Aesthetics Accreditation International presents a course to cover the four main PMU procedures, microblading, ombre brow, lip, and eyeliner. This course will begin with the general rules that apply to these PMU procedures and continue in-depth for each one. Permanent and semi-permanent procedures have become widely popular around the world to correct, enhance, and/or provide a lower maintenance makeup routine. PMU procedures have been able to restore or increase the confidence of many people and why they have become so popular. 

Procedures that will be covered: 

-Ombré Brow

-Microblading

-PMU Lip

-PMU Eyeliner 

Module One: Introduction 

Introduction 

Client Consultation 

Allergies 

Anesthetics 

Contraindications 

Health and Safety Guidelines 

Pre and Post Care 

Module Two: Materials 

Sanitation 

Pre and Post Care 

Materials you will be using for all of these procedures 

Needles and Blades 

How to operate a PMU Machine 

General PMU machine tips 

Color Theory 

Module Three: Ombre Brow 

Introduction 

Expectations 

Healing 

Videos 

Module Four: Microblading 

Introduction 

Design Technique/MeasuringTips 

Touch-ups 

Within this module, you will learn the necessary steps for the basic client communication process. The key to this process is the pre-treatment consultation. The consultation not only acts as an important sales tool, but also ensures that both the client and technician understand what is required. There are some important considerations to understand prior to commencing treatment that you will need to learn before diving into the procedure. We will also introduce you to contraindications that may arise and should be discussed during this consultation. 

The consultation is a valuable tool for both the client and the technician. For the client it provides them with the perfect opportunity to ask questions about PMU eyeliner, how the process works, their expectations and about longer term implications, including aftercare. For the technician, this is your chance to learn about their health history as well as their concerns and ultimately their desired look. Of course, the consultation is also the primary opportunity for the technician to secure a confirmed treatment booking from the client. 

All treatment begins with a consultation during which you, the technician, asks the client a series of questions about how they are feeling, medical history, and why they have requested this treatment. This is an opportunity for the technician to ensure that there are no reasons why it would not be advisable for the client to have a treatment, ruling out any contraindications. 

It is important that you keep fully detailed client records for every single client you have. 

Client Record Cards/Consultation Forms should be completed on every visit the client makes to you. Scalpa will provide these forms at the end of this module for your use. On their first visit, you will need to have a full consultation to ascertain if the client has any problems, and following the consultation, when you have fully recorded the details, you need to ask your client to sign the form to confirm that the details given are correct. 

Following this, on each visit that the client makes to you, you should mark on their client tracking form what the treatment undertook was, and ask the client to sign the form to say that he/she is happy with the treatment. The consultation is an opportunity to learn more about the client. Below we will provide some specific points to discuss with your client. 

Use Scalpa's client forms will help to keep the consultation structured and to ensure both the client and yourself enjoy a constructive consultation experience. Below we have provided some of the things that should be covered during your consultation, although bear in mind that the consultation should be individually tailored to the needs of the client. Follow our recommended format but allow the direction of conversation to be led by the client. This enables you to ascertain what questions and concerns they may have, increasing the likelihood of the consultation resulting in a booking. If your client is proceeding with treatment, make sure they see a copy of our pre-care guidelines. 

The purpose of the consultation process:

-To get the clients doing 80% of the talking and the technician to do 20% of the talking. 

-To help the clients discover, verbalize, and clarify their own wants and needs. 

-To help the technician understand the clients wants and needs. 

-Addressing concerns and showing how procedures can fulfill their desires.       

During the first procedure, it is important to stay light and conservative. You can always darken at the second procedure but it's harder to make it lighter. During the second procedure you are able to fine tune and make sure it is symmetrical with each eyebrow and make sure it is shaped to the clients request. If the client chooses to go thicker on the first appointment, explain that you may go thicker on the next appointment, remind them that you can never go thinner at the second appointment if they decide later that it is too thick. 

Your client might want a specific color or look but it is your responsibility to guide them in the right direction for the best look. You have to remember that you are the professional and that you make the ultimate decision to combine between their ultimate desire and your skills. 

Prior to the procedure, review the Medical History and chart information. You must establish if the client has developed any reservations about the procedure since the consultation. Do not assume they are still sold just because they showed up. In order to re-establish rapport, avoid complications and select the most appropriate colors. You will need to get the answers to the following questions: 

1. Are you excited about getting your new makeup? 

2. Are your friends and family excited about your new makeup? 

3. How do you feel today? 

4. Do you have someone to drive you home after the procedure if necessary? 

5. Have you taken any aspirin within the past 3 days? 

6. Are you on any other medications? 

7. Have you had any alcohol within the last 48 hours? 

8. Are you a smoker? 

9. Tell me about your experience with topical anesthetics. 

10. I see from your chart that you don't have any allergies. Is that correct? 

11. Do you have any questions about the procedures before we get started? 

12. How long have you been applying your makeup this way? 

13. What kinds of colors do you wear? 

14. Do you color your hair? How long have you had this color? 

15. Do you wear your makeup differently in the evenings? 

16. How much time do you spend in the sun? 

17. Do you need to use the restroom before we start the procedure? 

Before beginning the procedure, it is important to communicate with your client regarding the exact placement and color of pigments. You may suggest the client put on her make-up exactly the way she desires the permanent pigmentation to appear. Good communication with your client will prevent most problems. 

Never assume what they want, ask questions and be thorough! It is your client’s decision as to placement of pigment. Do not allow your client to place the responsibility for the decision of colors and shapes on you. You may make recommendations if they are very uncertain, but be sure to give them options and to come to the final decision on their own. It is their face, their decision, and it is permanent. Do not make choices for your clients! Do not alter the shape they like, even if you disagree with it. If a client is hesitant about the procedure, do not go through with it. The client should be completely certain about what he or she wants before proceeding. The comfort of your client ensures a successful procedure.  

Upon arrival, your client will complete the Medical History Profile that includes the client’s name, address, telephone number, information to help you identify potential problems with the procedure, and information to overcome objections to close the sale. There have been few reported cases of allergic reactions to pigment but will be listed along with other possible risks. If you have an impressive portfolio and have permanent cosmetics yourself, most clients will follow through with the procedure, trusting the success of your previous procedures. If you do not have a large portfolio, you can always point to the vast number of procedures done in the past, making those successes a tangible future for your client. 

More important facts to know... 

1. lntradermal pigmentation is a form of tattooing. 

2. Touch-up procedures may be required. 

3. Clients must wait 30 - 45 days minimum before a touch up procedure can be performed. 

4. Full lip colors work may take more than one treatment. 

5. Application of intradermal cosmetics can be uncomfortable and even considered painful depending on pain threshold. 

6. Pigments can and will fade. 

7. Pigments will heal a different color than what they appear when applied. 

8. There may be immediate or delayed allergic reactions to pigments. Testing for allergic reactions to the pigment is recommended at least 10 days prior to the procedure. An allergy test does not guarantee a client will not have an allergic reaction to the pigment after the full procedure. 

9. Infections can occur without client’s proper care post-procedure. 

10. Allergic reactions to antibiotics and anesthetics can occur. 

11. There will be slight swelling and redness following the procedure. 

12. Clients receiving treatment for lip liner who have had previous problems with cold sores/fever blisters (i.e., herpes - a communicable virus) may have an outbreak following the procedure. Zovirax is a prescription cream one can get from one’s physician which has been shown to prevent or minimize such outbreaks. 

13. Lip liner will appear “crusty” for one week following the procedure. 

Keeping records is important as it helps protect both you and your client before, during, and after the procedure. Before beginning, you should always take pictures to protect yourself, your portfolio, and to show your client before and after results. Secondly, make sure your clients fill out the release forms completely, even if they are friends or family. Lastly, keep record of all clients for future reference, they should include: 

a. Pat Test results (if she/he opted to take) 

b. Procedure done, note any special work or issues (Examples: Had brows done before by another technician and brows are pink, left is higher than right, different shapes, etc. Client would like eyeliner to extend past the corners. Client insisted on having black brows, even after you suggested brown.) 

c. Color or color mixture used, as well as how many drops of one color and how many of another color. Never ask the client if they remember what color you used. Also, you may want to swipe color onto a release form. 

d. Date of each follow-up/touch-up visit. 

e. Amount paid and if any discounts were given. 

f. Pros and cons about procedure. 

g. Notes to self about the client so you remember him/her. 

h. Document each visit and include photos of healed procedure.

It is highly recommended that you have your clients sign a waiver of consent at all times. We have provided an example of a proper Consent and Release Form: 

Add or delete any information you see fit. Remember, a signed Consent and Release Form does not guarantee you will not be sued and it can be challenged in a court of law. However, it does provide evidence that you prepared you client for the procedure that was performed. It also makes your client take the procedure more seriously. MAKE DOCUMENTING A HABIT – IT COULD PROTECT YOU IN THE FUTURE. 

Pigment skin testing is a procedure that consists of implanting a small amount of pigment into the skin to determine whether the client is allergic to the pigmentation selected for this procedure. Generally people do not have any reactions to the pigmentation however it can be possible. This is not a mandatory procedure. Technicians may want to consider a patch test if a client typically has reactions to the following: 

-Bacitracin 

-Novocain, Lidocaine and Epinephrine 

-Latex Protein 

-Pigment 

-Needles 

Bacitracin: A component of antibiotic ointments. Ask if they have any allergies to antibiotic ointments used at home.Novocain, Lidocaine and Epinephrine: Anesthetics that may cause reactions when used topically or given by injection. Ask if they have had any problems with anesthetics during any previous medical visits.Latex protein: Found in latex gloves. It can cause immediate hives or a more delayed contact dermatitis. (SCALPA Gloves are Nitrile)Pigment: The pigment may cause reactions because it is being embedded under the dermal layer of the skin.Needles: Needles are made of metal. Needles that are made of Nickel (ours are #304 Stainless Steel) and can cause an allergic reaction in clients who are allergic to this metal. Our main concern would be an allergic reaction to the implanted pigment, again this is the SCALPA pigment is your trust supply. True signs of an allergic reaction to the pigment: Cracking, bleeding, swelling, bumps, dry skin, oozing pain, Itching skin, raised blisters, scabbing, burning, won't heal properly, tender to touch. 

As an artist, it is vital to ensure the advanced ombre application is as pain-free as possible for our clients. Some clients find the procedure a little uncomfortable, whereas other clients report no discomfort at all.Our product created by SCALPA, is called GON, which is a topical anesthetic that reduces sensitivity by numbing the skin while it reduces bleeding during the procedures. GON is a great tool to help put your client at ease and is good for all different types of broken-skin procedures. 

DIABETES 

Diabetics have the tendency to both bleed and bruise easily, depending on the severity of their disease. The healing process for diabetic clients can be lengthy. Interview the potential client at length. Ask them how they react to a surface wound (i.e. a cat scratch). Avoid brittle diabetics and those that are insulin-dependent. 

PREGNANCY 

The most expensive insurance premiums and settlements in the medical community are paid by those involved with pregnant women. This is a condition that only lasts nine months. Wait for the child to be born, then do the procedure. 

GLAUCOMA 

Persons suffering from glaucoma may experience problems with eyeliner procedures because of the pressure in their eyes. Request a physician’s approval. 

PSORIASIS 

Psoriasis patients suffer from excessively dry skin characterized by peeling and flaky skin. Peeling can make the skin of psoriasis victims extremely tender, making a procedure very difficult to complete. In addition, more bleeding may occur and the final procedure may slough off, requiring additional touch-up procedures. 

HYPERPIGMENTATION 

More common in darker skin toned clients, hyperpigmentation is a result of a past injury to the skin which permanently blemished parts of the surface. Sufferers of hyperpigmentation will often experience further damage to the surface of their skin as a result of additional trauma to the skin inherent to cosmetic tattoo procedures. 

SCARS 

A scar is a result of past injury to the dermal layer of skin. Tattooing is applied to the upperdermal layer of the skin and therefore a tattoo is considered a scar of color. Scars vary in shape, size, texture and appearance. Camouflage procedures for the purpose of covering scars are considered experimental in nature. Always perform color testing on any scar before attempting to camouflage the entire area. Allow test patches to heal for 3 weeks to one month. 

KELOID SCARRING 

Keloid scars look like thick ropes under the skin and may be extremely tender to the touch whereas other scars are usually flat on the surface of the skin and may feel numb. 

QUESTIONABLE SKIN DISORDERS 

Clients suffering from any type of visible skin allergy or affliction should be required to see a dermatologist before receiving any type of intradermal pigmentation. Request a physician’s written approval before performing a procedure. 

ALLERGIES 

Any client who suffers from allergies of any kind must receive a patch test. This test should be performed 3 weeks to one month prior to the procedure. Persons who experience allergic reactions from earring posts and must wear 14 karat gold posts may be allergic to nickel. Most tattoo needles are constructed from a nickel alloy and may cause a great deal of swelling and irritation to these clients. People who are allergic to Novocaine or any type of Caine derivative may experience a reaction from topical ointments if they are applied. Other allergic reactions may be caused by latex gloves, powders used to lubricate gloves. 

HERPES SIMPLEX 

A viral infection commonly referred to as fever blisters which erupt at the base of the lips. Persons who suffer from herpes simplex may receive both eyeliner and eyebrow procedures with little or no difficulty. 

BIRTHMARK 

There are a wide range of birthmarks and many are risky for cosmetic tattooists. There are many preferable options for removal or camouflage of birthmarks. To avoid liability and, more importantly, to achieve the optimum result in birthmark removal, seek advice from a dermatologist specializing in cosmetic work. 

HAIR TRANSPLANT 

A commonly unknown fact is that scar tissue will form within the eyebrow transplant site. If your client had a hair transplant for their eyebrows, microblading is not a suitable procedure for them usually. Use your own discretion based on the type of sharing and your client has predicable expectations. 

IRREGULAR STATE 

If their body naturally runs hot or has a bleeding disorder, this will result in excess bleeding and prevent adequate color deposit. 

AUTOIMMUNE 

Even more seriously, if your client has an autoimmune disorder such as lupus, or frontal fibrosing alopecia, they will be not a good candidate for Microblading due to their compromised skin health caused by these disorders. 

TREATING CANCER PATIENTS

After undergoing a horrific life altering experience, cancer survivors often turn to medical aestheticians and PMU Technicians to help restore what was lost, or for guidance as to what can be cosmetically done to help make them feel better about their appearance once again. Be it PMU for hair loss ( sometimes hair does not grow back on brows or scalp), Areola reconstruction or Fibroblast for rejuvenation of lost skin tissue, there is one important fact that you as the medical aesthetician or PMU/SMP technician should always remember: The immune system has been compromised! Yes it’s safe to treat cancer survivors, as not only will most medical aesthetic treatments be confidence builders, but these procedures pose no real threat to the patient. In fact the only impact concern really is slower healing time. Anytime the immune system is compromised, or has undergone a procedure where exposed to radiation, the filtering organs take a beating thus rendering the immune system compromised. For this reason explain to them that healing may be slow and their post-care regimen will be extremely important. Make sure to include this important information in their intake forms. Aesthetic treatments can begin as soon as they are cleared 

OTHER CONDITIONS 

If your client is pregnant, nursing, has hemophilia, a heart condition, , it is absolutely not recommended that they get any form of permanent make up done as this puts them in a high-risk position. People who have heart issues often are on medications that thin the blood which will cause excessive bleeding a poor results with microblading.

EMOTIONALLY UNSTABLE CLIENTS 

An integral part of the consultation is establishing the client’s motives for getting the procedure and their emotional state. A client’s unstable frame of mind could lead to problems far more complicated than any medical problem. When a client is unsure of a permanent procedure, do not do the procedure. They may discover that they’ve made a mistake, and pointing to it will be your tattoo needle. These potentially dangerous clients come in all shapes and sizes and often give little clues to their uncertainty.If your client enters with a persuasive friend recommending your work, make sure that the client and not her friend is formulating the decision. If a client continually talks about how nervous they are, you may want to reschedule for a later date, maybe a year. One possibility which usually works with the dubious potential client is known as ‘’The Trial Period”. This is a two week span which the dubious client is instructed to diligently apply and never take off the permanent procedure. For instance, if Leery Louise has approached you for a set of bold, full eyeliner and you sense her ambivalence, direct Louise to apply a long lasting eyeliner color to her eyes and wear it constantly throughout the day.You may want to have some long-lasting eyeliner on hand for clients much like Leery Louise. Eye pencils, though drier in texture, often last up to twelve hours. Make sure your client applies it as often as possible, not allowing the color to fade. Have her look at her face first thing every morning. You, as the technician may want to call her and check on her progress. You should be able to gain a perspective on Leery's feelings towards a permanent full eye line. Another helpful tactic for protecting yourself may be to have a more extensive Consent/Release form, which you save in the back of your file cabinet for people similar to Leery Louise.

For all clients who have permanent cosmetic makeup procedure performed, we only use the very finest pigments available. Some procedures may need to be repeated because the original application can fade anywhere from 25% to 40%. Individual chemical and genetic makeup can affect the final result.

It is fully possible to get the perfect results with only one application; however, this cannot be guaranteed. Please remember that the amount of pigment you retain or lose after your initial application is not a reflection of the quality of work. Pigment retention varies with each person. In case your procedure must be repeated, you will need to wait at least 21 days of the date of your original application.  

The tissue is not ready to absorb new pigment although your skin looks healed. Please be patient. 

Most touch-ups can be done in 30 to 45 minutes.

• Do not work out 24 hours before procedure. 

• NO alcohol or caffeine 24 hours before procedure (Yes, there is caffeine in decaf coffee and tea!). 

• Avoid sun and tanning one week prior to procedure. 

• Do not take Aspirin, Niacin, Vitamin E or Advil/Ibuprofen 24 hours before procedure. 

• Avoid power shakes and power greens, Fish Oil, and "Hair, Skin, Nail" supplements 24 hours prior to procedure. 

• Discontinue Glycolics, Chemical Peels and Retin-A 4 weeks prior.  

• Refrain from use of any Alpha Hydroxy Acid (AHA) products close to the eyebrow area 2 weeks prior to and 2 weeks after your procedure. Check your moisturizer, facewash BB or CC creams and makeup primers for anything that says acid. 

• No brow waxing or tinting one week before. 

• Please Note: You will be more sensitive during your menstrual cycle as well. 

• You have to be off any kind of Accutane for 1 year. NO Exceptions! 

• No Latisse (on lashes or brows) for minimum of three weeks prior to permanent eyeliner or brow. 

• For permanent eyeliner, eyelash extensions must be removed 3-5 day prior. 

• Fillers should be done six weeks prior to scheduled procedure or six weeks after procedure. 

• Botox should be performed two weeks prior to scheduled procedure or two weeks after. 

In the case of permanent lip color, cold sores and fever blisters MUST be treated. If you get cold sores or have ever had one in the past, you will need an antiviral prescription from your doctor before a lip procedure. Physicians usually instruct to take it 2 days before. As this procedure will bring out the virus if not medicated beforehand. 

If you have oily skin, results will appear softer and may require additional procedures. 

To prepare the skin, you will need to cleanse the area free of makeup. Clean with baby-wipes, makeup remover or apply antibacterial soap with a Q-Tip to remove any excess skin oils.

PMU can be a painful procedure. However, there are great numbing solutions for before, during and after that can be used for comfort throughout your SMP procedure.

There will be an epithelial crust that forms in the days following the procedure. This crust is a combination of dried pigment and plasma that forms externally. It is important that you do not pick it. Picking the crust will result in a loss of pigment. The crust will fall off naturally within a few days. For the first few days following the procedure, the area will feel similar to that of a sunburn. A topical ointment can help soothe the area. Apply antibiotic ointment twice daily. This will soothe the area, keeping it moist and helping it heal properly.

• Do not touch the treated area unless applying ointment. No scratching, rubbing, or picking of the treated area 

• Be cautious around the area (such as pulling clothing over your head) 

• Do not apply makeup on treated area until healed 

• Apply ointment 1 - 3 times a day on treated area until peeling comes off; normally 5 to 7 days. (Again do not peel the area yourself, let this fall off naturally) 

• Follow with Scalpa Rehab or antibiotic ointment for one week 

• Artificial tears may be used if needed but not recommended 

• Touch up may be done after 21 days, however its best to wait 30-45 days