Tattoed eyebrows, permanent eyeliner, and lipliner pigmentation are becoming increasing popular, but are these makeup "surgeries" actually safe?

By Jenna Birch
September 11, 2015
Corbis Images

Right now, cosmetic enhancements like full lips and full brows are all the rage. Check Instagram, and you'll find thousands of photos of women who've undergone procedures to get eyeliner, eyebrows, or lip color stained on. Celebrities like Angelina Jolie and Gwen Stefani are rumored fans, but many top technicians stay mum about their A-list clientele. Of course, you can make your brows and lips pop with a little extra liner or brow powder-but some are going to more extreme lengths for the perfect pout or shaped eyebrow. (Taking the natural approach? Plump It Up! The Best Beauty Products for Full Lips, Eyelashes, and Skin.)

But what exactly is permanent makeup? According to Dendy Engelman, a dermatologist at Manhattan Dermatology & Cosmetic Surgery in New York City, permanent makeup is the art of implanting dyes or pigments in the first dermis layer of the skin to enhance certain features-most commonly brows, the lash line, and lips. Some docs do this, but so do skilled technicians like Dominique Bossavy, to whom Engelman regularly refers her clients. Think of the procedure like super-precision tattooing (involving local anesthetic, so it's not painful).

"Permanent makeup can also be used on the body to conceal skin imperfections, such as stretch marks and surgical scars, or skin conditions like Vitiligo, cleft lip, Alopecia," Engelman says.

The Good

Women usually get this procedure to save time. For instance, this past July, Cosmopolitan Australia editor Amelia Bowe decided to have permanent lipstick applied outside her lip line. Instead of constantly using liner to create fuller lips, she got the appearance of a subtly enhanced pout without the daily hassle of wearing liner.

The results are meant to be subtle. Think of permanent makeup like a delicate tattoo. "The biggest difference with permanent makeup application is that we don't want anyone to know what we did," says anesthesiologist and permanent makeup technician Linda Dixon, M.D., president of the American Academy of Micropigmentation. "We want women to look like themselves, only better."

Anne Klein of Aspen, CO, says she highly recommends the procedure. Not very skilled with cosmetics, Klein spent years attempting to apply eyeliner while she was working as a model. On her own, she says she'd wind up with a "circus clown" look. "Now, I love it," she says. "I can shower and be out the door in the morning, or have the option to add more if I want."

Engelman says permanent makeup also frequently helps those with allergies to makeup, or people who have movement impairments that make it difficult for them to apply makeup, like those who are post-stroke or have a condition like Bell's palsy, she explains. "Paired with fillers and Botox, the biggest payoff is definitely the ability to regain years of lost youth without surgery and no downtime."

The Bad

That said, permanent makeup isn't without issues. Lisa Cocuzza was living in Citrus County, FL, when she decided to have the procedure done at a local spa where her sister-in-law was the manager.

Her hope was that permanent eyeliner would solve the humidity-induced melting she had to deal with. "Instead, the numbing solution used to numb my eye area for the eyeliner application actually burned my cornea, and I had three months of discomfort," Cocuzza says. "I never tried the procedure again, and never will."

Dixon says a skilled technician needs to be able to appropriately use local anesthetic to numb the pain-especially working near delicate areas like the lips and eyes, where one false move can be costly. "The lips are probably the most common source of problems, as blisters can develop after the procedure," Dixon says.

Engelman says that besides mild pain in the aftermath of the procedure, side effects are rare with a skilled technician or doctor overseeing care. The biggest risk is generally dissatisfaction with the result-as this service is growing in popularity, so are technicians with little experience offering the treatment.

Dixon agrees. She says she's often enlisted to help with previous mistakes, or work with customers who didn't get the look they wanted. "Permanent makeup can be a tremendous thing, but it's important to meet with a technician beforehand, and keep looking until you find a match," she says. (And before committing to any procedures, read up on these 7 Permanent Makeup Considerations That Might Change Your Mind.)

If You're Considering It...

Since Dixon says permanent makeup requires both "the hands of a surgeon and the eyes of an artist," ask how many procedures the technician has done, as well as the exact color and shape of the ink they'd be adding. The American Academy of Micropigmentation is also an accrediting body; you can check the website to see if the technician you're considering has been certified, meaning they've passed the oral, written, and practical exam for permanent makeup application. This means they're at least competent in all procedures and safety measures.

Ultimately, Dixon says to go with your gut if the tech's vision doesn't feel like a fit. "Look for someone who is really going to listen to what will make you happy," Dixon says. "You have to feel that sense of trust." (Dixon's advice is one of the 12 Things Plastic Surgeons Wish They Could Tell You.)