The two types of permanent eye makeup (blepharopigmentation) are permanent brows and permanent eyeliner. The procedure involves cosmetic tattooing of high-quality pigment into the dermis, or second layer of the skin, using sterile needles. Application can be done with a special vibrating machine or by hand using a multi-pronged needle resembling a tiny flea comb.
Permanent brows (photo) have become especially popular in the Asian community due to naturally sparse brow hair density in many people as well as spotty hair loss from frequent plucking. The tattoos look more natural when applied to skin with at least some existing hair.
While originally a medical procedure, most applications today are performed by trained non-medical technicians and certified aestheticians at beauty salons or medical spas. Design and execution by an experienced operator usually produces excellent results. The color can be applied as closely-spaced dots, lines, or even strokes. It is not uncommon for the work to be completed over several sessions and require a touch-up or two.
Application of brow tattoos feels much like hair being plucked, while the more sensitive eyelash area can hurt a little more. A gentle touch helps, as do mild numbing solutions.
Pigment colors vary but some have proven problematic. Deep black tends to look artificial. Titanium dioxide, a white pigment present in many preparations, can slowly change into an odd purple-blue hue over time, while brown can eventually turn a light pink.
Full permanence of the tattoo is unusual. Most fade over time and some disappear completely after only several years, so "semi-permanent" is a more accurate name.
In cases where pigment application is too dark or shaped poorly, it may be possible to remove most but usually not all of the pigment by employing various treatments ranging from salt water injection to special laser techniques performed by a physician. Eyeliner is more difficult to remove than brow pigment.
A newer variation on brow tattooing is called eyebrow embroidery. Pigment is intentionally placed more superficially with the understanding that it will only last for a few years if even that. Some claim that the tattoo looks more natural and the color never really has a chance to change into unwanted tones.
While generally considered safe in the hands of an experienced operator, permanent makeup can result in complications.
The least of problems associated with so-called permanent makeup is that the color isn't really permanent but only long-lasting. Over time, the pigment particles fade, migrate, or are carried away by the body's normal defense mechanisms, not that other cosmetic injectables like Botox or dermal fillers last forever, either.
More severe mishaps range from painful bumps, excessive scarring, keloids, and blisters to severe allergies that can be difficult to treat or even control. Infections have been reportedly caused by the hepatitis virus, H.I.V., a number of bacteria, and even a mycobacterium related to tuberculosis that can invade the skin, bone, joints, and lungs.
Plus, there is worry that some complications from carcinogens or toxins introduced by tainted pigments or unsanitary equipment may as yet be unknown and not emerge for many years.
While the pigments used in the tattoos are subject to FDA oversight, not so with the practitioners, who are regulated at the local level. Most states have lax standards and enforcement.