MicroBlading - First Things First

To illustrate this lets take a look at the relative growth in searches that have been performed on Google for 'microblading' vs. the search term 'permanent makeup' which has had a long history of being the commonest search term, our research indicates that searches for microblading now outstrip any other related term by a wide margin.

The growth in search activity parallels the rapid growth in popularity that microblading has enjoyed over the past couple of years with a rapid uptake by those not previously working in the area of permanent makeup/cosmetic tattooing.

What is MicroBlading?

MicroBlading is simply another form of cosmetic tattooing using a hand tool, you may see it referred to as MicroBlading, Micro-Stroking, Feather Touch, Hair Like Strokes, Eyebrow Embroidery and a variety of other terms. Use of hand tools is the oldest form of tattooing dating back thousands of years, in fact the tattoos that have been discovered on the mummified skin of Ötzi the iceman (who was discovered in the Ötztal Alps in South Tyrol, Italy in 1991)¹ are likely to have been created by a method remarkably similar to the modern service of MicroBlading.

To quote the archaeologists and other scientists who have been studying Ötzi's tattoos²;

Quote: "Unlike modern tattooing methods, the tattoos were not produced with needles but by means of fine incisions into which charcoal was rubbed."

Image Credit: © Marco Samadelli

Modern methods to perform microblading are remarkably similar utilising a series of very fine needles in rows with varying shapes such as slopes or half circles (often called a U), which together form a kind of small blade. Ötzi's mummified body is believed to be approximately 5,300 years old so modern microblading is not a exactly a new invention it is more a case of using a more precise tool to perform the same kind of tattooing method that was used thousands of years ago.


Why Has MicroBlading Become So Popular?

The use of hand tools for tattooing using a tapping or pricking motion had become less popular with the introduction of extremely precise modern microprocessor controlled digital cosmetic tattoo equipment largely because the modern machines provide precise control over needle depth in comparison to hand tool work which relies upon hand pressure to control the depth. Technicians who continued to use the hand tools continued to experiment and adapted their technique to using a superficial cutting motion to create a very fine incision rather than a tapping motion and they realised that the oldest technique of tattooing actually managed to produce a very fine tattoo line and also provided them a little more control over the needle depth.

In skilled hands Microblading can create extremely fine tattoo lines which makes it ideal for the purpose of creating simulated hair strokes for eyebrows, for a short period of time use of hand tools to perform the microblading method appeared to have an advantage over mechanical equipment simply because needles could not be produced fine enough to cope with the bend load created with the sudden downward pressure in a tattoo device during skin penetration however the gap between the two methods has recently been closed with the introduction of new nano needle technology³.

Another reason why microblading has become so popular is the low barriers to entry, equipment costs are extremely low which is attractive to new entrants to the cosmetic tattoo industry.

Who Invented MicroBlading?

You can see from the above that this is the oldest form of tattooing dating back at least 5000 years, in modern times some technicians still continued to use hand tools to perform cosmetic tattooing therefore MicroBlading is not so much an invention but rather an adjustment in use of hand tools back towards the oldest form of tattooing technique. Many of the modern proponents of MicroBlading have their own slant on the hair stroke designs, favourite needle configuration and handles but the underlying technique is more of a rediscovery of an ancient technique rather than a new discovery, and modern manufacturing has also assisted with the availability of extremely fine needle profiles.


Is it True That MicroBlading is Not a Form of Tattooing?

MicroBlading is a form of Cosmetic Tattooing, in some locations it may be a breach of health regulations to mislead a client into believing that the service is not tattooing, regardless of what the name the technician uses to describe their own unique approach to the service it is still a tattoo.
 

Education Within the Cosmetic Tattoo Industry Changing Due to the Popularity of MicroBlading

The primary purpose of this article is to draw attention to the changes that are taking place, some consider the changes to be a disruption of the industry that is similar to the disruption of the taxi industry by ride sharing services such as Uber⁴, however others argue that there are safety concerns that also need to be considered carefully.

Traditionally education for cosmetic tattooists has been provided by technicians with many years of experience and often the trainers either had endorsement by one of the large not for profit representative industry associations and or formal qualifications in training and assessment. This has some advantages particularly if the training organisation has a well constructed course delivered by educators with many years of experience and comprehensive theory aimed at compliance with local health regulations and minimisation of complications. Some countries/states and territories have defined course frameworks with a precise outline of what subjects must be covered and what qualifications are required to provide the education⁵. Pre and Co requisites relating to hygiene practices etc are also part of the educational requirements for cosmetic tattooists in some countries such as Australia, the United Kingdom, and parts of the USA.

The explosion of interest in MicroBlading by new technicians has certainly disrupted the education pathway for cosmetic tattooists because introductory courses are now sometimes being offered to people in 1-2 day demonstration events without any educational prerequisites by demonstrators who hold no qualifications or endorsements to legitimately offer a vocational training course. The feedback from some of the attendees at these demonstration events provides due cause for concern particularly in relation to compliance with hygiene standards for skin penetration services.

We now have a situation where people with no prior background in cosmetic tattooing are attending 1-2 day demonstration events and being issued certificates that may have no standing/accreditation and further compounded by the lack of formal qualifications possessed by the demonstrator. Sometimes within a few days or weeks some of those people who attended the demonstration events start to offer their own demonstration events and issue their own certificates resulting in a rapid cascade of poorly trained service providers all engaged in skin penetration services.

Some believe this is an innovative new approach to education others believe it is a mounting problem.

What Standing do the Certificates From Demonstration Classes Hold?

If a technicians qualifications were examined within a legal forum or via formal inquiry by a regulatory authority below are just some of the questions that may be asked;

1. Is there local standard for a course relating to this service?
   For example is there a vocational education course framework that is recommended/endorsed.
    

2. Did the course content comply with 1) and local health and safety laws & regulations related to the act of tattooing?
    

3. Did the course provider have formal qualifications in vocational training and assessment that are recognised locally?
    

4. If the answer to 3) is no did the training provider have endorsement by a not for profit representative trade association? (i.e. evidence of independent industry assessment without vested financial interest).
    

5. Were formal records kept in relation to the education that was provided, the assessment of the trainee, and the attainment of an acceptable standard?

If answers to some of the above questions are NO then it may be determined that the demonstration class/training has no identifiable standard or in other words the technician did not have sufficient training to legitimately offer the service.

What Would a Professional Indemnity Insurance Company Do if Their Policy Holder was Found to be Unqualified?

The chances are that an insurer would have clauses in their policy document that may enable them to vacate the policy if their policy holder was found to lack a reasonable standard of training or if they breached any health regulations. This could pose a serious problem for both the technician and the client in the event of an adverse outcome because the technician may find that they are wholly liable and the client may find that the technician lacks the financial resources to cover the situation.
 

Not For Profit (NFP) Representative Trade Associations vs. For Profit Publishing & Marketing / Fee For Service Companies

In locations where no vocational training course framework guidelines exist for cosmetic tattooing not for profit representative trade associations may serve an important role in certifying instructors and endorsing course content.

However we caution that the current situation with new technicians bypassing the traditional education pathways provides an ideal opportunity for organisations with limited or no prior experience in the field of cosmetic tattooing to attempt to seize control of the industry with a profit motive.

A 'for profit' publishing and marketing/fee for service company with a membership structure could have a similar appearance as a not for profit representative trade association, however a 'for profit' company structure has conflicting priorities and the pursuit of profit and the interests of the company owners could potentially win out over the best interests of the wider industry. For example a for profit company operating on the basis of fee for endorsement may be tempted to endorse a trainer with limited experience in exchange for the collection of fees, promote those with low/average skills experience and knowledge as experts, or promote training courses in areas that only qualified health practitioners can legally operate (potentially placing clients and technicians at risk). For this reason any certification and endorsements provided by this type of endorsement structure may ultimately have a 'degree mill' flavour to them because there is a vested financial interest i.e. profit from the provision of endorsement documentation.

If you are considering joining a representative industry organisation for the purpose of certifying your credentials or endorsing your course content the first question you should ask is;

Is this a Not For Profit (NFP) representative trade association dedicated to cosmetic tattooing and do the all the presiding executive members have credentials and extensive first hand experience in the field of Cosmetic Tattooing?

If the answer to either of those questions is no then we suggest that you save your membership money for the purpose more effective marketing and seek out an appropriate NFP Representative Trade Association to affiliate with and provide your endorsements because well informed clients and others are likely to consider these types of questions when evaluating your credentials.

Equally NFP Representative Trade Associations should look carefully at their evaluation, certification, and endorsement procedures and ensure that a formal process is followed and documented. Evaluations of trainers and any endorsed course content should only be conducted by senior members with qualifications in training and assessment and most importantly extensive experience in Cosmetic Tattooing.

We cannot stress strongly enough that it is crucial that industry members act quickly to improve training standards for MicroBlading and all Cosmetic Tattoo education to prevent the cosmetic tattoo industry from being hijacked by outside organisations that may be eager to add to their revenue base. The current training standards provide a perfect opportunity for empire builders to seize control of the industry by encouraging regulatory action in an effort to attract new business to 'for profit' endorsement programs.


What Important Hygiene Factors Should Be Considered With MicroBlading?

One of the benefits of ensuring that a Cosmetic Tattoo technician has attended a comprehensive course provided by an accredited trainer and assessor is that the appropriate topics related to hygiene for skin penetration services should have been adequately covered. One of the areas of most concern to us is the reuse of hand tools and the lack of comprehension by some of the new service providers regarding the difference between disinfection and sterilisation and which method is appropriate for which circumstance.

MicroBlading Handles Become Contaminated During Use due to Direct Connection with the Needle

We are aware that some demonstration classes are recommending that technicians remove the needle and wipe over their microblading handle with a disinfecting wipe and reuse it for the next client.

Our view is: this practice poses a serious risk of cross contamination of a blood born communicable disease from one client to another, this could have significant epidemiological implications further down the track. Disinfection of a used microblading handle is an inadequate precaution as there is direct connection between the needle that has been used to penetrate the skin and the tip of the handle and no impermeable hygiene barrier between the two meaning it is highly likely that the handle will become contaminated during use which in turn could contaminate a new needle for the next procedure even with the disinfection methods being recommended.

Roughened surfaces around collars, threads, needle grooves and ornamental coatings such as diamantes are highly likely to harbour procedural residues and may be difficult to clean adequately enough to guarantee complete sterilisation even after a steam pressure sterilisation cycle. Therefore a MicroBlading hand piece should be considered as an extension of the skin penetration implement requiring disposal after use.

 
30 X Magnification Under Digital Microscope
Even after cleaning residue is still discovered on sides of MicroBlading needle grooves and collars.

NB. Hygiene regulations related to skin penetrations services often stipulate that used needles should not be handled or manually manipulated to avoid the risk of a sharps injury by the operator.

Most MicroBlading hand pieces are manufactured with the intent of them being single use disposables and the safest option for both the technician and the client is disposal of the microblading hand piece into a sharps container at the completion of the treatment with the needle still attached, this is also likely to be a compliance requirement by well informed health inspectors.

Disposable MicroBlading hand pieces are extremely cheap therefore cost is not a legitimate excuse for reusing high risk disposable skin penetration equipment.


Why is Disinfection of Modern Mechanical Hand Piece Different to a MicroBlading Handle?

The rationale for disinfection and reuse of handles being provided to attendees of some MicroBlading demonstration classes is that this is the same procedure as routinely occurs with modern mechanical cosmetic tattoo devices, this type of advice underscores a fundamental lack of knowledge on the part of the demonstrator. A modern mechanical hand piece that utilises an mt.derm-amiea encased cartridge module has a hygiene membrane separation between the hand piece and the actual needle.
 

Patented Impermeable Hygiene Membrane
Image Credit: © amiea

Whilst we still recommend that technicians use a complete barrier system to prevent cross infections⁶ the hygiene membrane separation between the needle and hand piece and the cartridge encasement of the needle dramatically reduce the risk of cross contamination with mechanical systems simply because the needle never actually makes direct contact with the hand piece during use, this means that these types of mechanical hand pieces can be reused with minimal risk of cross infection provided adequate cleaning and disinfection protocols are followed.

Modern Mechanical Hand Piece With Complete Barrier System Applied

Therefore the post procedure disinfection protocols routinely used for mechanical tattoo devices cannot be applied to the use of hand tools because of the differences in cross infection risk profiles.

What About Sterilisation of MicroBlading Handles with a Pressurised Steam Steriliser (Autoclave)?

There are 5 important factors that Autoclave cycles rely upon to ensure sterilisation of reusable surgical/skin penetration instruments relevant to this discussion;

1. Adequate Temperature

2. Adequate Steam pressure

3. Adequate Time frame

4. A smooth corrosion free instrument surface that has been completely cleaned (preferably manufactured from surgical steel)

5. Pressurised steam access to the entire instrument surface

If any one of the above factors does not comply with the recommended protocols⁷,⁸ the instrument may not emerge from the autoclave cycle sterile i.e. it may still harbour infectious micro-organisms. For example any residue of bodily fluids or solids, pigment, creams, or surface rust/corrosion on the instrument etc can potentially protect micro-organisms and their cysts/spores from destruction during a sterilisation cycle.

One of the problems with reuse of microblading handles (even if the technician is fortunate enough to have access to an autoclave) is that points 4 & 5 above are difficult to guarantee due to the nooks and crannies, threads and grooves in the needle connection point. This part of the handle also has the highest risk of contamination of bodily fluids from the needle and the technicians gloves during the procedure. For this reason we feel that most MicroBlading hand pieces are not good candidates for reuse even with pressurised steam sterilisation.

Gloving Sharps

Gloving sharps refers to any lapse in procedural practice where a gloved hand comes in direct contact with a sharps implement such as blades or needles, this might occur during a procedure that involves skin penetration due to inadvertent contact or due to inappropriate techniques during or at the end of a procedure. This includes actions such as deliberately touching a gloved hand with sharps or manually removing needles or blades from an instrument. It is important to keep in mind that surgical gloves are simply a hygiene barrier they do not offer protection against sharps injuries.

Gloving sharps may be a breach of your health and safety regulations pertaining to safe usage, handling and disposal of used sharps ^{9,10,11,12,13,14,15,16,17}.
 

These Practices Increase Sharps Injury Risks

Using the backs of gloved hands for pigment/anaesthetic dipping or manually removing a used needle from a hand piece poses an unacceptable risk of sharps injury.

Rule of thumb: if a procedural activity would be considered a serious risk of sharps injury without gloved hands it is also has the same sharps injury risk with gloved hands, we stress surgical gloves do not provide protection against sharps injury.
 

If You are a Client Considering Undergoing Eyebrow MicroBlading what are Some of the Initial Questions Should You Ask?

It is natural that the first thing that comes to mind when a person is considering any form of cosmetic service is what will the result look like and does the technician perform nice work?

Absolutely they are important questions but first things first, below are some of the preliminary questions that we suggest that you should ask;

• Who provided your training in MicroBlading?
   

• Was your trainer an accredited workplace trainer and assessor and or were they a trainer endorsed by a not for profit representative cosmetic tattooing trade association?
   

• Do you have a certificate of successful completion?
   

• Do you have other qualifications in Cosmetic Tattooing?
   

• How long have you been providing Cosmetic Tattoo services?
   

• Do you have a current licence to perform skin penetration/tattooing valid at the location where the service will be provided.
   

• Do you reuse your MicroBlading handle?
  If so how do you sterilise the handle and does your local health inspector endorse that method of sterilisation and reuse?
   

• Do you use the recommended personal protective equipment, relevant infection control protocols, and comply with applicable health regulations for tattooing?

If you are satisfied with the answers provided to the above questions then move on to asking the questions about likely outcomes and ask to see the photographs of previous clients etc, performing due diligence as you would with any cosmetic procedure.

Summary

Whichever method you prefer, using modern microprocessor controlled digital equipment or the modern microblading techniques exceptional results may be achieved by a skilled technician. MicroBlading is a useful additional skill set for cosmetic tattoo technicians however safety must come first, the rapid propagation of MicroBlading services may be a disruptor of the Cosmetic Tattoo industry but it must also be subject to the same educational standards and hygiene requirements as would be provided in any other initial commencement course in skin penetration/cosmetic tattoo and be provided by a person who is accredited in vocational training and assessment or at the very least endorsed by a not for profit representative trade association.

 

References

1. Marco Samadelli. ICEMAN Photoscan. Research Institute for Mummies and the Iceman, Bozen 2009.
2. South Tyrol Museum of Archaeology. Ötzi the iceman tattoos. 2013.
3. mt.derm & amiea nano needle technology 2016.
4. Moira McGregor, Barry Brown, Stockholm University. Disrupting the cab: Uber, ridesharing and the taxi industry. The Journal of Peer Production (undated).
5. Service Skills Australia. SHBBSKS003 Design and provide cosmetic tattooing. 2015.
6. Andrea Darby - Master Medical Tattooist. Tutorial: Cosmetic Tattoo Hand Piece Covering. CTshop.com.au Educational Articles. 07/01/2013.
7. Australian/New Zealand Standard AS 4187- 2003 ‘Cleaning, disinfecting and sterilizing reusable medical and surgical instruments and equipment, and maintenance of associated environments in health care facilities’ [AS4187].
8. Australian/New Zealand Standard 4815:2006 : ‘Officebased health care facilities - Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of the associated environment’ [AS4815].
9. USA Occupational Health & Safety Administration. Occupational Exposure to Bloodborne Pathogens. Section 4 - IV. Health Effects July 1, 1992.
10. USA Legislation. The Needlestick Safety and Prevention Act. Pub. L. 106-430.
11. USA Occupational Safety & Health Administration. Bloodborne Pathogens Standard. Pub. 29 CFR 1910.1030.
12. World Health Organization. Epidemic and pandemic alert and response - Standard precautions in health care 2007.
13. Victorian Legislation and Parliamentary Documents. Public Health and Wellbeing Act 2008.
14. Victorian Legislation and Parliamentary Documents. Public Health and Wellbeing Regulations 2009.
15. Victorian Legislation and Parliamentary Documents. Occupational Health and Safety ACT 2004.
16. Victorian Legislation and Parliamentary Documents. Health (Infectious Diseases) Regulations 2001.
17. Health Guidelines for Personal Care and Body Art Industries, Communicable Disease Control Section, the Victorian Government Department of Human Services, Melbourne, Victoria Australia 2004.
18. D. Darby RN, & Andrea Darby MT. Potential Causes of Nosocomial Type Infections in the Salon-Clinic Setting. CTshop.com.au Educational Articles 24/04/2013 inc revisions.

Date of most recent revision: 02/02/2016 (mutatis mutandis)
Original publication date: 18/02/2016

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