MIcroblading removal

Eyebrow Tattoo Removal

 itanium is a  metal that has been rusted into a white powder. When the laser hits this  oxidised metal, a chemical reaction occurs that turns the titanium to  its original state, which is a dark grey colour.  This is  why practitioners were previously told by laser manufacturers that they  could not laser permanent makeup pigments as it turns black.15  at , generally, the rate of scarring is far higher  than a laser as it causes damage to the epidermis.  

However,  coinciding with this growth is the number of patients  requiring Eyebrow Tattoo removal. Traditionally, patients have requested removal  because they feel the makeup no longer suits their more mature look (or they just had bad microblading done).  However, I am increasingly seeing people who have received bad permanent  makeup treatment and have been disfigured by untrained technicians. 

Currently, Level 5 training is recommended  for tattoo removal using lasers, although an individual does not need any qualifications to perform the actual permanent makeup treatment. However,  permanent makeup  is a difficult skill to learn, so even if one has  training, it does not mean that they can do the treatment well. 

For  medical aesthetic clinics currently performing tattoo removal, or if  they are interested in doing so, they should also consider incorporating  permanent makeup removal. 

Removing pigment from skin 

There  are three ways to reduce or ‘lighten’ pigment molecules from the skin:  topical, non-laser solutions applied with a tattoo machine, and laser. All  three of these methods have a place in your practice and can be  considered for different circumstances, as discussed below. 

1. Topical 

There  are many lotions that are being sold as ‘tattoo removal creams’, but I  have not come across any clinical studies showing their effectiveness  without combining laser. I have personally found them ineffective  because they cannot penetrate into the dermis to reach the tattoo ink.5-7 

One  guinea pig model study demonstrated a reduction in tattoo pigment using  imiquimod and tretinoin after 28 days, however application started six  hours after tattooing, which is not very reflective of real-life  scenarios.

There is also data that suggests that the use of imiquimod with laser is more effective than laser alone.

Prior  to laser treatments, I have found that there are alternative topical  methods that can help to assist with the removal of pigment. If a  permanent makeup tattoo is under six months old, I use a simple  technique of applying fine sea salt to the area and gently exfoliating  twice-per-day for two months, which draws out the ink. I have found this  can cut the number of required laser treatments in half, but it’s only  effective with new tattoos as after around six months the ink settles. 


2. Non-laser solutions 

These  procedures are performed by a trained permanent makeup artist and there  are many variations of this same treatment. Removal can be achieved by  opening the skin – in a way much like the original procedure – using a  tattoo or a permanent makeup machine. 

bonding agent is then applied to the open skin, which then draws the ink to the skin’s surface.  Bonding  agents can be anything from salt or glycolic acid, to any number of  branded products readily available to permanent makeup and tattoo  artists.

n my experience, one session will be  equivalent to two months of topical exfoliation. I have found that this  method is popular with artists who do not have access to lasers and it  is especially useful when removing the skin-coloured pigment due to its  large molecular size, which is discussed below. 

3. Lasers 

Lasers  are widely accepted as the most common treatment for removing pigment  from the skin, so, like regular tattoos, they are widely used to remove  permanent makeup. I do not recommend treating a tattoo that has been  done in under six months.12This is because there is a higher  ink concentration, which will mean that the patient will require more  laser sessions and the laser itself will react more violently, even on  lower power settings, as it is more attracted to the ink molecules.

This  translates into a more aggressive treatment, therefore increasing the  chances of scarring. Permanent makeup pigments are different in  composition to tattoo inks as they are made from different ingredients.

It’s therefore important to understand how makeup inks will react under the laser. 

The  two main things to consider when removing permanent makeup pigments is  whether the pigment contains titanium dioxide (the colour white) and the  molecule size. 


About Titanium dioxide 

Titanium  dioxide in the form of ‘white’ is used in most pigments for those with a  lighter Fitzpatrick skin type as those with darker skin require a  tattoo with darker pigment, hence unlikely to contain titanium. It is  also used in most lip pigments because it gives the tattoo a brighter  base to sit on, making the colour stand out more. 

itanium is a  metal that has been rusted into a white powder. When the laser hits this  oxidised metal, a chemical reaction occurs that turns the titanium to  its original state, which is a dark grey colour.  This is  why practitioners were previously told by laser manufacturers that they  could not laser permanent makeup pigments as it turns black.

Although  this does occur, practitioners should have no problems removing it with  further treatments – ranging from two to eight – and they should make  their patients aware that this may happen. However, this is not  recommended for the lip area as patients may find having black or grey  lips distressing if this contrasts with their skin colour. For this  area, I instead try to remove most of the pigment molecules with the  non-laser method and then clean up residual particles that may linger in  the deeper layers of the skin with a laser. 


Molecule sizes and colour 

Molecule  size for micropigmentation pigments can vary from one to 20 microns.  These measurements mostly take into consideration the agglomerates of  smaller molecules that happen in pigments and inks. The molecule size  will also vary from organic to inorganic or synthetic organic pigments. 

All  pigment components come in powder form, they are then mixed with agents  such as glycerin. Most molecules used in permanent makeup, such as  titanium molecules, are big; unlike carbon black molecules more commonly  used in black body tattoo ink. This is especially the case with skin  coloured pigments that are designed to cover up mistakes, which are  deliberately manufactured to have titanium molecules that are large  enough to be used as a cover up.16 


Types of lasers suitable for makeup removal 

When using lasers, the molecule size they target at their optimum level and the wavelengths need to be considered. 

In  my experience, when used correctly, a Q-switched Nd:YAG is the most  effective and is a gentle removal method. Research has shown that  picosecond lasers can be more effective than nanosecond lasers for black  ink tattoo removal.17 However, I have found that when  dealing with larger sized molecules, these cannot be targeted  effectively with picosecond technology and therefore I believe that a  nanosecond laser is far more effective when dealing with permanent  makeup. 


Images show patient before treatment, after one laser treatment and after three laser treatments on the brow. 

Up  to 10 treatments for the face and 12 for the body may be required when  using lasers to break the titanium molecules up enough. In my  experience, when treating skin-coloured pigment, you can get more  superior results by using two to three non-laser solution sessions.

Eyeliner removal 

Removing eyeliner has its own set of  challenges and I currently only know a handful of practitioners  competent in this procedure. The skin around the periorbital area is  extremely sensitive so we need to be very careful. 

You  must protect the cornea using the correct sized corneal protective  shields that need to be inserted under the eyelid. The laser must be  used on the lowest possible setting, with the least amount of power  output, using the largest spot size possible. These levels will vary  from laser to laser, but most users know their machine intimately by the  time they attempt this delicate procedure. Treatments should also be  spaced by a minimum of eight weeks, allowing for the epidermis to  complete its full shedding cycle and so the lymphatic system has more  time to dispose of the molecules, leading to fewer treatments.

Removal complications 

Scarring  is a risk of the non-laser approach, as well as any laser procedure,  including any form of tattoo removal. It is therefore important to  remove the pigment safely using the fewest laser sessions possible to  limit trauma to the skin.21 

Allergy can also be an  issue, as this can occur when attempting removal even if they have never  shown previous signs of a problem. Test patching is crucial, but  practitioners must bear in mind that test patching does not guarantee  that an allergy is detected. An allergy may still manifest when more of  the allergen is put through the body’s lymphatic system.22 

Summary 

Permanent  makeup removal can be an incredibly rewarding treatment and when done  correctly, it has a very low complication rate. There are still a  relatively low number of laser technologies available that have ventured  into this treatment and therefore there is room for future developments  in this area. 

Eyebrow microblading removal and correction by Christopher Drummond in NYC and Miami

Eyebrow microblading removal and correction by Christopher Drummond in NYC and Miami