As with tattoos, permanent makeup may have complications, such as migration, allergies to the pigments, formation of scars, granulomas and keloids, skin cracking, peeling, blistering and local infection. The use of unsterilized tattooing instruments may infect the patient with serious diseases such as HIV and hepatitis. Removal problems may also ensue, due to patient dissatisfaction or regret, and they may be particularly difficult to remove in places such as eyelids and lips without leaving permanent sequelae. Compliance with ‘standard precautions’ and a uniform code of safe practice should be insisted upon by a person considering undergoing a cosmetic tattoo procedure. It is essential that technicians use appropriate personal protective equipment to protect the health of the technician and the client particularly in the prevention of transmission of blood borne pathogens. It is also essential that technicians have been properly trained in the application of pigment into the skin to avoid migration. Tattoo pigments can “migrate” when a technician “overworks” an area, especially around the eyes where the pigment can “bleed” into surrounding tissue. Migration is generally avoidable by not over-working swollen tissue. Understanding the need to minimize swelling and recognize a good stopping point is paramount to successful application. Removing migrated pigment is a difficult and complicated process. On very rare occasions, people with permanent makeup have reported swelling or burning in the affected areas when they underwent magnetic resonance imaging (MRI). However a detailed review of the cases within the medical literature involving cosmetic tattoos indicates that poor quality pigments, pigments adulterated with heavy metals, and pigments with diamagnetic properties may have been the causative factors in most of those cases. Topical anesthetics are often used by technicians prior to cosmetic tattooing and there is the potential for adverse effects if topical anesthetics are not used safely. In 2013 the International Industry association CosmeticTattoo.org published a detailed position and general safety precautions for the entire industry. The causes of a change of color after cosmetic tattooing are both complex and varied. As discussed in the detailed industry article “Why Do Cosmetic Tattoos Change Color”, primarily there are four main areas that have influence over the potential for a cosmetic tattoo to change color; 1) Factors related to the pigment characteristics 2) Factors related to the methods and techniques of the tattooist 3) Factors intrinsic to the client 4) Factors related to the client’s environment and medicines Technicians need to have a comprehensive understanding of these influences to achieve more predictable outcomes for their clients. Clients need to ensure that they enlist the services of technicians that have proper training which should include a period of supervised application of pigments prior to allowing a technician to perform any procedure. Because regulations vary from state to state and country to country, training and experience can vary widely.