“Client Issues in Permanent Makeup” by Geraldin Flynn

We desided to get back to basics of PMU and asked Geraldine Flynn to help us on this issue.

geraldine-flynn-zWith women spending on the average a year and three months of their lives applying conventional makeup, we sometimes feel the pressure to accept clients who may not be the most suitable for treatment.

Sometimes there are grey areas for us technicians and sometimes, unfortunately, initial training courses may not delve into this subject enough.

So let’s talk about Contraindications and Cautions.

A Contraindication is a condition or factor that serves as a reason to withhold treatment due to the harm that it may cause to the client. 

When is it safe and ethical to proceed and when do we need to refuse a client?

We all know our major contraindications and cautions to any micropigmentation treatment, but to recap, here are a few of the main ones:

  • Anti-coagulants i.e. warfarin, blood thinning medication following illness or surgery. However, Asprin is also a blood thinner, client can be treated after ingesting it, but will bleed more and may bruise easily and may need an additional treatment.
  • Haemophilia patients should not be treated.
  • Diabetics – clients will bleed and bruise easily depending on the severity of the condition. It will be more uncomfortable for the client and it will take longer to heal, especially for insulin dependent diabetics. Could have prolonged bleeding and bruising so proceed with caution and a doctor’s note or not at all.
  • Steroids, Antabuse or Cortisone creams – clients must be clear of these for at least 6 months before the treatment and such medication shall not to be resumed until at least 6 weeks post final treatment. Healing will be slower and risk of scarring higher. Antabuse causes severe reaction to anything containing alcohol (pigments).
  • Keloid scarring – although clients may not develop keloid scarring from micropigmentation, if they have a history of keloids, micropigmentation should not be carried out. Normal scars can be worked over after at least 6 months after their formation, taking into account that the skin is tougher to work on and will require more effort for penetration.
  • Birth marks or port wine stains cannot be treated due to the vascularity under the skin.
  • Pregnancy and breast feeding – although there is no medical evidence of possible adverse reactions, it is always advisable not to proceed until client is no longer pregnant or breast feedin.
  • Corneal abrasions, Cataracts and Glaucoma– hopefully clients would not present themselves for an eyeliner treatment, but if they did I would refuse.
  • H.I.V. and Hepatitis – Hepatitis C is not insurable in the UK. It is bloodborne and can survive for 30 days in dried blood. It is advisable to have Hepatitis B inoculation and should you proceed with treatment you must use double gloves protection. H.I.V. does not live long outside the body.  Survival depends on which body fluid it is in, volume of the body fluid, concentration of the virus within it, temperature, acidity, and exposure to sunlight and humidity. HIV transmission has not been reported as a consequence of contact with spillages of blood. With H.I.V. you must ask for a doctors consent letter and only proceed with treatment if you feel comfortable and with strict hygiene procedures and cautions.
  • Epilepsy – it is usually safer to proceed if client has not had a fit for 2 years, however it may be a good idea that they bring someone with them to their appointment and proceed with caution.
  • Botox/Fillers – slightly grey area, different opinions on this, but general advice is 3 weeks post treatment at least; working on a botox/filler free face is preferable, but not realistic in our profession.
  • Cancer – 6 weeks either side of chemotherapy or radiotherapy is advisable as well as a note from oncologist to check if client’s blood count is high enough. However, with terminal cancer you may proceed with their doctor’s consent.
  • The Tattooing of Minors Act 1969 pre-dates the widespread use of micro-pigmentation in the UK,  it defines a tattoo as the insertion into the skin of any colouring material designed to leave a permanent mark, and prohibits tattooing (as per the definition) of any one in the UK under the age of 18 years. You have to check your country’s laws for this issue.

Less covered usually in our initial training, is the Psychology of potential clients.


Trichotillomania is a condition where a client pulls out their hair, it can be the brows or lashes. It’s a tricky one as the client is likely to really want the treatment, but can you be sure they won’t pick or cause infection post procedure? I usually trust my gut instinct with these clients and decide if they are suitable once we have had a consultation.

Mental health issues, depression, nervous or anxious disposition is another red flag as sometimes even with the best treatment and care possible, the client may never be happy. On the other hand, the client’s self esteem could be improved greatly and they could be your best advocate.

Inability to follow advice, aftercare, keep appointments. This can be a big factor in client’s satisfaction. It is important to explain everything verbally and in writing as it is amazing how many clients don’t seem to understand everything even though you repeat yourself. A physiologist Alan Baddeley found that people only remember about 3-4 things at a time! I remind every client 24 hours before the appointment and take non refundable deposit which helps prevent cancellations. Although sometimes it feels awkward to ask for money before a treatment, I find that it illuminates time wasters.

Different countries, insurance groups and professional memberships will have their own outlinedcodes of ethics too, so things can get confusing; always best to double check local regulations especially if working abroad.

Another issue I want to touch on is working on previously unhappy micropigmentation clients.  I went through a time where I just would not accept anyone who had been treated by another technician previously; I was unhappy as well to treat them since they rarely are completely pleased with the original treatment.

I have since decided to add a detailed disclaimer and outline what I can and cannot do for them very clearly after suggesting they return to the original technician to discuss as it may be very small adjustments required, but client loses confidence in technician usually, through it might not be technician’s fault, but the client’s inability to explain or confirm their requests in the first instant.

In conclusion, we are constantly learning new things in this industry and, thanks to social and other  media, we have more information and support from our peers than ever, and whether you are in the industry for 1 or 10 years, It is always good to recap on the basics.

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