NM Permanent Cosmetic Tattooer cheat sheet

Spaulding classification: critical items (needles, needle bars, pigment tubes that contact blood) require sterilization; semicritical items (skin-contact tools, reusable stencils, trays) require high-level disinfection; noncritical items (lamps, counters, chairs) require low-level disinfection.

OSHA 29 CFR 1910.1030 applies to any employer with occupational exposure to blood: written exposure control plan reviewed at least annually, hepatitis B vaccine free within 10 working days of assignment, PPE at no cost, training at assignment and annually.

Steam autoclave parameters: 121 °C (250 °F) at 15 psi for 30 minutes in a gravity-displacement cycle, or 132–134 °C (270–273 °F) for 3–4 minutes wrapped and about 15 minutes unwrapped in a prevacuum cycle.

Each pack carries an external process indicator and an internal chemical indicator; the internal indicator must be read and logged before the load is released for use.

Biological indicator for steam and chemical vapor cycles is Geobacillus stearothermophilus spores; run at least weekly, plus every new unit, repair, or load failure; a failed test quarantines all loads back to the last passing test.

Sharps handling: needles are single-use, placed directly into a puncture-resistant, leak-proof, labeled container that is replaced at three-quarters full; never recap by hand - use a one-handed scoop or a recapping device.

Hand hygiene: soap and water for at least 20 seconds before donning and after removing gloves; alcohol-based rub is acceptable only when hands are not visibly soiled; gloves are never washed, disinfected, or reused.

Gloves: single-use nitrile, changed between clients and whenever torn or contaminated; facial protection (mask plus eye protection) is required when splashes of blood or body fluids are reasonably anticipated.

Blood spill decontamination: EPA-registered hospital disinfectant with a tuberculocidal claim, or freshly prepared 1:10 household bleach (about 5,000–6,150 ppm available chlorine), used for the label contact time after visible matter is removed.

Depth rule: epidermis ranges from about 0.05 mm on eyelid skin to over 1 mm on palms and soles; permanent makeup targets the papillary dermis at roughly 0.5–1.0 mm (brows 0.5–0.8 mm, lips 0.4–0.6 mm).

Layer sequence from surface: stratum corneum, granulosum, spinosum, basale, basement membrane, papillary dermis, reticular dermis; pigment placed in the reticular dermis blurs, migrates, and scars.

Permanence mechanism: pigment particles in the papillary dermis are phagocytosed by macrophages and encapsulated by fibroblasts, which is why the deposit persists but slowly fades with cell turnover and sun exposure.

Healing timeline: hemostasis (minutes to hours), inflammation with neutrophils then macrophages (days 1–3), proliferation and granulation (days 3–21), remodeling (3 weeks to 1 year); epidermal closure in about 7–14 days.

Keratinocyte transit from stratum basale to stratum corneum is about 28 days; visible flaking after a procedure usually occurs between days 3 and 7, and the healed result reads 30–50% lighter than the fresh deposit.

Site differences: lips lack hair follicles, sweat glands, and sebaceous glands, have a thin stratum corneum, and are highly vascular, so they bleed and swell more but re-epithelialize faster; eyelid skin is the thinnest on the body.

Fitzpatrick IV–VI skin carries higher melanocyte activity, raising the risk of post-inflammatory hyperpigmentation and keloid at high-trauma sites; conservative passes, warmer pigment bases, and longer healing intervals reduce the risk.

Elective deferrals: pregnancy and breastfeeding, active bacterial, viral, or fungal infection at the site, active herpes labialis outbreak, sunburn or irritated skin, and recent chemical peel or laser resurfacing (typically 4–6 weeks).

Absolute exclusions: known keloid formation at the treatment site, documented allergy to pigment, lidocaine, or latex, impaired decision-making capacity, and treatment over an undiagnosed or changing pigmented lesion.

Isotretinoin: defer until at least 6 months after the last dose (some protocols 12 months) because the drug thins the epidermis, delays healing, and increases scarring risk.

Anticoagulants and antiplatelets (warfarin, apixaban, clopidogrel, aspirin, NSAIDs, fish oil, vitamin E) increase bleeding and pigment loss; require prescriber clearance and never instruct a client to stop a prescribed drug.

Diabetes, autoimmune disease, chemotherapy, radiation, and immunosuppression are case-by-case: require physician clearance and document the response, since poor control raises infection and delayed-healing risk.

Informed consent content: procedure description, alternatives, risks (infection, allergy, granuloma, pigment migration, scarring, asymmetry, MRI reaction with iron oxide), no guaranteed result, aftercare obligations, photography use, fee and refund policy, and the right to stop.

Patch testing: pigment and topical anesthetic applied 24–48 hours before the appointment; a negative result reduces but does not eliminate the risk of delayed hypersensitivity, and the result is documented.

Documentation set: health history and medication list, contraindication screen, consents, baseline and immediate post-procedure photographs, mapping measurements, and a note that aftercare instructions were given in writing.

Complementary correction: red cancels green, orange cancels blue, yellow cancels purple; modifiers are added in small ratios before the target color, not layered as a full-strength pass.

Common corrections: blue-grey or black brows take a small amount of warm orange or peach modifier; purple or cool lips take warm peach or orange; green-tinged brows take red or coral.

Pigment families: iron oxides supply reds, yellows, blacks, and browns; titanium dioxide is the white opacifier used to mute or lighten and can heal chalky, ashy, or yellowed over time, especially in thin skin.

Laser interaction: iron oxide pigment can darken paradoxically under Q-switched lasers because the oxide reduces; disclose this before any laser removal and refer to a qualified laser provider.

Healed color rule: the fresh deposit looks 30–50% darker and sharper than the final result; color is judged only after flaking and epidermal repair, at 4–8 weeks.

Fitzpatrick IV–VI: cool pigments can heal ashy or grey against higher melanin content; shift the formula warmer and avoid heavy white or violet bases.

Product handling: single-use pigment caps, never return pigment to the bottle, label each bottle with the date opened, discard per manufacturer instructions, and record brand, color name, and lot number in the client chart.

Correction sequencing: lighten before adding color; saline or acid removal sessions are spaced about 6–8 weeks apart, and retattooing waits until the skin is fully healed and no longer photosensitive.

Needle selection: 1RL for fine hair strokes, 3RL for detail and liner, 5RL for thicker liner and shading, 3F or 5F for lips and soft shading, magnum for broad gradient shading; taper controls line sharpness and penetration feel.

Angle and depth: hair strokes are delivered at roughly 45 degrees in the direction of hair growth, liner work closer to perpendicular; penetration stays in the papillary dermis, and a needle that needs pressure is too deep.

Skin tension: two-finger or thumb-and-forefinger stretch is applied before needle contact; without stretch the needle deflects, producing uneven depth, double lines, and unnecessary trauma.

Brow mapping: start above the alar crease, arch at the lateral limbus, tail at the alar-to-outer-canthus line; confirm symmetry with the client seated, eyes open, and both brows measured with calipers or string.

Eyeliner safety: with the eye closed, pigment is placed at the base of the lashes, staying 1–2 mm from the ocular mucosa, avoiding the inner canthus and any waterline placement prohibited by state rule.

Lip technique: outline the vermilion border first, keep the stretch constant, expect more bleeding and swelling, and avoid overworking one area because pigment pools and heals patchy.

Aftercare, first 7 days: wash twice daily with a fragrance-free cleanser, apply a thin ointment layer for 3–5 days, do not pick flaking, and avoid makeup, swimming, sauna, and direct sun for 7–14 days.

Touch-up timing: brows 4–8 weeks, lips 4–6 weeks, eyeliner 6–8 weeks; touching up before full healing over-works tissue and raises scarring and pigment-loss risk.

Daily-use sun protection of SPF 30 or higher on healed areas slows fading, because UV exposure degrades pigment and accelerates epidermal turnover.

OSHA recordkeeping: the sharps injury log is retained 5 years and bloodborne pathogen training records 3 years after the training; the exposure control plan is reviewed and updated at least annually.

Employee medical records under the bloodborne pathogens standard are kept for the duration of employment plus 30 years, confidential and stored separately from personnel files.

Client record contents: consent, health history, contraindication screen, pigment brand and lot, needle lot, mapping notes, before and after photographs, procedure notes, aftercare given, and touch-up documentation.

Retention: client records are kept per state rule, commonly 3–5 years after the last service, and longer for minors; a record is retained through the statute of limitations for claims in the jurisdiction.

Exposure incident response: wash needlesticks with soap and water, flush splashes, report immediately for confidential medical evaluation and source testing, and log device type, brand, and circumstances in the sharps injury log.

Hepatitis B: the employer offers vaccination free within 10 working days of assignment, keeps the acceptance or signed declination, and provides post-exposure prophylaxis evaluation per current CDC and USPHS guidance.

Hazard communication: safety data sheets for pigments, disinfectants, and anesthetics are kept on site, secondary containers are labeled, and staff are trained on the products they handle.

Credentialing: practice only under a current state permanent-cosmetic license or permit, in a licensed facility, with licenses and inspection results available; scope questions resolve to the issuing state authority's current rule, not to a training certificate.