Permanent Makeup Artist cheat sheet

Epidermis layers (deep to superficial): stratum basale, spinosum, granulosum, lucidum (palms/soles only), corneum.

Dermis contains papillary and reticular layers; pigment implanted here is more permanent than epidermal placement.

Skin barrier function resides mainly in the stratum corneum; compromise increases infection risk and pigment loss.

Healing phases: hemostasis (minutes–hours), inflammation (1–3 days), proliferation (3–21 days), remodeling (up to 1 year).

Collagen synthesis peaks during proliferation; premature trauma after procedure disrupts collagen and causes scarring.

Melanin production is stimulated by UV, trauma, and inflammation; post-inflammatory hyperpigmentation risk is higher in Fitzpatrick IV–VI.

Fitzpatrick scale: I (always burns, never tans) to VI (never burns, deeply pigmented); types IV–VI have higher keloid and PIH risk.

Langerhans cells in the epidermis are immune sentinels; their disruption by needle trauma can reduce local immune defense temporarily.

Oily skin tends to expel pigment faster; dry or mature skin may retain pigment longer but heals more slowly.

Spore test (biological indicator) is required for each autoclave cycle; chemical indicators alone do not verify sterilization.

Autoclave standard for wrapped instruments: 121°C (250°F) at 15 psi for 30 minutes, or 134°C (273°F) at 30 psi for 4 minutes.

Bloodborne pathogens of primary concern: HBV (most infectious), HCV, and HIV; all require standard precautions.

HBV can survive on dried surfaces for at least 7 days; HCV survives up to 4 days; HIV dies rapidly outside the body.

Disinfectants must be EPA-registered hospital-grade with label contact time; quaternary ammonium is not effective against mycobacteria.

Single-use needles and cartridges must never be reused or reprocessed; discard in sharps container at point of use.

Hand hygiene: soap and water for 40–60 seconds; alcohol-based rub for 20–30 seconds when hands are not visibly soiled.

Personal protective equipment: gloves, eye protection, and mask when splash or spray of blood/body fluids is anticipated.

Exposure protocol: wash needlestick with soap and water, report immediately, seek source testing and PEP evaluation within hours.

Absolute contraindications include active skin infection at site, pregnancy/breastfeeding (elective), and known allergy to pigment or lidocaine.

Relative contraindications: uncontrolled diabetes, autoimmune disease on immunosuppressants, bleeding disorders, keloid history, active herpes labialis.

Blood-thinning agents (warfarin, clopidogrel, aspirin, fish oil, vitamin E) increase bleeding and pigment loss; consult prescriber before stopping.

Isotretinoin (Accutane) requires waiting at least 6 months after discontinuation before pigment procedures.

Informed consent must document risks, alternatives, aftercare, no guarantee of result, and client signature/date.

Medical history form should capture medications, allergies, surgeries, skin conditions, and prior cosmetic procedures.

Photograph before and after with client permission; store securely per privacy regulations.

Patch test for pigment or topical anesthetic is recommended 24–48 hours before first session for sensitive clients.

Minors: require guardian consent and comply with local age-of-consent laws; many jurisdictions prohibit cosmetic tattooing under 18.

Pigment implanted in dermis appears cooler and lighter than in the bottle due to Tyndall effect and skin undertone.

Undertone correction: warm/orange brows can be neutralized with cool/modifier pigments; blue/grey brows with warm/orange modifiers.

Fitzpatrick I–II: avoid warm red-based browns that may heal orange; Fitzpatrick IV–VI: avoid titanium dioxide-heavy pigments that may heal ashy.

Pigment ingredients: iron oxides (stable), titanium dioxide (opaque, can migrate), organic dyes (fade faster, higher allergy risk).

Color wheel: complementary colors neutralize; analogous colors blend; split-complementary gives softer correction.

Lip color selection: cool undertones suit blue-based reds/berries; warm undertones suit coral/peach; neutral suits mauve/rose.

Eyeliner pigment should be iron oxide-based and ophthalmologist-tested; avoid dyes near the eye.

Pigment volume should be conservative on first pass; over-saturation limits correction options at touch-up.

Patch test and label check for nickel, cobalt, or preservatives in pigment to reduce allergic reaction risk.

Brow mapping: start at ala of nose vertically; arch at lateral limbus or iris edge; tail at ala to outer canthus.

Brow ratio: medial and lateral segments should be roughly equal; arch apex is typically at 2/3 of brow length from medial start.

Face shape adjustments: round face benefits from higher arch; long face from flatter, wider brow; square face from soft curved arch.

Hair-stroke technique uses fine single needles at 15–30° angle; shading uses larger grouping or mag needles.

Needle depth for brows: 0.5–1.0 mm into papillary dermis; deeper placement causes blurring and migration.

Stretch skin taut with non-dominant hand; work in small sections and wipe with sterile gauze to check saturation.

Avoid overworking the same area; repeated passes increase trauma, scarring, and pigment loss.

Symmetry check: measure both brows against facial landmarks and client's natural asymmetry; perfect symmetry is not always desirable.

Touch-up at 4–6 weeks after initial session; assess retention, color, and shape before adding pigment.

Eyeliner must stay outside the orbital rim and away from the ocular surface; use ophthalmologist-tested pigments only.

Upper eyeliner placement is along the lash line; lower eyeliner is more sensitive and higher risk for migration and irritation.

Eyeliner depth: 0.3–0.5 mm; too deep risks pigment migration (blowout) and injury to meibomian glands.

Lip procedures: map vermilion border, avoid going beyond natural border unless client requests and consents.

Lip skin is thin and vascular; expect more bleeding and swelling; use smaller needles and lower power.

Herpes simplex reactivation is common with lip procedures; prophylactic antiviral (e.g., acyclovir) may be prescribed by physician.

Lip pigment retention is lower than brows; touch-up at 4–6 weeks is standard; some clients need 2–3 sessions.

Avoid lip procedures on clients with active cold sores, recent lip fillers (wait 2 weeks), or history of keloids on lips.

Post-procedure lip care: keep moist with approved ointment, avoid spicy foods and lipstick until healed.

Needle groupings: round liner (1–3), round shader (3–5), flat/mag (5–15); finer groupings for detail, larger for shading.

Needle diameter (gauge): smaller gauge (e.g., 0.20 mm) for fine lines; larger (0.35 mm) for shading and lips.

Machine stroke length: 2.0–3.5 mm for permanent makeup; shorter stroke for eyeliner, longer for brows/lips.

Voltage settings vary by device; follow manufacturer's range; too high voltage increases trauma and pigment splatter.

Cartridge must be seated fully and locked; test run before client contact; discard if bent, clogged, or damaged.

Never touch needle with bare hands; use sterile barrier and aseptic technique when loading cartridge.

Machine and power supply must be cleaned and disinfected between clients; barrier film on surfaces.

Electrical safety: inspect cords for damage; keep liquids away from power supply; use GFCI outlet.

Dispose of used cartridges in sharps container immediately after procedure; never recap by hand.

Topical anesthetics: lidocaine (max 4.5% OTC, higher concentrations prescription), benzocaine, tetracaine; follow local regulations.

Apply anesthetic to intact skin only; never on broken skin unless product is labeled for that use and permitted.

Signs of lidocaine toxicity: tinnitus, metallic taste, perioral numbness, seizures, cardiac arrhythmia; stop and seek emergency care.

Epinephrine in anesthetic prolongs effect and reduces bleeding but increases vasoconstriction; caution in clients with cardiac disease.

Complications: swelling, bruising, infection, allergic reaction, granuloma, migration, scarring, and pigment loss.

Infection signs: increasing redness, warmth, pus, fever; refer to physician; do not treat with antibiotics yourself.

Allergic reaction: localized urticaria or angioedema; remove pigment if possible, apply cold compress, refer urgently.

Herpetic outbreak: prescribe antiviral via physician; defer procedure until resolved.

Anaphylaxis: call emergency services, administer epinephrine if trained and authorized, monitor airway.

Aftercare instructions: wash gently with mild soap and water twice daily, pat dry, apply thin layer of approved ointment.

Avoid sun, sauna, swimming, and heavy exercise for 7–14 days; UV exposure fades pigment and increases PIH.

Do not pick or scratch scabs; let them flake off naturally to prevent pigment loss and scarring.

Healing timeline: days 1–3 redness/swelling; days 4–7 flaking; weeks 2–4 color appears lighter; true color at 4–6 weeks.

Touch-up appointment at 4–6 weeks; assess retention and adjust color/shape.

Follow-up call or message at 48–72 hours to check for complications.

Document aftercare given and client acknowledgment in chart.

Provide written aftercare sheet and emergency contact number.

Long-term care: sunscreen on brows, avoid harsh skincare acids on treated areas, annual color refresh as needed.

Scope of practice: permanent makeup artist is not a medical provider; do not diagnose or treat skin conditions.

Licensing: requirements vary by state/country; verify current license, bloodborne pathogen certification, and local health department permits.

Insurance: professional liability and general liability coverage recommended; verify coverage for procedures performed.

Client records: retain consent, medical history, procedure notes, and photos per local record retention laws (often 5–7 years).

Advertising must be truthful; do not claim medical benefits or guaranteed results; disclose risks.

Infection control plan must be written and available for inspection; include exposure control plan and training records.

Ethical marketing: before/after photos require client consent; no misleading editing; respect privacy.

Financial: provide clear pricing, cancellation policy, and refund policy in writing before service.

Continuing education: stay current on bloodborne pathogens, device safety, and local regulations; document training.