The Role Of Permanent Makeup After Chemotherapy

The time-saving beauty benefits of semi-permanent makeup procedures (think: microblading and eyeliner) have been widely publicized. Women and men coveting the treatments’ ‘I woke up like this’ promise have propelled the industry into big business. But for many clients, permanent and semi-permanent makeup services go far beyond convenience. In the case of cancer survivors and chemotherapy patients, ‘beauty’ treatments like microblading, permanent eyeliner, lash enhancement, and scar camouflage can be a major step toward regaining self-confidence and a sense of normalcy. Here, we break down everything you need to know with the help of our medical and aesthetic experts.

How Semi-Permanent Makeup Helps Cancer Patients

Cancer treatments (like surgery, chemotherapy, and radiation) can often have an impact on how patients look and feel. Hair loss related to cancer treatments is known as alopecia. It varies from patient to patient and is dependent upon the chemotherapy drugs prescribed and how they react with each person's physiology. “Undergoing chemotherapy, the chances of hair loss are very real and usually rapid for both men and women,” says Craig Ziering, DO, a board certified dermatologist and hair restoration specialist in West Hollywood. “As the chemotherapy drugs rapidly attack growing cancer cells they also attack other rapidly growing cells in your body — including those in your hair roots.”

Some patients will have patchy hair loss or thinning, while others may lose more — including eyebrows, eyelashes, and armpits. Radiation therapy can also impact the hair, Dr. Ziering says, though usually only in the treatment area. Depending on their needs, patients can choose from both permanent makeup options (with traditional tattoo ink) and the more modern semi-permanent ones (using fruit- and vegetable-based pigments) to restore the appearance of lost hair. These treatments include:

• Eyebrow microblading
• Eyeliner and lash enhancement
• Hairline and scalp micropigmentation
• Scar camouflage
• Areola and nipple restoration

Permanent makeup expert Dominique Bossavy says that about 20 percent of her clientele is breast cancer patients. “They come to me first for eyebrows and lashes in anticipation of losing them to chemo or once they are done with chemotherapy,” she explains. “Usually eyebrows will not regrow or not regrow properly and they may have bald spots. Lashes typically thin out dramatically following chemotherapy. And then there is the need for replacement in trompe l'oeil for the areola.”

But it’s not just for women. Dr. Ziering specializes in hair restoration for men — including men who have lost hair to cancer treatment. He favors a method called scalp micropigmentation (SMP). “SMP is a type of tattooing technique in which microparticles of metabolically inert pigment granules are implanted below the epidermis with a specific, artistic technique of strokes to appear similar to a closely shaved scalp,” he explains. “Over time with SMP, the pigment will fade but the color will not change, so it may give a cancer patient confidence, support, a positive outlook and other positive psychological effects while their hair is growing back.”

Permanent Makeup Before & After Chemotherapy

Timing is important for cancer patients considering permanent and semi-permanent makeup procedures. Because these techniques cause trauma to the skin, they should not be performed on those with compromised immune systems. The general recommendation is to wait six weeks before or after any type of cancer treatment, though it’s absolutely necessary to consult with your oncology team before undergoing any elective or cosmetic procedure.

Both the technique and type of ink or pigment used should play a role in the timing, says permanent makeup expert Yelena Nesterenko. As she explains it, chemotherapy can alter the appearance of the organic, semi-permanent pigments that she prefers to work with — turning browns to blue, black, and even purple. While that’s a big drawback for permanent eyeliner, it’s not as big of a deal for microblading to replace lost eyebrow hair, since it tends to fade more quickly.

While many patients seek treatment (especially for eyebrows) prior to losing their hair, some experts advise a “wait and see” approach. “Methods used to help eyebrow loss may not be necessary in everyone, since not all patients lose brows,” says Evangelia Kirimis, MD, a board certified hematologist and medical oncologist at UCLA. “So, I would recommend reserving until after chemo to see what level of help is needed.”

Nesterenko prefers to work with post-treatment patients, though she makes sure all of her clients are prepared for every possible outcome, including additional rounds of treatment. “Your technician should explain everything with details about the color and about the quality,” she says. “Nobody knows how many times the cancer patient will need to undergo chemo.”

If you're concerned about replicating the color and shape of your natural brows exactly, it’s a good idea to meet with your permanent makeup artist for a pre-chemo consultation. If you do end up losing your brows and lashes, photos, sketches, and notes can later serve as a benchmark for your desired results.

Permanent Makeup Safety for Cancer Patients and Survivors

At this point, you’re likely wondering about the safety profile of such treatments. Most experts agree it’s relatively safe, as long as a highly trained technician using quality pigments performs the procedure. Because the body is so sensitive during cancer treatment, any form of tattooing — which introduces foreign substances into the body through trauma — should be vetted by your cancer care team. The type of pigments and/or ink used, the application technique, and the timing should all be carefully considered.

Many breast cancer patients undergo some form of hormone therapy, since certain types of breast cancer are stimulated by estrogen and/or progesterone. “We know that even low dose birth control pills can affect the pigment,” Nesterenko says. “So, women have to be especially careful about any kind of chemo that affects the hormones.”

Our permanent makeup experts always make sure they have a thorough understanding of their clients’ medical histories and treatment plans. Nesterenko typically works with cancer patients who are referred by doctors she regularly partners with. Bossavy says that many physicians refer patients to her, too, and she requires that clients undergoing treatment receive clearance from their doctor first.

Potential Risks and Complications

Cancer patients face many of the same risks and complications from permanent makeup as the general population. These risks include:

• Premature/unsightly pigment fade
• Infection
• Allergic reaction
• Scarring
• Granulomas

As mentioned, infection risk may be higher in chemotherapy patients. According to Nesterenko, the effects of chemotherapy on the body often alters the way the skin interacts with both ink and organic pigments, which is why she prefers to work with clients who have finished treatment.

Could tattoo inks and permanent makeup pigments possibly pose an additional cancer risk? Currently, there’s no evidence to suggest it. But Bossavy tells us that, when it comes to the long term consequences of permanent makeup, there’s just not that much scientific evidence out there. “More research is needed to further understand the true implications of these findings and to develop guidelines for the safest tattoo procedures,” she says.

How to Find a Permanent Makeup Artist Post-Chemotherapy

If you are curious about how to find a permanent or semi-permanent makeup artist post-chemo, it’s important to devote the same time and care into researching the technician’s credentials as you would any other provider. Below are five tips for finding the best person for your needs:

1. Talk to Your Doctor: Asking your physician(s) for a recommendation is always the best place to start, Nesterenko says.
2. Consult with Support Groups: Referrals from other patients can help tremendously when you’re already overwhelmed with treatment-related research.
3. Ask About Credentials: It’s important to seek out someone who has worked extensively with cancer patients, not just for cosmetic clients.
4. Interview Previous Clients: Ask prospective technicians if you can talk to their other post-cancer clients to learn about their experience and how their results fared over time.
5. Find Out Inks/Pigments: “Ink is more stable,” Nesterenko says. “It doesn’t change over time like pigment does, but it’s not safe to use those chemicals on the face.”

Bossavy also tells us that building a rapport is equally critical. “First and foremost is a trust connection. This is a very important part of the process,” she shares. “Many emotions will surface, so I would say [to find] someone that has compassion and someone who loves what they do.” As she explains, it's not uncommon that a cancer survivor will be overwhelmed and moved to tears during the session, which makes finding an artist who is warm, patient, and understanding (in addition to well-qualified, of course!) is all the more important.

The Takeaway

In the end, the decision to seek permanent or semi-permanent makeup before or after cancer treatment is a very personal one. “Many survivors refer to it as life-changing,” Bossavy says. “It brings back a sense of normalcy and makes them forget the constant reminder of their traumatic and arduous journey of survival during the battle they just had to fight.”