In the hands of a skilled person, the procedures are generally safe. But state regulatory agencies haven't kept pace with the growth of the permanent makeup lips industry, and there are lots of unqualified people wielding needles. Permanent makeup is considered micropigmentation, similar to tattoos. It involves using a needle to place pigmented granules beneath the upper layers of the skin. Tattooing and medical restoration, which corrects imperfections from scars and vitiligo (lack of natural pigmentation in the skin), are similar procedures. "They're the same procedures but used for different purposes," says ophthalmologist Charles S. Zwerling, MD, who coined the term micropigmentation.