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Definition, form of application and risk prevention

The application of pigments and dyes on the human body has been developing since ancient times. The religious or magical connotations or the demonstration of strength and power that prevailed in ancient civilizations have evolved parallel to man, so that merely aesthetic reasons, body worship or even differentiation of different cultural or ideological groups currently predominate. The authors address the characteristics of this type of decorative techniques and their application and offer a series of tips that community pharmacists can pass on to their pharmacy customers interested in these techniques.

It is undeniable that during the last decades decorative cosmetics in general have had a great expansion and an important social repercussion. This situation can find a logical explanation in the great diffusion that the media have had, the popularization of the seventh art, fashion, the professionalization of many services, as well as the integration of women in social and work life, among many other reasons.

Consequently, the enhancement of personal image, which occupies a prominent place in most of these activities, has imposed constant changes to the so-called color or decorative cosmetics. Its renewal, in addition to the guidelines set by fashion annually, has been forced by an attempt to adapt to new technologies, new cosmetic assets and excipients, new aesthetic currents and, as a highlight, an increasingly strict legislative environment.

The safety of the user is the objective that must prevail when establishing the legal requirements for this type of preparation, whose main purpose is to improve the appearance of the person and help them feel better about themselves. That is why guaranteeing the innocuousness of articles with exclusively aesthetic purposes must take precedence over other evaluation parameters.

The new aesthetic currents that have been taking root strongly during the last 5-10 years, especially in adolescents and young adults, have introduced potentially dangerous decorative techniques: tattoos , permanent makeup and piercing are examples of this.

application form

Dermopigmentation techniques (tattoo and permanent makeup) consist of the introduction of pigments of different shades under the skin. This requires small and fine needles connected to a dermograph, which transmits back and forth movements that facilitate the micro-implantation of the pigment to a maximum depth of 0.8-1.6 mm. Heads are usually used that incorporate a variable number of needles (1, 3, 5, 8) depending on the type and size of work that will have to be done. Given the invasiveness of the technique, there is a prerequisite for dermopigmentation: careful and thorough disinfection of the work area using a topical antiseptic solution.

Additionally, and in order to minimize the inconvenience or painful sensations typical of the process, it can be performed with local anesthesia –topical or subcutaneous administration–. In this case, the intervention of a doctor will be necessary.

Histopathologically, skin exposed to a micropigmentation process has been described as going through 4 different phases: inflammation, scarring, epithelialization, and repair.

inflammation phase

It is characterized by vasodilation, the presence of serous exudate, increased migration of leukocytes and macrophages due to chemotaxis, and the presence of free pigment in the epidermis and dermis as a consequence of the microtrauma caused by the multiple insertions of the needles to deposit the pigment.


Information and risk prevention

* Make the user aware of the importance of resorting only to centers that can guarantee that they have the mandatory hygienic guarantees.

* Convey to the user the importance of the technician using sterile and single-use material.

* Explain that the technical and artistic training of the technician is decisive in the results of these decorative techniques.

* Inform the user that permanent makeup or permanent tattoos require intensive and complex techniques for their removal and that, in addition, they can give rise to the formation of compounds of certain toxicity.

* Report the possibility of allergic and hypersensitivity reactions, a risk that increases if unauthorized dyes and pigments are used.

* Report the risks associated with micropigmentation techniques.

* State the need for the consent of the parents or legal guardian when the micropigmentation or tattoo technique is to be carried out by a minor.

* Inform of possible interactions with certain medical diagnostic techniques or even the inappropriateness of performing medical-surgical practices in tattooed areas (lumbar punctures, such as epidural anesthesia, etc.).


* Verify the suitability of the center and professional that will carry out the operation. Viral blood-borne diseases such as hepatitis C, B or human immunodeficiency, as well as innumerable fungal and bacterial infections can take place if a minimum of hygienic conditions are not respected in the application center.

* Cleaning and disinfection of the area to be treated.

* Do not drink alcoholic beverages or medications with antiplatelet activity (for example, acetylsalicylic acid), anticoagulant or vasodilator the days prior to the session.

* Do not take stimulants.

Precautions to be taken before and after exposing yourself to a micropigmentation session


* Clean the compromised area daily (twice a day) using an antiseptic soap.

* Do not expose the affected area to the sun or UVA rays, as well as not bathing in the sea or in swimming pools until it is completely healed.

* Keep the area dry, without scratching or scrubbing it.

* Avoid the use of cosmetics or non-exclusive preparations for this purpose.

* Do not remove the scab.

* Consult a doctor in the event of any abnormal reaction in the affected area or fever.

scar phase

It begins with the formation of a small superficial crust, the presence of lymphocytes, eosinophils, plasma cells, giant cells and macrophages full of pigment. This phase provides a false appearance, darker, than the effected pigmentation will actually show.

epithelialization phase

The repair of the epidermis begins approximately from the tenth day after dermopigmentation. A redistribution of the pigment particles is produced, with the consequent elimination of the granules deposited in the most superficial layers by cell renewal.

repair phase

Total repair of the dermis and epidermis and color stabilization take place.


* Wounds or acute and chronic injuries in the area where the micropigmentation is to be performed: eczema, psoriasis, herpes, warts, insect bites, allergic reactions, etc.

* Skin infections.

* Moles, skin spots, thickened angiomas, nevus, chloasma, etc.

* Immunocompromised or HIV positive patients.

* Patients exposed to chemotherapy and radiotherapy.

* Individuals with significant systemic diseases.

* Pregnancy.

* Predisposition to develop keloids.

Dyes and pigments

Finally, it is important to emphasize the fact that the pigments intended for use in tattoos and permanent makeup must meet a series of requirements that guarantee that the health and safety of people and the environment will not be damaged, so Each product will need to have a risk assessment based on toxicological data. A Council of Europe Resolution (Resolution ResAP(2003)2 on Tattoos and Permanent Make-up) dictates a series of recommendations, including:

* Limit the composition of tattoo dyes, taking into account a series of negative lists (carcinogenic, mutagenic and toxic substances for reproduction belonging to categories 1, 2 and 3 contained in Directive 67/548/CE, substances included in annexes II and IV of Directive 76/768/CE, specific annexes of the aforementioned resolution and preservatives). These measures are aimed at all times to ensure the safety of the compound and minimize the risk of developing allergies and hypersensitization.

* Guarantee the sterility of the product until the moment of its application; for this, the type of container is a critical parameter. The size of the container must be adequate to contain product only for a single application and the same consumer.

* The products must be accompanied by the necessary data to identify the manufacturer and the product (description, composition, batch number, expiration date, sterility), as well as inform about the conditions of use and warnings.

All these measures are especially important, since tattoo or permanent make-up techniques suppose, given their form of application (intradermal implant), a rupture or alteration of the body’s natural barriers. Therefore, its application and the facilities in which it must be carried out must meet a series of specific, legally established hygienic requirements. The professionals who practice them must have adequate training in the techniques they have to carry out and, in particular, basic health training that guarantees the proper use of the material and minimizes the risk of infection or contagion.

Additionally, the technician must be responsible for the suitability of the equipment and pigments to be used and their sterility before use. He must inform the consumer of the potential risk of microbial and viral contamination through the use of these techniques.

In conclusion, despite the fact that the foregoing focuses on the characteristics, objectives and fundamentals of permanent makeup techniques, the basic characteristics and requirements that apply to them can be extended to tattoo techniques, since practically their differentiation only lies in the area of ​​application (facial for permanent makeup and body for tattoos).

Micropigmentation or permanent makeup

It can be defined as the intradermal application of colored products for aesthetic purposes, that is, to highlight facial contours or expressions. As detailed in its definition, its ultimate purpose is merely aesthetic, but this does not limit the fact that the main requirement of intradermal implantation of pigments is focused on being able to guarantee its total innocuousness and safety.

Although the best known aspect of micropigmentation is purely aesthetic, its use also extends to the field of aesthetic medicine, as a complementary technique to reconstructive surgery after certain pathological situations. Its beginnings for medical purposes are located in the middle of the last century; We currently have some examples of this in the pigmentation of mammary areolas after mastectomies, correction of certain scars, cleft lip demarcation, etc. In all these cases, the connotations of the treatment are totally different from the purely cosmetic ones and the consideration given to both the pigments and the equipment for their preparation falls within the regulation of medical devices.

Decorative micropigmentation, commonly known as permanent makeup, is excluded from this regulation and, within the framework of Spanish legislation, the regulations applicable to the pigments used for this purpose are included in the legal provisions that regulate cosmetic products. Despite this, it is worth mentioning that micropigments intended to be implanted by definition cannot be considered cosmetics, but rather aesthetic products, which require a specific evaluation for their use.

Given the characteristics of the product, permanent makeup is not positioned as an alternative to traditional decorative cosmetics for topical application, but rather seeks to be one more complement to it. Permanent makeup techniques are not usually very striking by themselves, but seek to give shape and color to certain parts of the face (lips, eyebrows, eyes, etc.), hide small imperfections or highlight their own features to increase personal attractiveness.

On the other hand, its name “permanent” is not entirely accurate, since the duration of this technique cannot be considered to be “for life”, although its effect is, without a doubt, very prolonged. The implanted pigments present a series of modifications over time depending on the type of skin, the ability of the carrier to absorb them, the type of pigment used, the way it is applied, etc., which will determine the duration of the makeup (2-4 years) and its degradation.

on lips

The main objective of decorative micropigmentation of the lips is to highlight this part of the female face, which is especially striking and sensual. Traditionally, the lips have been and continue to be one of the pillars on which traditional decorative cosmetics have been based. Lipsticks and lip liners have played an active role throughout history, but in recent decades permanent pigmentation techniques have made a strong inroads into various consumer circles.

Correcting small imperfections, asymmetries, increasing the lip contour and optically increasing its volume are some of its objectives in women of any age. On the other hand, in mature women, the lips become thinner and lose color as a result of the passing of the years, so permanent coloring techniques allow the tone of the lips to be increased and visually restore their lost size.

This type of makeup is not exclusive to women, but is also requested by men who want to correct color loss both due to age and herpes.

In all cases, a color tone should be used that matches the skin and is natural.

in eyes

Highlighting the eye contour, offering a more expressive, vivid and deep look, as well as simulating a greater volume of the eyelashes are the objectives of conventional eye liners and micropigmentation techniques that are performed around the eye.

Eye delineation, whether on the upper or lower eyelid, is recommended to follow the line of the eyelashes and to be done using natural tones (black, brown, gray, etc.).

in eyebrows

There are a series of key points in the face that give expressiveness and personality to the individual. Eyebrows are one of those elements, which is why since ancient times they have been one of the protagonists of visagism. Eastern cultures (Chinese, Japanese, etc.) are clear representatives of the importance that aesthetics gave to that part of the face.

Currently, the trends that mark fashion give rise to cyclical eyebrows adopting different shapes: fine and arched eyebrows, thick and populated eyebrows, elongated, short eyebrows, etc. Permanent makeup offers a wide range of possibilities for changing its appearance, although it is recommended, in the vast majority of cases, to maintain a natural look: soft tones and coloration in harmony with the color of the hair, eyelashes, skin tone, shapes not exaggerated, adequate density, etc. Two techniques are used: the hair-by-hair system, without large or continuous strokes, which avoids the effect of painted eyebrows, and the shading technique.

Both allow a permanent touch-up of the eyebrows in order to shape and accentuate their presence, camouflage sparse or scarred eyebrows, make them longer or even facilitate daily makeup for people, especially mature women with pulse or vision problems. tired, requiring help for it.