Think of permanent makeup as a tattoo for your face — a technician uses needles to add pigment to your skin by making hundreds of punctures that push the pigment beneath the surface. Eyeliner and eyebrows are popular treatments, but permanent color can also be added to your lips and cheeks. Like regular tattoos, this beauty procedure can come with risks, including adverse skin reactions to the pigment, unsanitary salon conditions, and poor application by an unskilled technician.

Infectious Diseases

Unsterile tattoo equipment and needles potentially spread a number of infectious diseases, including HIV and hepatitis. In addition, the equipment can spread a staph skin infection. Even when the equipment is properly sterilized, contaminated tattoo ink can cause an infection that requires antibiotic treatment, according to the U.S. Food and Drug Administration.

To minimize your risk of infection, choose a provider with a posted certificate from your state health department. Determine that your technician holds a certification in permanent makeup, such as the Certified Permanent Cosmetic Professional designation. Ask the technician to show you that the instruments come out of a one-time-use sterile bag for the procedure.

Skin Reactions

In some individuals, needle punctures can lead to an adverse reaction.

  • Granulomas: Granulomas are nodules that form inside tissue under the skin. They develop as a reaction to a foreign substance — fragments of the tattoo ink — under the skin. Colored tattoo pigments, such as chromium (green) and mercury (red), may trigger granulomas, even when a skin patch test does not respond to these pigments.
  • Keloids: Keloids are areas of irregular tissue that form around a scar, and some individuals are prone to them. Permanent makeup can lead to the development of keloids around the tattoo site. If you have developed keloids in the past, discuss the risks of permanent makeup with your dermatologist before undergoing a procedure. Many treatments for keloids, including laser treatments and cryotherapy, exist, but not all are compatible with permanent makeup.

Allergic Reactions

Although allergic reactions to permanent makeup are infrequent, the FDA has received reports of reactions to some colors of ink used in permanent makeup. Reactions have included the following symptoms:

  • Swelling and burning at the injection site
  • Rash
  • Cracking, peeling and blistering at the injection site

Reactions do not always occur immediately; you may experience a reaction later — even years later. Opt for an iron oxide-based pigment, which is the least likely to cause a reaction. Avoid organic, natural or plant-based pigments, such as azo dyes, which may lead to adverse reactions.

MRI Complications

Permanent makeup can infrequently lead to complications should you need to get an MRI. The FDA reports that swelling or burning of the tattooed areas may occur after undergoing an MRI. Typically, this reaction is caused by the iron oxide, a metal, or other ferrous materials found in tattoo pigments, which can interact with the electromagnetic fields used in an MRI. Reactions most commonly occur when an individual with permanent eyebrows has an MRI of the eyes. Notify your doctor or MRI technician before undergoing an MRI. Additionally, if you experience a burning or tingling skin sensation during the MRI, inform your technician immediately. Reactions are minor and temporary, and typically subside within a few hours.