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Why Permanent Eye Makeup Tattoo Removal Is Riskier

by Dr Wan Chee Kwang
July 21, 2022

Patients are increasingly requesting laser removal of eyeliner or eyebrow permanent makeup tattoos or embroidery as these have become mainstream.

Laser tattoo removal is already widely available among medical aesthetics clinics in Singapore. Broadly speaking, the mechanism through which the pigments are removed from eyeliner or eyebrow embroidery or tattoos is similar to tattoo removal elsewhere on the body.

However, there are little-known but important considerations specific to permanent makeup removal that you may not be aware of. It is important to know these nuances for a safe and effective treatment. Attempting laser treatment without a good understanding of the differences between removal of eyeliner or eyebrow tattoos or embroidery and tattoo removal elsewhere may lead to serious complications such as blindness, hair loss or make the treatment unbearably painful.

Proximity to eyes

In laser tattoo removal for tattoos in other parts of the body, there is a minimal risk of damage to the eyes and simple external eye shields would suffice to protect your vision.

Permanent eye makeup tattoos or embroidery are situated very close to the eyes and hence, there is an elevated risk of laser-induced eye damage. High-intensity light energy from laser tattoo removal for eyeliner or eyebrow tattoos or embroidery can penetrate through the eyelids, damaging the retina and other eye structures. External eyeshields are totally inadequate when it comes to laser treatment of tattoos or other lesions that are very close to the eyes.

Specially designed metal corneal shields are absolutely necessary to safely treat permanent eye makeup tattoos such as eyebrow or eyeliner tattoos or embroidery. These instruments, which look like metal contact lenses, have very smooth surfaces to prevent corneal injury. They are also autoclavable to ensure sterility and prevent transmission of diseases and infection between patients.

Anaesthetic eye drops, eye lubricants and an experienced doctor are vital to ensure that insertion and removal of these metal corneal shields does not hurt the delicate eye structures or result in corneal abrasions.

Preventing eye damage is paramount in laser removal of eyebrow or eyeliner tattoo or embroidery
Preventing eye damage is paramount in laser removal of eyebrow or eyeliner tattoo or embroidery

Scarring and eyebrow or eyelash hair loss

Permanent eyeliner or eyebrow makeup also differs from tattoos in other areas of the body in that they are done in hairbearing areas to highlight these facial features. While scarring may occur during tattoo removal elsewhere, it is doubly devastating in eyeliner or eyebrow tattoo or embroidery removals. This is because scar tissue does not contain normal skin appendages like hair follicles. In other words, once scarring develops in these areas, you may lose what little eyebrow hair or eye lashes you may have had in that area in the first place. Furthermore, even if you tried to transplant hairs into the area later, scar tissue has poorer blood supply than normal skin, resulting in poorer hair graft survival.

Hence, preventing scarring from laser tattoo removal is even more important in eyebrow or eyeliner tattoo or embroidery than in normal tattoo removals.

Advanced combination laser tattoo removal techniques reduce blistering and hence scarring. Newer shorter pulsed tattoo removal lasers such as picosecond lasers tend to reduce hair loss risk. Equally important is to avoid overly aggressive settings that produce excessive amounts of heat and hair root injury. Special techniques can also be utilized during laser eyebrow or eyeliner tattoo or embroidery removal to reduce damage to the hairs instead of just quickly blasting the whole area indiscriminately.

Scarring from laser removal of eyebrow or eyeliner tattoo or embroidery may lead to unsightly patches of hair loss
Scarring from laser removal of eyebrow or eyeliner tattoo or embroidery may lead to unsightly patches of hair loss

Pain and discomfort

The face is definitely more sensitive than most other parts of the body, with a higher concentration of nerve endings. Eyes are obviously one of the more delicate parts of the face. Imagine a laser exploding ink particles under your eyelid skin, and you'll have some idea why the most common reason why eyeliner or eyebrow tattoos cannot be removed is due to pain and discomfort from the laser tattoo or embroidery removal.

While many patients can tolerate the treatment with strong numbing cream and forced cold air to deaden the skin sensation further, some patients will not be able to tolerate the discomfort. One way to still be able to proceed with laser removal is to use lower settings that would be less uncomfortable. However, this means that less of the permanent eye makeup pigments are broken up necessitating more removal sessions. If your doctor is competent, a better alternative is to use nerve blocks, which involve injecting local anesthetic around the nerves that supply sensation to the skin where the eyebrow or eyeliner tattoo or embroidery is placed. This greatly reduces discomfort, swelling and bruising while allowing the usage of optimal settings. Nerve blocks carry the risk of complications such as injection into arteries, seizures or heart rhythm abnormalities, thus your doctor should be comfortable with the anatomy of the area and experienced with performing nerve blocks.

Nerve blocks can dramatically increase patient comfort during laser removal of eyebrow or eyeliner tattoo or embroidery
Nerve blocks can dramatically increase patient comfort during laser removal of eyebrow or eyeliner tattoo or embroidery

My take on eyeliner or eyebrow permanent makeup removal

Tattoo removal in Singapore is ubiquitous. Many patients tell me that they've been offered very cheap 'laser' tattoo removals at the tattoo parlor or beauty salon where they got their ink. Tattoo removal is also easily available at medical aesthetics, dermatology and plastic surgery clinics at various price points. However, patients should exercise extra caution when selecting where to get laser removal of eyebrow or eyeliner tattoo or embroidery, as these areas are relatively riskier and have vital pitfalls that could lead to serious consequences.

Advanced machines and techniques are important but also look for a doctor that is familiar with these areas and experienced enough to calibrate the treatment to your personal circumstances.

If you have a eyebrow or eyeliner tattoo or embroidery that you would like to remove, feel free to drop us a line or call us if you would like to find out more!

References

  1. Cannarozzo, G., Negosanti, F., Sannino, M., Santoli, M., Bennardo, L., Banzola, N., Negosanti, L., & Nisticò, S. P. (2019). Q-switched Nd:YAG laser for cosmetic tattoo removal. Dermatologic therapy32(5), e13042. https://doi.org/10.1111/dth.13042
  2. McIlwee, B. E., & Alster, T. S. (2018). Treatment of Cosmetic Tattoos: A Review and Case Analysis. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]44(12), 1565–1570. https://doi.org/10.1097/DSS.0000000000001572
  3. Lee, S. E., Lee, S. J., Lee, J. H., & Cho, S. B. (2011). Preservation of eyebrows during laser tattoo removal. Clinical and experimental dermatology36(4), 422–423. https://doi.org/10.1111/j.1365-2230.2010.03973.x
  4. McGee, J. S., Chung, W. S., Lee, H., & Chung, H. J. (2018). Hair wax for preservation of eyebrows during laser tattoo removal. Journal of the American Academy of Dermatology, S0190-9622(18)30462-6. Advance online publication. https://doi.org/10.1016/j.jaad.2018.03.012
  5. Geronemus R. G. (1996). Surgical pearl: Q-switched Nd:YAG laser removal of eyeliner tattoo. Journal of the American Academy of Dermatology35(1), 101–102. https://doi.org/10.1016/S0190-9622(96)90504-6
  6. Watts, M. T., Downes, R. N., Collin, J. R., & Walker, N. P. (1992). The use of Q-switched Nd:Yag laser for removal of permanent eyeliner tattoo. Ophthalmic plastic and reconstructive surgery8(4), 292–294. https://doi.org/10.1097/00002341-199212000-00010
  7. Chrystelle Sola, Christophe Dadure, Olivier Choquet, and Xavier Capdevila. Nerve Blocks of the Face. The New York School of Regional Anaesthesia. https://www.nysora.com/techniques/head-and-neck-blocks/nerve-blocks-face/

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