Infection...what to do?

Eyebrow complication one week after permanent makeup 

One of the greatest parts of being active on many microblading forums and groups is that I get a lot of questions from uncertain or newer artists. This gives me the opportunity to really contribute my experience and help them.  An artist recently posted her case to seek help with the situation and pictures described in this post.  Along with me presenting my advice, I’m sharing this case so our entire community can benefit…especially clients.

Before I get started I want to remind everyone that I’m not a medical professional, but I have over 16 years of practical experience with healing situations in PMU.  Unfortunately, proper aftercare protocol is varied and is often contradictory, leaving not only artists confused but clients as well, especially with too much information be presented on the internet.  The techniques I outline below have proven to be very helpful within my own clinic. I hope you find them helpful too.

Here’s the artist’s post:

“OMG!  My client’s eyebrows look infected!  What should I do?"  I just finished a beautiful set of eyebrows for her last week, gave her detailed aftercare instructions on how to take care of her skin and sent her on her merry way.   A few days later, she’s messaged me in a panic and sent these pictures.  What do I do?  Shall I send her to the doctor?  I think she may have picked at it.”  

   

 

 

This is a very difficult and stressful situation for any artist, and especially for the client. Fortunately, I’ve seen these cases before and recognize the problem.  

Symptoms: Thick raised scab, crusty texture, redness around the skin, yellow discharge, pain, itchiness, the skin may feel hot around the area.


                              Notice redness around the perimeter of the brow 

What’s happening?  The client has developed a thick, congested scab on her skin and it cannot breathe. This could be due to a buildup of products, or even due to the buildup of scabbing.  Due to the lack of oxygen and congestion, it cannot heal and may possibly be infected.

Thick scabbing on eyebrows one week after permanent makeup

Why did this happen?
After a permanent eyebrow procedure, the body will immediately start to heal by oozing plasma to forming a thin, protective scab.  If aftercare products are repeatedly applied to the area without daily cleansing, suffocation can occur. This causes a nasty buildup of old product, dust, oil, scab, and bacteria.  It is the build-up of product and lack of washing/cleaning that causes this problem.  This can even occur if no aftercare product was applied but the area just hasn’t’ been washed for many days.  

Often, clients are told not to wash or wet their eyebrows for up to two weeks for fear that it will cause the color to “fall off” or not heal well but nothing could be further from the truth.  

The fact is - the application of permanent eyebrows causes a mild injury or wound to the skin and the body will naturally heal the area as long as it’s kept clean and calm.  

This is why it is important to wash the area daily and avoiding activities that would cause stress to the area such as friction, long hot showers, facedown swimming, and suntanning. I highly advise using a moisturizing ointment 2-3 times daily on the skin to aid with hydration and to keep the area from feeling dry, itchy, or tight.  See my aftercare instructions HERE

Now, how can we fix this problem once it has occurred?

Since the skin is angry and cannot breathe, the first step is to clean the area and remove the built-up scab.  Once the scab is removed, the skin can breathe and the client can continue to seek medical advice asap.  Again, your job is not to diagnose the problem but to provide the first sensible step:  CLEAN IT!

Here are the steps for your client:

1. Take a warm to hot shower and rinse your brows directly under the showerhead for 5 minutes. This will start to soften the thick buildup of the scab.

2. After the scab is softened, GENTLY begin to rub the scab under the running shower water until it is completely removed from the gently rubbing action.  Remember, you have to rub under running water. The continuous running warm water will allow the release of the scab quickly and gently.

3. Once finished, gently pat the eyebrow/face with a CLEAN, fresh towel.

Do not put any product on eyebrows AT ALL. The scab has now been removed and the skin needs to BREATHE. You may put moisturizer on your face, but not on the brows.

At this point, you can see the doctor for further advice.  The skin can now breathe and can receive oxygen which aids in recovery.

4. Over the next week, gently wash with area with soap and water morning and night. DO NOT APPLY ANY PRODUCTS ON THE EYEBROWS WHATSOEVER.

Over the next few days, another thin scab will form and peel off after a week.  You will start to see the redness subside and a lot of dry flaky skin.  Do not pick at it, rather leave it alone so it can continue to heal. After one month, the skin will be fully healed and then you can return for a follow-up.
   
         

2 days after the scab has been removed.  A new thin scab is forming

               7 days after the scab has been removed: the scab is starting to dry up

One month post, skin is fully healed



FAQs

Q:  Should I send her to a doctor?

Yes, you may, but ask her to do this step first, and once the scab is removed, she can seek medical advice.  After the scab is removed and cleaned, immediate improvement will be noticeable in 1 day.

Q:  Could this be an allergic reaction?

Allergic reactions are rare and few and far between.  Unfortunately, neither you or the client will be able to determine this as it requires testing by a doctor.

Q:  Should I tell her to put anything on it for healing such as Polysporin®?

The answer to this is the same as above. You can advise an OTC topical antibiotic such as Polysporin® after she has completed this first step and removed the scab and build-up.

Q:  Will there be any color left if she does these steps?

There should be but it is hard to say at this stage. The important thing is to clean it and remove the scab so it can begin healing.  Oftentimes, there will be a lot of color remaining but it needs to be properly cleaned and healed before you can assess how the results were affected.

Q:  When should I do a touchup on my client?

Typically, I recommend a waiting time of 3 months for microblading and 1-2 months for machine work so the skin can heal and be strong before another PMU procedure. From my experience, doing a touchup prior to 3 months is not enough time for the skin to fully recover and be strong again to endure more tattooing, especially if there has been an infection. The touchup will be possible - just make sure you properly qualify the client’s skin first and ensure that they are ready.  It’s better to be safe than sorry and put client care first. In the meanwhile, you can advise your client to use eyebrow pencil/powder to fill-in her brows between procedures.

Q:  Will removing the scab leave a scar?

Yes, it’s possible for it to scar, but the scab MUST be removed first and foremost, there is no way around it. After the scab is removed, another scab will form over it so as long as this new scab is allowed to heal well, there should be little to no scar.

Customer service and followup are critical here.

This is a good time to stay in close contact with your client and get daily updates on her treatment and healing progress. She is going thru a very tough situation and you want to make sure you provide her with a lot of support, even though it just means just checking in with her.  To aid in diagnosis, be ready to provide information to her doctor or specialist on products that were used such as pigments, topical anesthetics, needles, and aftercare products.

Your commitment to your client and excellent customer care will show through in this time of need. Now that you know what to do and how to handle these types of situations, remember to stay calm as well as you guide your client through this process.

To see my recommended aftercare instructions  (ABSORB, WASH, MOISTURIZE) for a smooth and speedy recovery after permanent makeup procedures, click here