Permanent makeup tattoo treatments have been gaining popularity in recent years, especially microblading. As the demand for permanent makeup increases, so does the need for tattoo removal. Removal is usually requested when the patients feel that the makeup no longer reflects their style or when the results are not what they were expecting. Permanent makeup is hard to master, even with proper training. Recently, there has been a trend of untrained individuals administering permanent makeup. While it is recommended to receive certification, an individual can perform permanent makeup treatments without any qualifications.
Removing pigments from the skin
There are several methods to lighten or reduce pigment molecules in the skin. This includes laser, non-laser solutions, and topical lotions. Each approach has its strengths and weaknesses. You should determine the most appropriate treatment after evaluating the circumstances of the patient.
1. Lasers
Laser treatments are the most common method for removing skin pigment and permanent makeup. Generally, laser procedures are not recommended for a tattoo that is less than 6 months old. Due to the high concentration of ink, this may increase the risk of scarring. The ingredients of permanent makeup are also substantially different from tattoo ink. Therefore, it is important to understand how makeup pigments will react with the treatment. Before using laser treatments, check if the pigments contain titanium dioxide. In addition, the molecular size should be taken into consideration.
2. Non-laser solutions
There are many types of non-laser procedures, all of which should only be performed by trained beauticians. To remove unwanted makeup, the skin is opened using a permanent makeup or tattoo machine (similar to the original tattoo procedure). Bonding agents such as glycolic acid or salt are put on the open skin to draw the pigment from the surface. A single session is roughly equivalent to 2 months of topical exfoliation. Non-laser treatments are widely popular among estheticians who do not have access to a laser. Due to the larger molecular size, these procedures are particularly effective against skin-colored pigments. However, they could result in epidermal damage, and therefore have a higher risk of scarring than laser treatments.
3. Topical Lotions or Creams
While there are many tattoo removal creams available on the market, their efficacy has yet to be proven in clinical trials. Being unable to penetrate into the dermis, these topical products cannot reach the tattoo ink; therefore, they are generally considered ineffective. A study showed that tretinoin and imiquimod successfully reduced the tattoo pigment in guinea pigs; however, the agents were applied 6 hours after tattooing.
Studies have also suggested that a combination of imiquimod with laser is significantly more efficacious than laser treatment alone. This implies that topical treatments may be useful in facilitating pigment removal. For makeup of less than 6 months old, it is recommended to exfoliate the skin area with fine sea salt twice a day for 2 months. This helps to draw out the ink, reducing the number of laser treatment required by half. The method only works on new tattoos where the ink has not settled.
i. Molecule size and color
In general, the molecular size of pigments ranges from 1 micron to 20 microns (taking into account the agglomerates of small molecules in inks and pigments). The nature of pigments (i.e. inorganic, organic, or synthetic organic) will also affect the molecular size. Available in the form of powder, pigment components are usually mixed with substances like glycerin. In contrast to carbon black molecules (which are incorporated in black body tattoo ink), most molecules used in permanent makeup (e.g. titanium) are larger in size. For example, skin-colored pigments (which are intended to conceal mistakes) are formulated with large titanium molecules.
ii. Titanium dioxide
Titanium dioxide is typically found in pigments for lighter skin. Darker pigments are not likely to contain titanium dioxide. The compound is also added to lip pigments to create a brighter base (which allows the color to stand out). Titanium dioxide is essentially an oxidized metal which has been transformed into white powders through the process of rusting. It will turn into the original state (a dark gray in color) through chemical reactions after being hit by laser.
When treated with lasers, permanent makeup pigments may turn black; however, this can be reversed through further laser treatments. In most cases, a total of 2 to 8 sessions are required. Patients should be warned of the initial darkening effects. In general, laser treatments should not be used on the lips, as this could result in grey or black lips. For the lip area, it is recommended to use a non-laser approach to remove pigment molecules, then clean up the remaining particles in the deep skin layers using lasers.
iii. Types of lasers for permanent makeup removal
Before using laser treatment, consider the molecular size and the wavelengths. Q-switched Nd:YAG is an effective method of permanent makeup removal. Despite being highly effective, Q-switched Nd:YAG is gentle on the skin. Studies have shown that picosecond lasers are superior to nanosecond lasers in terms of black ink tattoo removal. That being said, some practitioners find that picosecond lasers are unable to target large-sized molecules effectively and prefer nanosecond lasers to remove permanent makeup. It takes up to 10 treatments to break up the titanium molecules in the face (12 treatments for the body). For the best results, laser procedure should be used in conjunction with 2–3 non-laser solutions.
Eyeliner removal
Some doctors only use laser for eyeliner remover. Other methods such as salt exfoliation or non-laser bonding agents can be too harsh for this delicate area. Eyeliner removal is a challenging procedure due to the sensitive nature of the skin around periorbital area.
It is important to insert appropriately-sized corneal protective shields under the eyelids. This helps to protect the cornea. Always use lasers with minimum power output at the lowest possible setting. At the same time, the largest spot size should be used. The exact values vary depending on the type of laser. Practitioners should be familiar with the laser machine before performing an eyeliner removal. A treatment interval of 8 weeks is recommended. This allows the skin to fully complete the shedding cycle, thereby promoting the disposal of molecules by the lymphatic system. Ultimately, the number of treatment needed is reduced.
Complications of removal
As with all laser and non-laser procedures, tattoo removal is associated with a risk of scarring. To minimize skin trauma, use the least number of laser treatments to remove pigments. Additionally, there may be a risk of allergy. It is important to perform test patching. Keep in mind that patch tests are not fool-proof. Allergies may occur when more of the allergen is present in the lymphatic system.
Summary
Permanent makeup removal can be extremely rewarding. If performed correctly, it is unlikely to cause any complications. Currently, there is a limited number of laser technologies. Further development is needed to enhance safety and efficacy of permanent makeup removing procedures.