The popularity of permanent makeup has increased dramatically over the past decade, most commonly of the eyebrows, eyelids and lips. There are many reasons why one would seek out micro-cosmetics including less time needed to put into appearance and to enhance one’s natural features. Permanent makeup can be considered a form of tattooing as it utilizes a needle to insert pigments into the skin. Microblading is a semi-permanent tattooing technique where a blade is used to create super thin, hair-like strokes in one’s natural eyebrows. The needles scratch the skin and deposit pigment into the wounds created. Lip blushing is the semi-permanent tattooing process that defines and fills in your lips. Permanent eyeliner involves placing pigment on your lash line.
These procedures while having aesthetic benefits can lead to serious, harmful side effects. The most common adverse reactions include tenderness, swelling and itching. Allergic contact dermatitis and granulomatous inflammatory reactions are more severe side effects observed. The black inks used in microblading and permanent eyeliner procedure contain carbon nanoparticles, additives, and water. The nanoparticles are capable of inducing reactive oxygen species resulting in inflammatory reactions. Due to the fact that the FDA considers tattoo inks, including the ones used in permanent makeup, to be cosmetics, they do not undergo the approval process before entering the market. This lack of regulation can lead to detrimental effects as certain ingredients have not been evaluated for their safety.
It is also important to research the facility/practitioner responsible for the procedure as several patients have been injured due to improper treatment. The regulations for permanent makeup vary from state to state. Depending on the state, physician supervision might be required, but some allow estheticians and tattoo artists to perform. For example, in California microblading is considered “body art” and requires the individual performing to be at least 18 years old, registered with a local enforcement agency, properly trained on bloodborne pathogens, and working in a body art facility that meets health and safety code standards with a valid health permit. Whereas in Illinois, microblading is considered a form of cosmetic tattooing and is regulated by the Illinois Department of Public Health.
Giulbudagian, M., Schreiver, I., Singh, A.V. et al. Safety of tattoos and permanent
make-up: a regulatory view. Arch Toxicol 94, 357–369 (2020)
Goldman, Alberto, and Uwe Wollina. “Severe unexpected adverse effects after
permanent eye makeup and their management by Q-switched Nd:YAG laser.”
Clinical interventions in aging vol. 9 1305-9. 11 Aug. 2014.
Straetemans, Masja, and Linda Katz. “Adverse Reactions after Permanent-Makeup
Procedures.”NEJM.org, The New England Journal of Medicine, June 2007.
Donna Salib & Natalie Eshaghian
Chemical Exposure at Hair Salons
Recent news of a study in the International Journal of Cancer(1) came out in 2020 that found an association of women who regularly use permanent hair dye and chemical straighteners with a possible high risk of developing breast cancer. The National Institute of Environmental Health Services looked at data from 46,709 women over a mean of 8.3 years and discovered that white women who use permanent hair dye regularly had an 8% increased risk and black women, a 60% increase if the product was applied every 5-8 weeks. It is important to recognize the difference between permanent and semi-permanent hair dyes. (2) Permanent hair dye alters the hair permanently by opening the outermost layer of the hair, delivering color deep inside of the hair shaft, and then resealing it in turn preventing color from escaping. Semi-permanent hair dye can be used to softly tone and correct but not alter hair colors. It is the least aggressive of all hair dyes and does not last for very long. Permanent hair dyes and chemical straighteners can contain up to five thousand chemicals such as aromatic amines which can cause disruption of the endocrine or hormone system in the body and sometimes are not always listed on the box which can make it difficult for consumers to know what they are getting. The study also concluded that the effect is stronger in black women who have products with more chemicals marketed towards them than white women. A weakness of this study is that it reports observational data, relies on self-reports, and does not include names of hair dyes used therefore ultimately, it's important to remember this study found a correlation and not a causation. The research also included participants that already had a higher than average risk for breast cancer because participants had sisters with breast cancer, a close first-degree relative that increases the risk. There is still more research that needs to be done, but women who are already at risk for breast cancer, they might want to minimize how often they use permanent hair dye or chemicals straighteners.
Chemicals such as formaldehyde not only put consumers at risk but also hair stylists. In 2011, The OSHA(Occupational Safety and Health Administration) program(3) conducted air sampling at three salons and found formaldehyde in the air when stylists were using hair smoothing products such as Brazilian Keratin Treatment. Formaldehyde is a cancer-causing substance and exposure above 0.1 ppm(parts per minute) can cause eye and nose irritation as well as skin sensitivity and breathing difficulties. It is used as a preservative for the animal protein in the straightener which is used to make the hair shiny, sleek, and silky. Women like treatments such as these because their hair remains in the silky smooth style for some period of time even after they wash their hair. Some of these products were even labeled formaldehyde-free or did not list formaldehyde on the product label or on its MSDS(material safety data sheet).
OSHA reports that workers who use these hair products with formaldehyde can be exposed to the chemical through inhalation, and skin contact. OSHA has since implemented regulations for salons that choose to use products with formaldehyde: “Requirements include steps such as testing salon air during treatments to determine formaldehyde levels, providing adequate ventilation and appropriate personal protective equipment for workers performing treatments, and training workers on the hazards of formaldehyde.”
Additional research is needed to study specific hair dye colors (light versus dark) and exposure levels (personal versus occupational). The American Cancer Society(4) has looked to organizations such as the International Agency for Research on Cancer (IARC) and National Toxicology Program(NTP) for guidance which has not classified exposure to hair dyes to its potential to cause cancer. The FDA also does not approve each ingredient used in hair dyes before it goes on the market, thus the safety of products and ingredients is the manufacturer’s responsibility. Treatments have improved but it's important to be careful and do your research on the chemicals in the treatment you're interested in by making sure you understand the product’s label and looking for its MSDS, even if it is formaldehyde-free.
(1) Eberle CE, Sandler DP, Taylor KW, et.al. Hair dye and chemical straightener use and breast cancer risk in a large US population of black and white women. Int J Cancer. 2020;147(2):383-391. doi:10.1002/ijc.32738
(2) Hair.com. 2021. Available at: https://www.hair.com/permanent-vs-semi-permanent-vs-bleach-hair-dye.html
Date Accessed: 2 August 2021
(3) Hair Salons: Facts about Formaldehyde in Hair Products 2021. Available at: https://www.osha.gov/hair-salons Date Accessed: 2 August 2021
(4) Hair Dyes. 2021. Available at: https://www.cancer.org/cancer/cancer-causes/hair-dyes.html Date Accessed: 2 August 2021