REGRET my decision to have permanent eyeliner and lip-liner in early November 2003. I wish I had given it more thought and done the research before I assumed that permanent make-up tattoos were safe. After all, people have been getting tattoos for thousands of years, and my only concern

The pigment manufacturer, Premier Pigments, was well aware of the allergic reactions associated with their product and did not disclose it. I also learned that industrial paint had been used as one of the ingredients

then was finding an experienced tattoo artist at a reputable salon.
   The procedure, micro­pigmentation, is better known as permanent make-up. The name can be misleading because the colour eventually fades and a touch-up is normally required within three years. Besides its association with make-up, micropigmentation has been instrumental in scar camouflage and aiding in medical reconstruction.
   I was initially happy with the results. I did not have the need to wear eyeliner and my lips were well defined by the lip-liner tattoo, which was a little darker than my natural lip colour. Nobody noticed anything different about me at work, but everybody told me that I looked great. Everyone thought that I had used eyeliner for a change because it was rare for me to wear make-up other than lipstick. It’s not that I dislike wearing make-up; I just don’t have the time to go through the daily ritual of make-up application.
   I’ve never liked tattoos and I never understood why people wanted tattoos on their bodies even despite the recent fashion fad. Somehow this was different because it looked like make-up. Yet, what if the tattoo artist made mistakes and the results were uneven? Or worse, what if the colour didn’t turn out the way I anticipated? What if new needles were not used and the salon products were not sterile? What about the risks of infections including hepatitis B and C as well as HIV?
   I never thought I would take this risk because the disadvantages always seemed to outweigh the advantages of permanent make-up. I’ve always been scared of needles—anything that could possibly cause me any pain!
   Then, my mother decided to have permanent make-up a year ago and the results were incredible. The permanent make-up technician, my mother’s friend, has over eight years’ experience in applying permanent make-up and works at a doctor’s office, aside from offering the service at her Carmel, Calif. beauty salon. I especially liked my mother’s lip liner since it looked so natural with a hint of colour. Therefore, the lip liner was very subtle and didn’t stand out if my Mom decided not to use lipstick. So, I changed my mind about permanent make-up. I suddenly met many people who had great results with permanent make-up. My mother encouraged me to do it and I surprised myself the most by my decision to have permanent make-up.
   The procedure wasn’t painful because numbing creams were applied to areas that were going to be worked on. Afterwards, I was instructed to ice my eyes and lips and use antibiotic creams for a few days, without wearing make-up for 10 days. The swelling didn’t really go down and my lips became more irritated until it was obvious that something was wrong. My allergic reaction symptoms consisted of burning, itching, swelling, bumps or so-called ‘granulomas’, dryness, peeling, bleeding, and the constant formation of yellowish fluids around my eyes and lips that were impossible to completely remove. My lips were sensitive to the touch and my eyes hurt when I blinked. I still can’t open my mouth wide enough to floss my teeth and I have to use baby utensils in order to eat. In addition, I still have swollen lymph nodes because I have big lumps under my chin and the sides of my face. At one point, my eyes and lips were infected and I was on antibiotics.
   I was told that a small percentage of people react to permanent make-up tattoos. I was also told that I didn’t have to worry about allergic reactions since I haven’t had a history of allergies or any cold sores. Yet, my tattoo artist didn’t have any experience with these allergic reactions and wouldn’t have been able to explain the severity of the potential allergic reaction to me.
   On the other hand, the pigment manufacturer, Premier Pigments, was well aware of the allergic reactions associated with their product. Later, I found a notice on the internet from this manufacturer claiming that they had reported the allergic reactions to the Food and Drug Administration (FDA) of the United States. The FDA confirmed that this company had never reported any issues or adverse reactions.
   These tattoo pigment companies are not required to provide a list of all their ingredients to doctors who rely on this information in order to attempt to treat patients with the allergic reaction. I also learned that industrial paint had been used as one of the ingredients based on general research on the topic.
   Prior to my research, I didn’t realize how common the allergic reactions were and what the consequences were. I simply thought that I could visit my local dermatologist and get a quick fix for my allergic reaction. I now know that my reaction is not an isolated incident and many other women are allergic to the same pigment brand. Actually, there have been recent cases where women only got the allergic reaction when they returned for their second or third touch-up treatment.
   It was a challenge for me to find a doctor who could treat my condition. I was doctor-hopping for at least four months and every doctor said that they had not seen anything like it. They all prescribed steroid creams that only eased the burning, itching sensation while my appearance continued to appear abnormal. Most doctors recommended getting the allergic reaction in a controlled state with steroid injections before I had the tattoo pigments removed via laser. I’ve always been healthy and health-conscious and I didn’t permit any steroids to be injected in my body. Later, I learned that steroid injections and oral steroids were temporary suppressants, not a solution.
   There are many doctors who are trained to remove tattoos by laser, but none of them wanted to treat a condition that they were unfamiliar with. Finally, I reported my allergic reaction to the FDA and they referred me to Dr Linda Dixon in Hawaii. Dr Dixon, Anæsthesiologist, is the president of the American Academy of Micropigmentation (www.micropigmentation.org), which is a non-profit organization dedicated to promoting excellence in micropigmentation through a voluntary examination for its members. Dr Dixon referred me to Dr Mitchel Goldman of La Jolla Spa MD (www.spa-md.com), in La Jolla, Calif. Dr Goldman, Board Certified Dermatologist, Cosmetic Surgeon, the Medical Director of La Jolla Spa MD, author of numerous books, has had experience treating allergic reactions due to permanent make-up and specializes in many cosmetic procedures of dermatology, phlebology, laser surgery and liposuction.
   I’m actually still travelling once a month from my home in northern California to southern California for routine laser treatments and doctor appointments. I may need up to 30 laser sessions. With each visit, I am greeted by new doctors who want to observe my condition. I wish that my costs were many painstaking months of recovery and expensive laser treatments. It is very likely that I will never look the way I did before I had permanent make-up. I will have scars and discoloration as a result of the allergic reaction and laser therapy. A miracle will only give me my normal appearance back. •

Nancy Erfan is a realtor based in California and a Lucire reader.

Note: The FDA issued a warning about certain Premier Pigments’ ink shades as this article went to press, carried in Associated Press and Reuter reports. The manufacturer, the American Institute of Intradermal Cosmetics, claims that it had asked the FDA to investigate the allergic reactions in 2003 and had recalled five shades. However, the FDA received complaints concerning shades not subject to Premier’s recall. US consumer enquiries should be directed to 1 888 INFO-FDA.

ABOVE: Nancy Erfan’s eye and lip before the permanent make-up process. BELOW: Nancy’s excruciating reaction to the process and the eventual, but steady, reduction in swelling thanks to laser treatment from Dr Mitchel Goldman in La Jolla, Calif.

April 9, 2004

May 8, 2004

May 12, 2004

May 19, 2004, five days after laser

June 23, 2004, after third laser

May 13, 2004

May 14, 2004, before laser

June 24, 2004, after second laser