube of mascara due to risk of bacterial presence in used tubes. Stay a little farther out on the lashes, not too close to the liner. Remove with vaseline or baby oil without rubbing it into the liner.
* Eyes will be swollen for a few days. Eyes may feel dry or irritated. Lubricating refresher drops may be used.
Specifics For EYEBROWS
* Do not dye, wax, tweeze, or use electrolysis for 2 weeks in the cosmetic tattoo area. You can tweeze outside / around the permanent makeup.
* It can take a little time for the eyebrow tattoo to soften up, and to see how the color is going to do. After the skin is healed over you can put brow powder on it to mask it while waiting. Many women buy eyeshadow to use as brow powder because there are more tones available. Just make sure it is matte and doesn’t have sparkles in it.
Specifics For LIPS
* Lips will ooze a couple of days. Blot and reapply ointment. After sleeping, crust will have dried on the lips. Rinse with water or put more ointment on to loosen crust, blot and reapply ointment. Most tissues like the ones you blow your nose with will leave lint on the lips. Use something stronger and lint-free like Bounty hand towels. A soaking wet cloth feels good to blot with.
* Lips will be tender at first. Drink through a straw. Choose foods you can place in your mouth with a fork without touching lips.
* Place an old towel on the pillow you will sleep on until the oozing stops so you won’t ruin good pillowcases or pillows.
* Do not excessively stretch lips while they are healing with big smiles, or pucker lips with smoking. Those motions push and pull against the lip edges, applying tension and friction between the strong normal skin surrounding the mouth and the broken inflamed lip edges. Lip skin is a continuation of the delicate mucous membrane in the mouth. It is not strong like normal skin.
* On the third day, lips stop oozing and start peeling. This is when the chapped lip feeling is strongest. You may relieve the chapped lip feeling by lightly massaging the lips after placing a thick layer of ointment on them and making gentle circular motions with one finger. The light, wet massage helps get loose skin off that is ready to come off without yanking out skin that is not ready to come off. The massage relieves the chapped feeling for several hours, then it returns, and you can massage again.
* Lips will peel for a week. Other than the massage mentioned above, allow it to flake off on its own. Picking and pulling off skin that is not ready to come off will cause pigment loss and can pull out deeper tissue. The edges or lip liner will be the last to fall off. Pulling this off will result in an uneven splotchy line or an indented scar (like messing with a pimple).
* Try to keep toothpaste off lips while healing.
* Do not have teeth bleached while healing.
* During the peeling process it may look like there is not much color there. Color is more apparent by the second week. Final result is not judged for 2 months.
* It is normal to have discomfort or a feeling of pressure the day of the lip procedure. The next day should be minimal. If you begin having pain on the 3rd or 4th day after being pain-free, it is a signal that something is wrong. It is usually one of three things: 1) Infection, 2) Cold sore, or 3) Allergic contact dermatitis from antibiotic ointment. Switch ointments to rule out that as the cause, and consider a culture to determine bacterial vs yeast infection. We take cultures at our office. We offer consultation and culture collection for anyone who has had permanent makeup procedures elsewhere and is having a healing problem. The lab will send a bill for their services if health insurance does not cover the expense.
* Lip infections after permanent makeup procedures are usually described as burning pain. Bacterial lip infections have a yellow gooey discharge, but begin peeling as expected on day three. Candidal lip infections do not begin peeling on time as would be expected with healthy healing lips (possibly due to candida adhesion properties), and may have a velvety appearance. Candida lip infections have one or more of the following depending on the strain or severity of the infection: cracking and bleeding – more likely near the corners, itching or tingling, whitish bumps/ nodules/ blisters/ pustules – more likely along the edges of the lips. Fungi concentration has been more prominent on the periphery of healing lips where they do the most damage causing blisters, scarring, or tightness. The tightness may relax in time but can take months to years.
* Lip skin yeast cultures taken before the lips heal over usually return positive results in individuals fitting yeast symptoms. Lip skin yeast cultures taken after the lips heal over may return false negative results. Being past the point of reliable results for skin swab culture, a person might need to speak with a dermatologist about a biopsy for diagnosis. Candida strains have a tricky ‘switching’ ability to change phenotype and display various colonial morphology and physiological properties to invade and survive in various environments/ tissue types or body areas, which might account for some of the false negative testing results. Candida should be given the last name chameleon. Candida antibiotics started early (within the first week) clear up lip infections well. Delayed therapy can allow the organism to penetrate deeper tissues, and the person may experience a lengthy spell of sore lips, and be able to feel knots deep in the lip tissue.
* Much information is available online about Candida yeast infections: 1, 2, 3, 4, 5, 6. Books on the subject can found at Amazon.com using search words like yeast, candida, and fungi. They have significant discounts on used books. The worst of the permanent makeup problems happen with the lips. The candida yeast fungal lip infection is a frustrating problem. Often, Candida is not suspected as being the culprit of the lip problem because obvious yeast signs are not visible. Nursing mothers who have developed breast yeast infections know that you don’t have to be able to see it, but it is there. Some of the breast yeast treatments recommended by Dr Jack Newman are also beneficial for lips and facial skin around the mouth (APNO ointment, Gentian Violet in glycerine, Grapefruit Seed Extract, Olive Leaf Extract oil).
* After the lips are healed over and all is well, they still feel more chapped than normal. The chapped feeling subsides over a period of weeks to months. Certain lip balms create the problem. Do not use anything made for cold sores or blisters (carmex, blistex) because although they initially feel moisturizing, they turn around and dry the lips out. Some do more damage than that, especially if applied on broken lip tissue during the healing process. Read This. And This. Applying vitamin E will usually help.
Permanent makeup will appear extremely intense and thick immediately after the procedure. The color will not even look right the first few days. Other factors are added to the permanent makeup pigment bottles to counteract the undertones of facial skin. Browns can look orangish-brown, blonde brows may look too yellow, lip colors are shocking! Some colors initially look too bright and others look too dark. But don't worry - it changes. Excess pigment sheds off over the next 2-3 days, and then the skin starts healing over. A layer of healed skin on top of the pigment masks and tones it down considerably. As swelling goes down the lines will be thinner. On about the fourth day you are close to looking normal and no one notices anything. Colors will continue to soften over the next few weeks. It will look very natural in 2-3 months. You see another difference around the 7-9 month time period. It looks even softer and lighter. Brows and lips that looked fine at 2-3 months may have faint areas or be too light after 7-9 months. Because it can take up to a year to know if you need a touchup, I have extended the touchup timeframe to one year. I want your makeup to look great. That is how I get more business.
OUTER HEALING completes in about 3-6 days for eyes, 7-10 days for lips. INNER HEALING completes in 1-2 months.
Swelling migrates as it resolves. Dispersion into a larger area aids dissipation of swelling. In addition to on-the-spot absorption of swelling by the lymphatic system, excess fluid travels down with gravity through the fatty tissue. Anyone who has had breast implant surgery may remember having edema in the lower abdominal skin a few weeks later. Or, if you have watched someone heal from a bruised eye, you noticed that by the time it is almost healed the last little bit of swelling and discoloration is an inch or two lower at the cheekbone. Swelling from eyebrows can drain to the top eyelids. Swelling in top eyelids have a little movement out and down from the sides over the outer half, but fluid over the inner half is mostly trapped there until absorbed. Swelling in the bottom eyelid drains down to the cheekbone. Swelling drains out of the bottom lip faster than in the top lip. Fluid from the bottom lip can drain down the chin and neck to speed removal. Since the top lip doesn’t have anywhere to drain below it, other than a little movement out to the sides, fluid is stuck there until the lymph system can suck it all out.
How easily a person swells and bruises may be affected by age, food and meds consumed, and hormonal cycles. I have seen everything from no noticeable swelling to bruising. Brows have minimal swelling, but the wet paint look is difficult to hide unless you have long bangs or big rim sunglasses. Eyes have moderate swelling, but can be easily hidden with sunglasses. Generally speaking, younger women’s eyes swell less and the swelling goes down faster after eyeliner procedures. Older women have loose skin that provides a greater water holding pocket. Additionally, circulation and cellular turnover slows with aging. Lips can swell four times their normal size, and there is no hiding them. Request a few surgical masks if you are embarrassed to walk out of the building, or for use at home in case you have to answer the door, or make a trip to the store. After three or four days when the area is healed enough that you don’t have to worry about infection, you can mask the area with other makeup/ powder/ lipstick while waiting for healing to complete.
How quickly a client returns to work depends on which permanent makeup procedure she had performed, and what type of occupation she has (greets the public, or works more privately in office). Eyes and brows are a breeze. Clients have eyes and brows done on Friday or Saturday and return to work Monday. Lips are a bigger ordeal. Clients usually have lips done on Thursday or Friday and return to work on Monday or Tuesday.
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