Photo #1: Tattoo
Photo #2: Cheap joke
Photo #3: Micropigmentation
Photo #4: Micropigmentation
Photo #5: Micropigmentation
(photos 3 and 4 from: http://www.permanentcosmeticsbyjamilla.com/gallery)
A couple of years ago, my beloved patient (and friend!) Jacki told me she was going to get her eyebrows tattooed, but not really tattooed. WHAT??? I was immediately wary and drilled her with 8 million questions about the person doing it, the cleanliness of the place etc. Jacki is a wise woman and allowed me to tag along with her on her second appointment to spare herself from getting the third degree by me at a later date.
Jacki is a 14 year breast cancer survivor who lost some of her eyebrows during chemo and some when she was on an Aromatase Inhibitor (Arimidex, Aromasin, Femara, etc). Aromatase Inhibitors (AI's) are the hormonal therapy pills that you take after your chemo is over to inhibit the amount of estrogen in your body (there will be another post in the future to discuss Tamoxifen and Aromatase Inhibitors). One of the side effects of some of the AI's is hair thinning.
After a lot of thought (many years after her cancer treatment was over and her blood counts were stable), Jacki decided to get her eyebrows tattooed. On the web, there are a lot of different names for this: "permanent makeup, permanent cosmetics, micropigmentation". By all definitions they are all some type of "tattooing", albeit there are different techniques, styles and levels of expertise involved apparently. The woman who Jacki chose to do this procedure was Jamilla El-Shafei.
I can't speak with any authority about what micropigmentation entails. Jamilla told me that she uses a different instrument than the one that tattoo artists use. On her website, she describes Micropigmentation (or Permanent Cosmetics) as "a method of implanting medical-grade, hypo-allergenic colored pigments in the delicate tissues of the face. Specialized instruments are used to apply the pigment to the face".
Another website calls micropigmentation: "the process of inserting colored pigments just beneath the skin's surface. The insertion of color reaches only the papillary layer of the dermis."
But back to Jamilla...
I must tell you that despite Jacki telling me how great Jamilla was and how clean her place was, I was still suspicious. I'm a nurse and have seen some botched "tattoos" in my career. I've seen a lot of really bad and undecipherable ink tattoos on every type of patient and every body part imaginable. I swear, every veteran of WWII had a tattoo. I promise you that those tattoos 60+ years after the fact, don't look so great. : ) Most nurses have heard a few horror stories about sketchy tattoo artists causing infections, Hepatitis C and worse. So, I was skeptical.
We walked into Jamilla's beautiful office in Portsmouth, NH. I call it an office, but it is really a beautifully restored New England home and her office is on the first level. Her waiting room looks like something out of "House Beautiful".
Because I am a nurse, I also am aware of places that perform "cosmetic or plastic surgery" that look all fancy-schmancy and upscale, but aren't up to snuff medically speaking. So, while I thought her waiting area was lovely (and it smelled FABULOUS!!!), I still wasn't sold.
Several volumes of photos of her work sit on the coffee table of her waiting area. I LOVE this!! Obviously she is not going to show pictures of crappy work out in her waiting area, but to see actual (deidentified) photos of her work is really helpful. She does amazing work!! Client testimonials are also there. That is exactly what a new client wants to see....examples of her work.
With Jacki's permission, Jamilla allowed me to watch her work. She also answered many of my questions throughout the procedure.
I also loved that she had made sure that Jacki had used her EMLA cream (which is a prescription local anesthetic cream that we use in the chemotherapy world on port-a-caths prior to sticking them with a large bore needle).
My final grade of Jamilla, her working environment and Jacki's eyebrows?
1) A+ for spotless, sanitary, aesthetically beautiful, obvious use of clean techniques and good handwashing. Also credentialed. She is board certified. She spent time training in hospitals with plastic surgery teams so she is well versed in cleanliness, sterile technique, proper cleaning and sterilization of instruments and the usage of sterile one time needles etc to do the actual work. She also gets referrals from plastic surgeons. Guess what? No plastic surgeon is going to risk having their hard work screwed up by a bad "tattoo" person. It would make them look bad.
2) A+ for providing photos of her work to show prospective clients. I loved the way she described to Jacki exactly what the goal of her visit was and what they were going to accomplish that day. She also told her what they wouldn't be able to accomplish in that visit. She laid out the plan of what would happen in the final visit before we left. She also told her "it's going to get very dark, and you will not like it, but in a week it will fade" (or something to that effect). That is exactly what happened and Jacki was prepared for it. She also gave good instructions for how to care for it at home to prevent infection.
3) A+ for her artistry. Why do I keep yapping about how beautiful the surroundings were? Well, Jamilla is an artist. No, she really is an artist! She paints and used to work as an interior designer if I remember her story correctly. This is important because in her micropigmentation work, it is her eye for color, detail and artistry that makes the final product look so good. She speaks of using her flair as an artist to be able to select different colors for different skin tones for the best outcome.
In some of the books of photos of clients, you can see that a lot of her work is trying to "fix" the botched up work of other "tattoo" artists or other permanent cosmetics practitioners. I think her experience as an artist is evident. Her canvas in this case is human skin.
I have seen a couple of women with badly tattooed eyebrows. Yikes. The difference between that and the very subtle brush strokes of Jamilla's work is like night and day.
4) A+ for experience. She's been practicing since 1994. In my world (the medical world), the more cases you do the better you get. She has the long term experience I would be looking for if I were a potential client.
5) A+ and extra credit for her compassion. She gives discounts to cancer survivors and those with alopecia (hair loss due to medical reasons other than chemotherapy). I have been blathering on about eyebrows because that is what Jacki had done. Jamilla also does post-mastectomy areolar (nipple) work and scar "camouflage". Of course she sees a lot of clients that do not have any medical issues. These are women that just want to look better. She loves those clients.
But, ask her about her work with cancer survivors, and you can immediately sense her joy when she speaks about helping them. She knows that she makes them feel better about themselves and more confident about their appearance. She says that those clients give her the most satisfaction, and that is one of the major reasons why she loves her job so much. BAM!!! GAME OVER. That's the answer a nurse likes to hear. Jamilla, YOU ROCK!!! Thank you for all of the great work you do for cancer survivors. I was a skeptical nurse, and now I'm a fan!!
6) A+ for Jacki's eyebrows! She looks great and received a lot of compliments. Her eyebrows were a hot topic of discussion in our chemo clinic.....very favorable reviews by all!!!
See Jamilla's website below. She has a lot of great before and after pictures. Make sure you check out her photos of women who came to her with botched jobs from someplace else.
Jamilla sees clients in Portsmouth, NH and at The Boston Center on Comm. Ave. in Boston.
Jamilla has a list with her prices for the services she provides. Jacki told me that it cost her approximately $500 for her 3 sessions. She is "extremely happy with the results". When I asked her how painful it was, she said "it's not painful it just feels like electrostimulation at the brow area". She is going back for an annual touch up soon. I will ask her to take a photo afterwards (like the one she gave me yesterday), and will post it here again so you can see what a touch up does. She says that it fades a little over time. Apparently you can go back every year or couple of years to freshen it up.
I know I asked Jamilla if the nipple work was covered by insurance, but I can't remember if it was covered (it should be!!!). I do know that she emphasized that she would try to work with cancer survivors if there were financial issues preventing them from having this final piece of their reconstruction completed.
While she states that she has clients in from all over the world, obviously most of us can't afford to do that. If you don't live in New England, see the bottom of this post for some tips from The Cleveland Clinic on what to look for in a professional micropigmentation practitioner.
One more thing..... MRI's and Tattoos: If you are undergoing an MRI test (magnetic resonance imaging) you should let the tech know that you have had a "tattoo". This is because some ink or pigments contain metal (Iron oxide) and MRI machines are like a big high powered magnets. No, the tattoo doesn't explode, but the area tattooed can heat up and in rare cases burn at the tattoo site. Most importantly the metal can interfere with the images, affecting the results of your MRI.
It would be a good idea to ask your micropigmentation practitioner if the skin pigments used contained iron oxide. Looking at the literature on the web it looks like this is a bigger issue for older tattoos...tattoos that were done more than 20 years ago. Apparently it is not as big of an issue with some of the pigments they use now. But, if you have an area where a lot of black pigment was used, this contains more iron oxide (a metal).
When we order an MRI for a patient, there is a long checklist of all the things that may or may not either interfere with the results of the MRI or would preclude you from having an MRI for safety reasons. Whether you have had a tattoo is definitely one of the questions asked. Having a tattoo might not keep you from being able to get an MRI, but depending on the body part they are examining in relation to the area that was tattooed.
"MRI complications. Rarely, tattoos or permanent makeup may cause swelling or burning in the affected areas during magnetic resonance imaging (MRI) exams. In some cases — such as when a person with permanent eyeliner has an MRI of the eye — tattoo pigments may interfere with the quality of the image." http://www.mayoclinic.com/health/tattoos-and-piercings/MC00020
Per the Cleveland Clinic site: Do your homework"Be sure to find a doctor or specialist who has experience in this procedure. Before having the procedure, visit the doctor you have selected. What should you look for? Examine the office area for cleanliness and professionalism. Are there appropriate waste containers for proper disposal of medical products used during the procedure? Are supplies properly stored? If your initial visit is not in the actual room where the procedure will be performed, do not be afraid to ask to see the room and request a general tour of facilities. Be aggressive - this is your appearance".
"Some other questions to ask:
- May I see your credentials?
- May I see photos of your past work?
- If possible, may I contact a current or former patient?
- How long have you been practicing?
- What is your follow-up care policy?"