Eyelash extensions and permanent make-up: how toxic are their ingredients?

In ancient Egypt (3100–2700 BC), cosmetics and make-up were an essential part of day to day culture, for both women and men. In addition to the beauty ideals of the time, the most well-known type of make-up – dramatic eyeliner – also had spiritual significance. Even then, the visual manipulation of one's appearance was a form of status and the pursuit of divine beauty. The makeup particles of the originally green eyeliner included malachite, resin and vegetable oils. At that time, malachite was a basic ingredient in medicinal tinctures used to treat various eye diseases. However, eye health protection underwent a change between 1550 and 1170 BC: the black make-up tincture no longer contained malachite and was already being used to fulfil an ideal of beauty.¹

Permanent make-up around the eyes

Even many millennia later, eye health protection no longer plays a role. For some people, achieving a certain look is more important than the health of their eyes and facial skin. As a result, people – especially women – are willing to endure pain in order to avoid having to apply make-up to their eyelids and eyebrows every day. There are groups of people for whom permanent make-up provides relief. This can be the case for older people with declining near vision or a loss of facial hair such as eyebrows and eyelashes.

However, micropigmentation, which is used in permanent make-up, can be associated with a whole range of undesirable effects, as can other types of tattoos. These include fading of the tattoo, scarring, phototoxicity, granulomatous inflammatory reactions, allergic contact dermatitis, infections and hypomelanosis.²

Case report of an 84-year-old patient with permanent make-up on her eyebrows and eyelids

An 84-year-old patient had permanent make-up applied to her eyebrows and eyelids at a beauty salon. A few days after the tattooing of her lower eyelids, she noticed unwanted pigmentation that had spread to the left side of her face (section A of Figure 1). This revealed dermatochalasis and swelling in the cheekbone area. The lateral nasal area and the lower left eyelid showed dark hyperpigmentation. Stripe-shaped hyperpigmentation was also visible on her cheek along the lower border of the prezygomatic space. The lymph node between the eyebrow and upper nasal root on the left was also swollen.²

Massive displacement of micropigments with lymph node swelling

The reason for this finding was a massive displacement of micropigments after eyelid tattooing. The unwanted hyperpigmentation was treated in three consecutive sessions with an Nd:YAG laser at intervals of 4-5 weeks, a pulse width of 2 ms, a pulse repetition rate of 0.5 to 3 Hz, a spot diameter of 4 mm and a fluence between 4 and 16 J/cm². After each laser therapy treatment, topical clobetasol propionate 0.05% cream was applied for 3 days to support healing. The patient was also instructed to avoid direct sunlight after the laser procedure. The findings gradually improved (sections B and C of Figure 1) and the lymph node swelling disappeared completely.²

Tattooing the eyelids affects the tear film break-up time

Permanent make-up on the eyelids can also lead to pathological changes in the Meibomian glands and an associated disturbance in tear film stability. This was demonstrated in a study (DOI: 10.1097/ICO.0000000000000452) involving 40 female patients, 10 of whom had eyelid tattoos (control group n = 30). To assess the tear film, measurements of tear film break-up time (BUT) were performed.³

Eyelid tattooing leads to a loss of Meibomian glands

In the group with eyelid tattooing, the BUT was significantly shorter at 4.3 ± 0.9 seconds than in the control group (11.0 ± 4.3 seconds; p < 0.001). Compared to the control group, the group with eyelid tattooing also showed significantly more pronounced fluo-positive corneal erosion. The loss of Meibomian glands was also significantly higher in the group with eyelid tattooing (vs. control group: p < 0.001).³

Longer eyelashes at the expense of eye health

Eyelash extensions are becoming increasingly popular worldwide. In cosmetic eyelash extensions, individual synthetic eyelashes are applied to the natural eyelashes. However, this involves the use of adhesives that pose a risk to the eye. In the present study, the research group uncovered and investigated eye diseases that can occur after such eyelash extensions.⁴

What exactly is in the adhesive used for eyelash extensions?

To find out, data from 107 women aged 21–52 (period: 2007–2010) who had visited an ophthalmology clinic in Japan due to eye symptoms following eyelash extensions was retrospectively examined. The patients had no history of eye disease. Three adhesives, whose ingredients were not disclosed, were chemically analysed for more than 70 substances. Analysis of the ingredients revealed formaldehyde in concentrations above the standard limit in all three adhesives. In addition, lead and benzoic acid were also detected. However, the concentrations of these specific compounds were low. The research group therefore assumed that it was unlikely that these two ingredients could cause symptoms in humans at the concentrations present.⁴

Ocular diseases caused by eyelash extensions

All 107 patients showed improvement in symptoms with adequate treatment using eye drops and/or ointments.⁴

Conclusion for medical practice

[Only in German] Cosmetics in Ancient Egypt. ( Kosmetik im Alten Ägypten ).
Goldman A.et al (2014). Severe unexpected adverse effects after permanent eye makeup and their management by Q-switched Nd:YAG laser. Clin Interv Aging. 2014 Aug 11;9:1305-9.
Lee YB. et al. (2015). Eyelid Tattooing Induces Meibomian Gland Loss and Tear Film Instability. Cornea. 2015 Jul;34(7):750-5.
Amano Y. et al. (2012). Ocular disorders due to eyelash extensions. Cornea. 2012 Feb;31(2):121-5.