Anticoagulant therapy in eyebrow microblading: Low hemorrhagic risk, underreporting patterns, and the thromboembolic hazards of unsupervised drug withdrawals

Background: Permanent makeup (PMU) procedures, particularly eyebrow microblading performed with tebori technique, are increasingly sought by adult populations that include a relevant proportion of individuals receiving anticoagulant or antiplatelet therapy.In the absence of procedure-specific clinical protocols, PMU practitioners frequently recommend suspension of anticoagulant therapy prior to the procedure -a practice that carries documented thromboembolic risk and falls outside the professional scope of non-medical practitioners.Objectives: To determine the prevalence of anticoagulant and antiplatelet therapy among clients seeking eyebrow microblading procedures; to document patterns of pharmacological underreporting in standard PMU anamnesis instruments; and to characterize intraoperative bleeding behavior in relation to pharmacological and anatomical risk factors.Methods: Retrospective observational analysis of 250 anamnesis records from clients who underwent eyebrow microblading with tebori technique over a two-year period across multiple clinical settings in Spain.Records were reviewed for declared anticoagulant or antiplatelet medication use, presence of thromboembolic conditions, anamnesis completion patterns, and intraoperative bleeding observations.Results: Eleven clients (4.4%) declared use of anticoagulant or antiplatelet agents, including apixaban, dabigatran, and low-dose acetylsalicylic acid.One additional case presented with declared thrombophilia without corresponding medication.No client in the pharmacologically identified group presented with clinically relevant increased bleeding during the procedure.Intraoperative bleeding above baseline was associated with anatomical factors -reduced skin thickness with superficially visible microvasculature, and atrophic scarring in the brow area -independently of pharmacological status.Three systematic patterns of pharmacological underreporting were identified, suggesting that the true prevalence of anticoagulant use in this population exceeds the documented 4.4%.Conclusions: Eyebrow microblading with tebori, when performed at the correct papillary dermal depth, presents a low intrinsic hemorrhagic risk that does not justify anticoagulant suspension.Anatomical factors are stronger predictors of intraoperative bleeding than pharmacological status.The recommendation to suspend anticoagulant therapy before PMU procedures exposes clients to thromboembolic risk without demonstrable hemorrhagic benefit.Standardized screening protocols and practitioner education are needed to address this patient safety gap.