Consumer Safety Tips
Each day millions of people enjoy the benefits of cosmetic tattooing—but only when it has been done correctly and safely by a certified professional. Perhaps you have seen someone with unattractive permanent makeup applied by a poorly trained technician. But did you know that there is more at stake than the risk of bad looking makeup? There is the risk to your health.
FACT: California has very few laws regulating Permanent Cosmetics, Tattooing (Body Art), or Piercing.
Anyone can do it regardless of his or her training, background, qualifications, location, or equipment. If the person who performs your permanent makeup procedure uses unsafe equipment or does not know, understand, or follow proper infection control guidelines, you could contract a disease like Hepatitis, HIV, or Tuberculosis. You could also develop a severe bacterial infection such as MRSA (Methicillin-Resistant Staph Aureus).
For all medically-related cosmetic procedures, you should do research to select the right professional for you. This includes cosmetic tattooing. The advantages outweigh the risks if you do your homework: Be diligent and thoroughly investigate anyone you are considering to perform your permanent cosmetics procedure.
The Consumer Safety Tips below will help you select a professional so you can look good and remain healthy. Please follow these 10 steps and ask these questions:
- Inspect the Facility: Before you schedule a procedure, visit the business and pay attention to the location and environment: Is it comfortable, quiet, and relaxing? Or is it noisy with loud music, conversation, or the sound of hair dryers? Inspect the procedure room for cleanliness—is it sanitary and secluded? Can you smell chemicals from permanent hair solution or acrylic nails? If so, does the salon have an air filtration system preventing those airborne chemicals or particles from contaminating your freshly tattooed skin? Also, do not assume that a technician or nurse working in a doctor’s office will do good work. Most physicians offering permanent cosmetics do not do the work themselves and hire a technician or nurse to work for them. You must screen those tattooists just as thoroughly as if they were self-employed (which they are if they rent space from the physician).
- Ask to See a Health Department Permit: Many cities in Orange and L.A. Counties are not regulated under their County Department of Health. In a “regulated city”, an inspector visits the business where a tattooist works and examines the procedure room annually. The inspector determines if the tattooing equipment is safe, if correct CDC-OSHA sterilization methods are followed, if the autoclave functions correctly, etc. A permit is issued only if the business passes. If there is no health permit, then the tattooist did not pass or she is working in a “non-regulated” city. Also, health departments and cities generally do not allow any tattooist to work from home. So if a tattooist works from home or on location (travels around), she has probably never been inspected or is violating ordinances. But even tattooists working inside a legitimate business (salon, day spa, or doctor’s office) will not be inspected if that business is in a non-regulated city.
- Ask About Equipment: Do not be fooled by a tattooist’s reassurance about sterile needles. Even when single-use sterile needles are used, diseases CAN be transferred between people. This is called “cross-contamination” and occurs through body fluid and airborne particle contamination of the machine’s hand piece. With most rotary pen tattoo devices, many steps are needed to clean the motor mechanism and hand piece. The parts must be autoclaved to be sterilized or disposed of and replaced completely. If the technician skips a step or performs it incorrectly, cross-contamination can occur. There are also some machines that should never be used because they allow cross-contamination, even when properly cleaned. The only pre-sterilized disposable equipment that prevents cross-contamination is the patented Nouveau Contour System, the patented I-Star System, or manual hand tools. With other types of equipment, there is no way to guarantee safety unless it has been examined and approved by a health department inspector.
- Ask About Training: California has no state board or agency that requires a license to practice cosmetic tattooing. And the state does not require passing an examination to do it. No board regulates school accreditation, supervises a curriculum for basic or advanced training, or sets continuing education requirements. That means all schools are NOT alike— with no regulations, basic training varies from 1 day to several weeks. Schools get unsuspecting students into their classes by promising that they can make a lot of money quickly and easily. So many schools are interested in their number of students, not the quality of their education. Example: Some schools offer “Home Study Courses” and some “schools” are just one person training students from his/her home. Some schools require supervised procedures on human models to graduate, while others do not. Tuition ranges from a few hundred dollars to several thousand dollars. Students—and later on their clients—get what they pay for!
What should you do? Ask for details about the technician’s fundamental (basic) education and training. Ask to see a certificate showing the number of training hours. Guidelines by the American Academy of Micropigmentation (AAM) and Society of Permanent Cosmetics Professionals (SPCP) recommend that any fundamental course of instruction should have a minimum of 100 hours. Also ask to see any certificates for advanced courses. And ask if the technician’s instructor (for basic or advanced level) was certified by the AAM or SPCP. Their trainers must meet certain criteria for education, competency, and experience. Finally, ask if the technician has been trained in Bloodborne Pathogen Control that follows CDC-OSHA guidelines and ask to see her/his certificate.
- Clarify the Person’s Title: Beware of technicians who claim to be “Licensed for Permanent Cosmetics” or a “Licensed Permanent Cosmetics Technician.” He or she cannot be “licensed” since California does not require one for cosmetic tattooing. That technician is probably licensed by the California Board of Barbering and Cosmetology as a cosmetologist, esthetician, or manicurist.* Also ask technicians who use abbreviations following their names for more information. A technician may use letters after his/her name such as “PCT” for Permanent Cosmetics Technician or “PMA” for Permanent Makeup Artist. This implies that he/she has earned a license or degree in the field, but the initials probably stand for a title written on a certificate offered by a school. They are pointless unless they signify an abbreviation for a college degree or a legitimate license from a state board or agency. The only exceptions to this are abbreviations for certification titles offered through national professional associations: “CPCP” is issued by the Society of Permanent Cosmetics Professionals and “FAAM” is issued by the American Academy of Micropigmentation.
*Note: In California, anyone working as a beauty professional must have a cosmetology license. And most of the technicians doing permanent makeup work in the beauty industry. However,
permanent makeup is not regulated by the California Cosmetology Board. The Board’s regulations “specifically prohibit invasive procedures that affect the structure or function of living tissue of the face or body” and they state that “permanent cosmetics are considered an invasive procedure.”** Therefore, permanent cosmetics are not within the scope of practice for any licensed cosmetologist, esthetician, manicurist, barber, or electrologist. The Board has been reviewing the laws relating to the practice of permanent makeup conducted in Board licensed establishments (e.g. hair, nail, and skincare salons). As of this date, a decision with a firm plan of action has not been made. (**CA BBC Business and Professions Codes 7317, 7320; Title 16, CA CCR 991)
- What is the Person’s Background? The most recent national membership survey (2006) of the Society of Permanent Cosmetics Professionals reported that only 10% of its members are nurses and only 1.4% are physicians. The majority (over 85%) of its members have backgrounds in cosmetology (hair, skin, or nail care) or traditional tattooing (body art). The beauty expertise of these individuals may be excellent, but their education in human anatomy, physiology, and microbiology is limited. Since there is no standardized and regulated education in permanent cosmetics, they will practice according to the level of training they received in “school” (which might be an inferior one-day course). And without medical experience, they may not know or realize when they are doing something incorrectly during a procedure.
- Find Out About Experience: Modern-day permanent makeup has been around since the 1980s and its popularity has increased over the years. However, there are technicians who trained in the early years whose skills may not be current even though they have been practicing for 10, 15, or 20 years. Since California has no licensing or continuing education requirements, those technicians might still be using older equipment and outdated techniques. The number of permanent cosmetics procedures performed on a regular basis is more important than length of time in practice. One technician may perform several hundred procedures in a year while another may perform only a few procedures in a year. That happens more often (fewer procedures) when permanent makeup is offered at a salon where other beauty services are performed by the tattooist. In addition, an experienced cosmetic tattoo artist will offer more than basic permanent makeup. He or she will usually offer scar camouflage and other tattooing treatments that require greater knowledge, advanced skills, and a mastering of different techniques.
- Look at Photographs: Ask to see a portfolio of “Before” and “After” photos of REAL clients. Any experienced cosmetic tattoo artist who does good work will not hesitate to show you her/his portfolio. If the artist resists in any way, that is a red flag and you should move on. If you can look at a portfolio, here are some tips so you know what you are looking at:
- Try to determine if the photos are real or counterfeit: Are they prints processed by a photo lab or colored photocopies? Real prints are a sign of original work. To help determine if the photos are fraudulent or the actual work of the technician, pay attention to consistency—does the photography style look the same for each set of photos or different? If they look different, they may be “purchased” Before and After photos. It takes time and experience to build a portfolio, so a new or low-volume technician may buy copies of Before and After photos from a school or trainer. One pigment manufacturer sells pre-made portfolios and also website templates supplied with photos. Technicians can also copy photos from brochures, books, supply catalogs, and the internet from other technician’s websites to use as their own.
- Look for sets of “Before”, “Immediately After” and “Healed” photographs: The Before photo is without makeup and the Immediately After is taken following the procedure. Those photos are not the prettiest—the makeup is dark and the tattooed area may be red or swollen. The Healed After photos look better because they show the result weeks later. If there are no “Immediately After” photos, then the sets may be Before and After photos of regular makeup application (topical cosmetics).
- Look at the tattooist’s artistic abilities and techniques: For makeup design, do all eyebrow shapes look the same as if made with a stencil, or are they customized to the client’s face? Look at color choices—do pigment shades look appropriate for the client (e.g. different colors for blondes, brunettes, and redheads)? You should be concerned if everyone has black eyebrows and black eyeliner. Look for examples of different tattooing techniques like simulated hair strokes and shading. And are there examples showing the application of advanced skills such as areola repigmentation and scar camouflage?
- Look for Affiliations and City Licenses: Ask if the technician has joined a professional association.
Professional associations require members to abide by a code of ethics, and they offer continuing education and certification programs. Association membership is voluntary but it does require a significant financial investment by the technician. It does not provide any guarantees to the public, but it shows that the technician is dedicated to the field and desires ongoing learning. Also ask the technician if she has a city business license. This indicates that she pays city and state business taxes and fees. Operating a legitimate business is a sign of a long-term commitment. In the future you will want that technician to still be around when you need a maintenance visit or another procedure.
- What Do You Get For The Price? You should not make a decision based on price alone.
A low price means the tattooist is a beginner and needs experience or she/he is cutting corners somewhere. Ask what a procedure fee includes so you can compare “apples to apples.” Does it include a consultation and one or two visits? Is custom makeup design included? Do you have many color choices? How long is the total appointment? (An entire procedure completed in an hour is a red flag.) Although money is a consideration for everyone, price should be your last consideration. Any cosmetic tattooist who is well-trained, experienced, and practices safely, correctly, and ethically will not have the lowest prices because they cannot afford to. With few laws regulating cosmetic tattooing you, as the consumer, are at risk. Remember the saying, “You get what you pay for.” A cheap price may result in unattractive results, a viral disease, or a bacterial infection. Permanent makeup lasts a lifetime, so it is worth paying a little more to look good and be safe.
All reputable permanent cosmetic professionals will not hesitate to answer your questions, show their work, or display their credentials. Protect yourself and be informed, be careful, and be safe—you are worth it!
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