Cosmetic Tattoo
Guide
Breast/Scarring
Paramedical
con
t
ents
Chapter 1 Genera/Information
M icropigmentation27
Scars
1
The Healing Skin28
Keloid Tissue 2 Wound Healing Post Application
29
Burns
3
Tattooing & Skin Cancer31
Facts On Burn Survivors
4
Scar Contractures
4
Chapter 3 Pigment &Colour
Vitiligo
5
Camouflage32
Skin Disorders
7
Corrective PigmentHyperpigmentation
9
Camouflage3
4
When To Camouflage
11
Colour Skin Tones39
Scar Relaxation/ Basic Colour Knowledge
41
Skin Needling
12
Mixing Colours43
Chapter 2 The Client
Colour Trouble-Shooting43
Consultation
13
Use Of Colour- PigmentProcedure Day
14
Update44
Application
14
Tips For Colour Mixing45
Application Tips
15
Pigment Do's And Don't's45
After Procedure Needles
47
Day
16
Glycogel (Remover)48
CPC After Care
17
Anaesthetic in Cosmetic Tattoo
Chapter 3 Tattooing The Breast
Procedures
18
The Technician49
"Left Side"
19
The Client50
Bio Touch Anaesthetic Surgeries
51
Ingredients
20
Drawing The Areola
54
Client Details Form
21
Areola I Nipple
55
Female Full Body Template
22
Nipple Artistry
58
Male Full Body Template
23
Needle Technique
59
Chart Notes
24
Colour Technique
61
Interpreting Client History Forms
25
Medications That Effect Blood Coagulation During
CHAPTER 1
GENERAL INFORMATION
SCARS
o A scar is the direct result when dermal tissue is lost and replaced. This represents the final stage of the healing process. A superficial scar is said to be atrophic like a smallpox vaccination. If tension is placed on a scar it will become thin and elliptical (oblong) rather than linear (longitudinal).
o All scars need specific application treatments with special attention to meticulous technique.
o Hypertonic (raised), red scars are thickened scars usually resulting from deep surgery, accidental injury, chemical or heat burns. They usually remain within the perimeter of the original wound.
o When a scar is raised or jagged, it may be excised. The type of surgery should be considered 6-12 months post initial injury depending upon the patient's own healing process.
o Scars usually heal within 6 months to a year.
a The Z-plasty and Y-plasty is a technique used to reposition scars, usually to an existing crease or facial line so they are less noticeable. The scar is removed and several incisions are made on each side, creating small triangular flaps of skin. The flaps are rearranged and interlocked to cover the affected area. The new scar will be thinner and much less visible.
a Tanning beds and sun bathing may increase scarring while the wound is healing. o You should not apply pigment into the skin of a patient whose scar is less than 6
months old. Ideally you should wait at least 1 year before beginning any CPC application.
a Scars should be kept moist. Dense scabs can impede the cellular growth.
a When nerves are damaged, their fibres degenerate toward the spinal cord, then grow after the scar tissue has formed. The tangle of nerves in a new scar often gives rise to abnormal sensations, and should disappear in a few weeks. Tangles nerves in an old scar may, however, cause annoying tenderness.
a The deeper the wound is, the greater the chance the scarring will be.
o Some scars can be treated with steroid preparations to relieve symptoms such as tenderness and itching.
o Pressure placed on the wound site may stimulate the fibroblast activity. This may cause more collagen protein to be secreted, and will increase the size of the scar.
KELOID TISSUE
o According to 2000 Reuters Limited: "Keloid (which is 'cheloide' in French) was called such in 1835 by a dermatologist named Jean Louis Albert. According to the Nouveau Petit Robert Dictionaire, the word 'Keloid' was used in F ranee in the early 1817's.
o A keloid is an abnormal scar that may be hard, smooth and rounded. lt is a tissue mass of interwoven broad bundles consisting of dense fibrotic tissue. o Keloid scars occur when a wound scar grows excessively, producing fibrous
protein (collagen) after the wound has healed. o Keloids are benign tumours.
o Keloids appear shiny and can be shaped like a 'dome'.
o Keloid tissue is hard, dense and often red or darker in colour than the surrounding tissue.
o Keloids are the most prone on the breastbone, earlobes and the shoulders. Other locations prone to keloidal scarring are the shoulders, upper chest, and lower abdomen.
o Keloids occur more often in dark-complected people than fair-complected people.
o If follicles are lost, the area is predominantly bald; if the glands are lost it is permanently dry.
o Treatments of Keloidal tissue may include:
• Kenalog (a steroid injection that may be injected directly into a scar to flatten the area)
• Cortisone
• Silicone gel sheeting • Compression garments • Surgery (scar revision) • Kelo-Cote gel
BURNS
a The most common cause of burns is fire. a 80% of accidental burns occur in the home.
a Direct heat (including scalding water), chemicals, electricity, radiation or sun damage may cause burns.
a First and second-degree burns are classified as partial-thickness burns. a In a first degree burn, the outer layer of skin is red, injured and will not blister. a In a second-degree burn, the epidermis is totally injured and much of the
corium. Blisters are formed and there is oedema in the sub-cutaneous layer. a First and second-degree burns are painful because the nerve-endings have
been injured.
a Third-degree burns are classified as full-thickness burns.
a In a third-degree burn, all layers of the skin are destroyed. Muscles, bones and blood supply may also be destroyed or injured. The nerves that are destroyed make the wound painless.
a Burned tissue is usually covered by skin grafts.
a Types of Skin Grafts
• Skin grafts are a very common procedure used in reconstructive surgery:
• Autograft: bone, muscle, fascia, fat, cartilage, or nerves that are moved from one part of the body to another
• Allograft I Homograft: tissue that is transplanted from another human being shortly after their death
• Xenografts I Heterografts: tissue from another species
• Free Grafting: tissue that is cut from one part of the body and moved to another part
• Thin Split-Thickness Grafts: used to replace mucous membrane and skin in reconstructive surgery
• Full-Thickness Grafts: used primarily to cover small areas where matching skin tones and texture are important
• Pedicle Flap: used when a deep and large defect needs to be covered
FACTS ON BURN SURVIVORS
o "Itching is considered to be a form of pain due to stimulation of nerve fibres just below the skin surface caused by the release of histamine from the healed burn," this according to Or Robert Demling.
o Prudoxin is used for the management of moderate itching of atopic dermatitis and lichen simplex. Prudoxin is now used by burn survivors.
o Prudoxin is nearly 1,000 times more potent than Benadryl and 100 times
more potent than Atarax. See Information below:
SCAR CONTRACTURES
o Skin contractures are one of the most serious long-term complications for a burn survivor.
o Contractures occur when the skin from the scar pulls the edges of the skin together. The contractured skin may affect adjacent muscles and tendons
and restrict normal movement.
o There are two major types of contractures.
o Contractures that are caused by joint and muscle stiffening or lack of motion. o Contractures that occur after skin grafting.
o Early skin grafting can help to prevent contractures because the patient is mobilised months earlier than would otherwise be possible.
o Chewing gum and blowing balloons will help the patient to prevent facial contractures.
o Burns that occur on the hand can easily result in contractures, and can be greatly reduced with 'scar relaxation'.
o Most burn and scar patients have lower self-esteem, social anxiety and fear of rejection.
o Burn and scar patients that wear a compression garment such as a 'Jobst garment' will sustain lesser contractions, if they wear the garment faithfully.
a Scar Care "A safe and effective method for managing hypertrophic and keloid scars." FDA approved.
a Scar Esthtiqe - "The choice of plastic surgeons and dermatologists for non-surgical scar care."
a
Kelo-cote - a topical silicone wound dressing for the repair, healing and remediation of damage to the surface of the skin from trauma surgery or tattooing.VITILIGO
a Vitiligo (leucoderma) is an autoimmune disease of unknown etiology. ('Leuco' means white and 'derma' refers to the skin.) lt is characterised by 'white areas' (the absence of melanin" in the skin.
a Vitiligo affects 1% to 2% men and women in all races. Peak onset is 20 years of age.
a
Approximately 40% of patients have other members in their family who are also affected with Vitiligo.a Treatments that may help Vitiligo:
• Sinvitil - According to the manufacturer, "Sinvitil is a specially formulated gel that contains an extract of proteolipids, which gives that product its main properties. Sinvitil helps the skin to regain its normal colour by naturally stimulating the pigmentation process, enhancing the capacity of the skin melanocytes to respond to sunlight (or artificial ultraviolet light)."
• Topical Oxsoralen • Mini grafting
• Topical corticosteroid creams • Oral Psoralens and UVA irradiation
• Beboquin (bleaching with monobenzylether of hydroquinone 20% cream)
• Vitamin therapies • Excimer laser
• Bioskin therapy- is the latest generation in Mictophototherapy.
• Irradiation of UVB rays of the affected skin. This treatment is currently only available in Italy.
• Micropigmentation. -adding colour pigment to the skin • Skin Needling
a Common areas for Vitiligo are: • Face
• Lips
• Hands
• Arms
• Legs
• Genital areas
o Results and concerns of CPC on Vitiligo patients:
• Some patients will keep their pigment for months and then it may
gradually be absorbed by the body.
• After the patient has received CPC, others areas of Vitiligo may develop
elsewere on the patient's body. Example - We repigment the areas of Vitiligo around the mouth. Months later, because of the trauma to the body, the client may develop Vitiligo around the knees, fingers or
elsewhere on the body.
• You must make the patient aware of this potential problem and that this
could happen to them.
o You should not guarantee success or perfect results on any CPC application.
You can only try to make the patients skin appear more normal looking. o Discuss the terms of application with the patient, making them aware that his
procedure may take many repeated applications. Make sure the patient initials this information on their consent forms.
SKIN DISORDERS
Acne Vulgaris
lt is an inflammatory affection of the pilosebaceous apparatus where the comedo
is the primary lesion.
If the comedo causes a perifollicular inflammation, other lesions of this pathology occur: papule, pustules, nodules and cysts. Severe forms often degenerate into more or less deep scars appearing as small round depressions with more or less wide irregular passages similar to bridles or bridges surrounding comedones.
Flat angioma
lt is a red or bluish red birthmark. lt's shape, size and contour vary remarkably.
Senile or actinic keratosis
Small, elevated, rough surfaced patches. They are usually covered by a thin desquamation and their colour varies from greyish yellow to vivid brown.
Scar
Scars occur when the skin is destructed and then "reconstructed" by the growth of connective tissue. In this area the epidermis is smooth, thin, pink or whitish. Scars can be atrophic or exuberant (cheloids).
Chloasma
Pigmentation patches of variable size without traces of sunburn and desquamation. Their contours are irregular but well defined and symmetrically distributed (forehead, nose profile, temples and cheeks). They can occur during pregnancy, but they may be often due to other causes. Only women are affected by chloasma. This hyperpigmentation can also be caused by exposure to the sun.
Broken veins
Skin imperfection characterised by a congestive condition (erythrosis) or certain facial regions (cheeks-paranasal areas, forehead- chin) and by telangiectasis.
Dyschromia
The pigmentation activity of the skin can be subject to quantitative pathologic variations both positive and negative (hyperchromia-achromia). Hyperchromatic
conditions include those due to endocrine disorders (Addison's disease), to oral intake of drugs (antibiotics, psychotics, hormones) or to the topic application of cosmetic or pharmacological substances (in particular if based on essential oils derived from bergamot, perfumes, creams, powders, etc). In the last two cases pigmentations appear as brown hyperchromatic spots located on photo exposed areas (face, hands, neck, throat and breast) since this process is stimulated by solar radiations. They are often preceded by a short sunburn which sometimes goes unobserved.
Sunburn
lt is an actual allergic reaction catalysed by light. Clinically it appears as erythemato-exudative itching lesions located on neck, throat, breast, arms and forehead. However the severest forms can affect any photo exposed region.
Nevoid lesions
Anomalies in the development of melanocytes characterise a number of nevi:
variations in the melanocytes population density and/or melano genetic activity produce achromic nevi, flat hyperchromatic nevi and freckles.
Psoriasis
lt is an idiopathic chronic inflammatory skin disease.
The primary lesion is an erythemato-squamous patch of variable size with well-defined regular contours. There are a lot of variations: pustular, palmoplantar, etc. The traditional form, normally affects the scalp, elbows, knees, while the extensive forms affect more or less the whole surface of the epidermis including the facial region.
Rosacea
lt is a skin disease which affects the central regions of the face. lt is characterised by three symptoms: erythrosis, telangiectases and papulopustular lesions.
Stretch marks
Stretch marks are linear atrophies well-delimited in the dermis and covered by a corrugate epidermis.
Tattoo
lt is produced by the introduction of indelible monochromatic or multichromatic pigments into the dermis for creating images, drawings, inscriptions, etc.
HYPERPIGMENT ATION
One of the most frequent issues I am called upon to address is in regard to the · problem of facial hyperpigmentation after tattooing. The discussion that follows
should answer most of the common questions.
The perceived "colour" of the skin is determined by light reflected from the skin.
The light reflected is determined by the skin's chromophores - those molecules which absorb various colours or wavelengths of white light. The colour of light you see is white light minus the colours which have been absorbed. There are four basic chromophores in human skin:
o -Melanin (seen as brown or blue based on the level of melanin in the skin) o -Carotene (yellow)
o -Oxygenated haemoglobin (red) o -Deoxygenated haemoglobin (blue)
The intensity of each of these four colours combine to give skin its natural hue. In general, levels of blood flow determine red and blue tones, skin type and sun exposure determine browns and diet affects yellows.
Each person has a genetically determined skin colour, termed the "constitutive" colour, which can be found on habitually non-sun exposed skin. Each person also has a genetically determined response to sun exposure commonly known as tanning. The response to sun exposure gives human skin its "facultative" colour. Varying levels of tanning response have been categorised as skin phototypes, referred to as Fitzpatrick skin types after the dermatologist who defined them. @
Fitzpatrick skin types range from I to VI as follows:
tfYPE UNEXPOSED SKIN COLOUR TANNING RESPONSE
I White Always burns, never tans
11 White Always burns, tans with difficulty
Ill White Burns minimally, tans gradually
(light brown)
IV Light Brown Burns minimally, tans well (moderate brown)
V Brown Rarely burns, tans profusely (dark
brown)
VI Dark Brown or Black Never burns, tans profusely (black) *Based on 45-60 minutes of sun exposure to untanned skin after winter or no previous sun exposure.
Why are these skin types important? Because skin types Ill-VI almost always respond with hyperpigmentation to a variety of insults or injuries to the skin: sun exposure, acne, picking or scratching, trauma, hormonal changes, chemical peels, dermabrasion, laser treatments or even tattooing.
Any of these insults cause the pigment cells (melanocytes) to dramatically increase melanin production in the epidermis and sometimes are associated with loss of melanin into the dermis, where it is consumed and held in place by macrophages (melanophages). These result in increased brown colour (epidermal or superficial dermal melanin) or increased grey-blue colour (deep dermal melanin). The increased colour of skin resulting from these injuries is termed post-inflammatory hyper-pigmentation (PIH). In general, PIH will resolve on its own within weeks to months, once inflammation resolves.
But who wants to wait weeks or months for PIH to fade, or even get PIH in the first place? Fortunately, PIH can be prevented and/or treated. Broad spectrum sunscreens, which protect against ultraviolet A and B damage, decrease melanocyte activity by preventing UV radiation-induced stimulation of melanocytes to produce more melanin. Retin A can help to inhibit melanin production induced by various stimuli. Hydroquinone, found in a variety of "bleaching creams", inhibits the production of melanin in melanocytes. The most recent arrival in treating pigmentation disorders is kojic acid, a fungal derivative from Japan, also appears to decrease melanocyte activity. Any of these can be employed to improve existing hyperpigmentation or prevent PI H. The major disadvantage of prolonged use of hydroquinone is the possibility of causing increased hyperpigmentation, a condition known as exogenous ochronosis. Kojic acid does not appear to have this effect.
When these methods do not satisfactorily prevent or resolve hyperpigmentation,
the extra melanin can be removed more quickly by judicious use of chemical peels or short pulsed lasers. Superficial (epidermal) chemical peeling agents (such as glycolic acid or Jessner's solution) allow faster removal of the hyperpigmented epidermal layers, by speeding the natural sloughing of these layers. The ruby and green dye lasers all target melanin and therefore can be used to remove hyperpigmentation. One must remember that chemical peels and laser treatments are also injuries which may cause hyperpigmentation. Use of these medications before and after peels or laser should prevent the hyperpigmentation from reforming.
For those clients who have skin types of Ill or greater or a history of hyper pigmenting easily, suggest they begin Retin A, sunscreens, and hydroquinone or kojic acid before tattooing and restart these after the skin has healed from the procedure (about a week). While Retin A and hydroquinones require prescriptions, kojic acid is being included in a number of OTC preparations available through physicians offices. One must be cautious in using these medications near the eyes or lips as they tend to cause irritation. For repigmentation of scars which initially have both hyper- and hypo- pigmented areas, use of these medications may even out the brown tones before repigmentation work begins.
Whitney Tepe, MD
WHEN TO CAMOUFLAGE
Camouflage colours are used to cover:
1. birthmarks (nevus)
(note: not all birthmarks accept fill in colour. Always trial
a
test area before colouring.)Suitable colours for dark brown birthmarks are beige, skin and yellow. For
lighter birthmarks try to match the skin tone. This may require 2 or more applications spaced 4 weeks apart.
Note that strawberry or port wine stain or raised birthmarks or stains are not suitable.
2. Hyperpigmentation
An over production of pigment can be corrected often with a mixture of skin or beige with a little water added to thin down the colour.
3. Chloasma (Liver Spots)
Lentigenes (freckles or yellow spots) are both suitable for camouflage in small areas.
4. Vitiligo (White Spots-loss of pigment)
Small areas are suitable. Begin by mixing a colour identical to the skin ( do not allow for fading) Many colours when used on the body will not fade. Do not take on large areas for pigment re-colouring as it will not look natural.
5. Alopecia
Good results have been recorded for hair loss areas. Begin by mixing an
identical hair match, test patch and ask client to return in 4 weeks for further treatment.
6. Keratoma or Keloids
Do not tattoo keratoma or keloids or very raised scar areas.
7. Nipple- Areola re-pigmentation
SCAR RELAXATION
I
SKIN NEEDLING
o Scar Relaxation is the application of repetitive obovoid tattooing to create a
softer skin texture and to soften the fibrous bands of collagen (scar tissue) to
give the patient more flexibility in their movements. Needling is a softer
technique to plump up the collagen in the existing tissue of fine lines and wrinkles in the skin.
o Scar Relaxation is best accomplished by using a powerful machine like the
Mosaic which is also suitable for Needling is best accomplished with a rotary
machine.
o lt is very difficult to use the manual method or a lightweight machine for Scar
Relaxation. The lightweight rotary machine, as well as using the manual
method does not have enough power to penetrate through the dense bands
of scar contractures.
o If we are using the coil machine, we always use a large needle configuration
and disposable tubes for Scar Relaxation. Needling takes a 3-5 prong round
needle and we usually use a rotary machine.
o We do not find it necessary to patch test the skin when performing either of
these procedures.
o Susan Church, CCPC first introduced 'Scar Relaxation' at the first SPCP
conference in 1991, after she discovered this and Needling, while working on
several burn survivors in concert with Or Richard Grossman of 'Sherman
Oaks Burn Centre' that was later named Richard Grossman Burn Centre'
o Scar Relaxation and Needling appointments should be scheduled at 4 week
intervals if you will be working on the same area. If you are working on different areas of the body, you can schedule the appointments at the
patient's convenience.
CHAPTER 2
The client
CONSULTATION
o Discuss correct colour choices for each procedure.
o Decide the amount of risk you are willing to take with each client. Example:
thickness of eyeliner, lip enhancement and so on.
o Lesson and heighten the client's expectations of each procedure.
o Answer all of your client's questions without being condescending.
o By the time the consultation is through the client should feel as though they have already had the procedure done.
o All proper forms should be completely filled out, signed and dated. Have the client write out a detailed description of exactly the procedure they desire.
o Thoroughly discuss 'Before and After Care' of procedure with client.
o Take photos of how the client looks with their regular make-up on and without any make-up on. (Always take more than 1 photo.)
o Do not work on a client if you have any doubts about them.
o Discuss medical considerations, contra-indications and physician's release statement with your client.
o If a client refuses to accommodate you in any of the above requirements you should refuse to work on them.
o Clients should pay for all procedures. If you accept cheques, make sure they have cleared the bank prior to your initial application.
o Write down all of your colour formulas from your patch and sensitivity tests.
Be sure to include the lot number and the expiration date on the pigment bottle.
PROCEDURE DAY
o Review all client release forms for total completion and any new medications prior to application.
o Take photos of client.
o Always make a post-op appointment for 4-8 weeks later. Be sure to give your client a number you may be reached at after hours in case of an emergency. o Always give client After Care Instructions
o Recommend a tube a tube of Protat or Bepanthen.
o Complete client file with necessary notes, consent and release forms, photos and so on ...
o Check desired colour with client prior to application.
APP
LICATION:
o Cleanse the area to be treated with an alcohol wipe.
o Apply Bio Quick allow 20mins unless working on a Breast with no feeling due to nerve damage
o Work in concert with the patient.
o Have the patient turn their body to show you exactly where the scar contractures are the worst. Gently start your procedure application in this area.
o Topical instant numb and bio gel may be applied once the skin surface is broken open.
o Start with a 7 prong needle (Mosaic or a Shader if using Nouveau Digital Medical Machine) If the machine bogs down, switch to a smaller needle cluster. Depth 2mm
o Go over the area as many times as needed to create manoeuvrability by the scar relaxation.
o Clean the area as many times as needed to create manoeuvrability by the scar relaxation.
o Clean the area and apply Vira Gel to assist healing and colour retention then a smear of either Protat or Bepanthen.
a Cover the area lightly with a gauze dressing to protect the abrasion from free radicals.
a The dressing should be kept on the procedure area for the first 24 hours
APPLICATION TIPS
a For the best application, your machine or hand tool should be held as though you are writing.
a All cosmetic applications should be applied 'straight' into the skin as possible to create even, clean lines.
a Settings for rotary, coil or digital machine should be obtained from the manufacturer.
a Skin will vary in thickness and texture. Adjust your needle and speed accordingly.
a If the pigment is not being inserted into the skin because of thickness: • Stretch the skin more taut
• Slow the speed of your machine down • Hold the needle in the skin longer
o Needle should be flush with the tube or tip when you first learn your applications. As you become more proficient, you may extend your needle out further.
o Always check your needle for burrs or corrosion prior to application.
o If your client has thick skin (avid sun worshipper, dark complexions and oily skin) consider using a hot compress or a very light glycolic peel prior to your application to soften the skin.
o Other options to soften the skin. One week prior to permanent cosmetic application, the client may choose one of these services:
• Microdermabrasion • Glycolic peels
• Enzyme peels
AFTER PROCEDURE DAY
o Phone the client the day after their procedure to see how they are feeling. o If a client phones you with an immediate concern, speak with them as soon
as possible.
o If they are concerned about the procedure, answer all of their questions.
o In certain circumstances problems may occur. If you are in doubt, consult with your physician.
o Send your clients a thank you note. Remember: They selected you!! o Ask your clients for referrals.
The more you pamper your clients the more your business will
grow!!
CPC AFTER CARE
Instructions should be explained in detail.
o Before showering or bathing, apply a light coating of Vaseline to the
procedure area. This will enable the water to bead off of the damaged tissue.
(Follow this advice for at least 1 week post procedure.) Apply Protat or
Bepanthen cream twice daily.
o After the procedure area has healed, the patient must apply a sun block daily
to prevent future pigment fading.
o If crust appears on a procedure area do not pick or peel it off! Pigment will be
removed along with the crust.
o No sun, soap, sauna, Jacuzzi, swimming in pools or the ocean for two weeks
post procedure. This also applies to each touch-up application.
o To prevent infection- do not touch pigmented area with your fingers until it is
completely healed. Use clean cotton tips to apply ointments.
o You may not donate blood for one year following any procedure.
o Follow regular after care instructions as well.
Hopefully this series on CPC will help you to understand the psychology of beauty that is created to present unique concepts of thinking about beauty that extends
beyond traditional basic value.
ANAESTHETIC IN COSMETIC TATTOO PROCEDURES
Any non-physician practitioner involved in semi-permanent makeup knows the
number one problem we face is effective anaesthesia. Some of us probably
remember being told we were learning a "painless" procedure to later discover the
only pain-free person in the room was the Practitioner. Some Educators have
tried to convince us ice cubes are the only anaesthetic we would ever need.
Anyone with experience quickly learns otherwise.
Needling is very much a non invasive treatment so usually apply a topical
anaesethetic only and normally no further application is required.
In an environment of increasing regulation, using prescription drugs without
medical supervision can lead to charges of practising medicine without a licence
and possible loss of your permanent makeup malpractice insurance, if a claim
should arise from the improper use of a prescription anaesthetic. Worse yet, you
might end up with a medical emergency you or your facility are not equipped to
handle. If you do not work in a doctor's office, develop a relationship with a
nearby, reasonably priced physician who can examine your client, prescribe for
them as needed, and/or administer a local anaesthetic, after which the client can
return to our office for her cosmetic tattoo treatment.
If your client is going to take any kind of oral medication with analgesic or sedative
properties, you might suggest she take one at home the day before to make sure
she can tolerate the dosage with no adverse side effects. Anaesthetics
o Bio-quick Anaesthetic Cream (4% Lidocaine)
Pre-numbing for unopened skin. Apply cream 15 to 20 minutes on skin
before any pigmentation procedures. Can be applied suitable for all
procedures
• INSTANT NUMB (4% Lidocaine)
• To be used after the procedure has begun
• Lidocaine is a substance that effectively penetrates the skin to numb the
effected area and works to control pain.
o Bio Gel ( 1% Phenylephrine Hydrochloride)
• Apply gel on skin when bleeding or swelling occurs. lt will stop the
bleeding and swelling immediately. Can be applied during all
procedures.
"LEFT
SIDE"
When pain is afflicted to a part of the body the brain will direct endorphins, the body's natural pain killers, to that area. When the pain is abruptly switched to another area it seems to be more painful than the first was for two reasons. First, if you have applied a topical anaesthetic that is made for unbroken skin to both sides at the same time, it will have peaked and lost it's efficacy by the time the second side is started. The fact that most of us are also using a topical designed
for broken skin makes the area a little more numb each time we apply it. That combined with the body's natural endorphins directed to that area make it more comfortable. When the opposite side is started it can be a shock to the client as they were expecting no more pain than they were experiencing on the first side. This often leads to them shying away from you and flinching more. For this reason a new technician (and often a seasoned one too) will repeatedly get one side that takes and one that doesn't. lt's usually the second side, where you were trying to inflict less pain, that didn't take.
I have found a solution that, for me, is quite simple and works very well. I apply the topical (for non broken skin) for the appropriate amount of time. I then make a pass, clean the tissue and apply the topical made for broken skin. I immediately
proceed to the second side and repeat the procedure. By the time I get back to the first side it is normally quite comfortable to work on. I only work on that side a short time before I apply more topical and switch back to the second side. By the time I finish the procedure, the client has maintained the same amount of pain control bilaterally and, I normally have not overworked any one area. By the time you've read this far you already realise that this will also help prevent one of the banes of the technician's existence, the side that didn't take. If you've not already figured this out on your own by just trial and error, then try it. Modify it, make it work for you and then let me know how you've improved!
By DIXIE MEDFORD
Anesthetics Ingredients B·oouic< A<>esthetic Cream:
15 Grams-Use lafo .. e procedure apply 15-30
m•nutes before p.-oc.clUt·e.
-10,, Ldoui"le. Aloe Sa-bacer~, leaf Jt..ice, Hvd•ogo:nated Polyi;ob .. ~ene, Pro::.v e!'e G 'fCO Po vacr•;lal""ice, C13-:4 hoparrafn, La..re:h-7.
Glyce~, I S:earatt-, llropvlere Glvcol 0 c~ptylate!Otcaprate, Solu:>le Collagen, Hy:h:ly2ec Ela;:in. SociJI"" Hva uronate, ~et•rvl Pall""otate, TotCO"''e')' Ace:a:e.
Malva Syi\Oti'S:ris (Mal!o.~) E·-.:ract,. Hecera He"· (h-y) E t ac:,
Cut.Jmts SattVUS (Cucwmber) Frutt E,t-acr., S<Jmbucus \i~ra =ic.,·e E-.:t·act. Arn ea Mo-una Ffn~••r E -ru:, llilr;ttt;w;;a Off c nal s E· t"ll~t.
Aloe Sarbad~<ns > L;oaf E··.tract, Sc:liu""' PCA, PEG-:OO Scea·ate, Cety A cnhol. Pc yso•oa:e 20, Trte:htro a,.. he, Oiuol d nyl Urea, Wethv'para!IE"'', Propylo<Jraben
BIJe :. Rec l3,
Instllnt Nu~b:
B oCa ·e:
Veta Gel:
12 Gr01ms-Aoply durirg ptocedt..te. Pe-clatum. U::iccair 40,•
12 Grams· Apply durirg procedt... e. Pet•-olat .. l"", Tetraca•ne :H.
1/2 O;z ·Reduces s .. el ng ilnd bleed.ng.
'Nater, Alce Bar'::laCe'"ls·s Leaf J~ice. H)·dro:-;yet~y eel utose. AJian:o,.,,
Sodul"" B ;~lf1:e, Ph!rylephrine Hyd"'c•.lorice ~0·>,Pheno·-:yethanol. f•letrylparaben, Bt.tyloara~e'"l, Prooy pi!l'llt>en,Etry pari!ben a"ld lsob.Jtvioa"iiben
4 Grams· Soot.,es & moistur.zes. pt events b'isters.
Ca"''cla o,., Polvb.Jtere He a~t'\LoS .!..n'II.US :su'\flo·,.er) Seed Oil, Bo;!!s"•a,, Jo;o:~a esters. Paraffh. Suty'OS:le'T'"Ut~ Parko (S~ea 8.Jtte ).
Carnau.:Ja (Ccoe 'lieta Cerifer:a: Wa•, Eupro-bia Ce fe-a (Ca~ae'il a) wa·,, Mtcrocrystalhre wa .. O'ea Eu"''paa 'Olive) Fru t 01l. Aloe Barbadeos3 Ln" E't -ace,
Ret nyl Pa mltate, Toce>pl"ery Acetate, Phytonad O'le. Cro acalc fe-ol, Alo1r,
~J'III""'ice 3, Bisaoo o, Vacaca..,,a Te"'"i"':liil Sud Ool. Mert'\a Vo-,:ls (Spearmt't) Lea' Oi Bct'Or Nt~rce. BHT
1/:l. O;z • Reduces f'.ealing tome and locks tn color.
Water. Aloe Sarbadens•£ lea' Ju'ce Soco~om B·ca-bo1a:e. Be1=a kcn·u.., Ch oride, Calci~m Crlon<le,
SoC:il.m P--osphate. Xan:r:ar Gum. Pota:ssi..;l""' C~lorice Scdi.JIT' Cl-lorce, S.oci_.,.. Hvero··:ide
CLIENT DETAILS- COSMETIC TATTOO (PARAMEDICAL)
(The information supplied below is confidential and for professional use only)NAME ... DATE ... . ADDRESS ... . ... Postcode ... . PHONE(Bus) ... (Res) ... (Mob) ... .
HAVE YOU EVER HAD ANY OF THESE HEALTH CONCERNS PAST OR PRESENT?
0
Diabetes OHeart Palpitations O Hepatitis0
Any Blood Clotting Problems0
Currently on Blood Thinners such as aspirin, lbuprofin0
Consumed Alcohol with 24 hoursCONSENT I understand that this treatment is for cosmetic purposes only That no guarantees have been made to me regarding the results
I am responsible for the "at home care" which may have risk of infection if not carried out fully
I will not hold the Student/Therapist responsible in the event of any damage and shall not be entitled to take action against her at Law or in Equity for such treatment
I consent to before and after photographs of this procedure which is at the Student/ Therapist's discretion. I cannot donate blood for 6 months from today
I am over 18 I am not pregnant
I have had the opportunity to ask questions relating to this treatment I am aware that latex gloved are used and consent to their use. I am not allergic to latex.
I am aware that the topical anaesthetic used contain contains Lignocaine I give my approval for these creams and lotions to be used before and during my procedure.
PROCEDURE ... COLOUR ... .
NEEDLE SIZE ... THERAPIST ... . COST $ ... FOLLOW UP VISIT ... ..
CLIENT SIGNATURE (Pre Procedure) ... .
I am satisfied with the results obtained from this procedure and I have been informed that colour may vary as the skin heals.
CLIENT SIGNATURE (Post Procedure) ... DATE ... .
21
Female Full Body Template Front and Rear Patient Name: Procedure Report: Patient Signature: 22 Paramedical Tattoo
Male Full Body Template Front and Rear Patient Name: Procedure Report:
V
Patient Signature: 23 Paramedical TattooCHART NOTES
Successful professionals in our industry keep a precise record of all their clients and the issues around work done on them. These Chart notes are referred to each time the client comes in. They help the Practitioner learn what colours work best to avoid both mistakes with that client in the future and with a particular colour. When a client comes back for an adjustment, the Chart notes provide the record of what happened at the last appointment so the proper follow-up treatment will be provided. Also, these notations provide a record of what occurred in the event of a lawsuit. lt is impossible to run a successful semi permanent cosmetic tattoo business without keeping accurate notes.
There are many ways to keep Chart notes. Each Practitioner learns what best suits them over time. Chart notes are not to be confused with Informed Consent/Releases or Medical Questionnaires. Chart notes are detailed notes made during and after each procedure. These notes can include the following: o Date of Procedure
o Client Name, Address, Phone
Area of Treatment- Some people have outlines to show where the work was performed
o Machine- Which machine was used and how it worked for the procedure. o Needles- What grouping and size of needles were used and who
o manufactured the needles.
o Pigments- Brand of pigments, colour and recipe if pigments were mixed. o Amount of time spent on the procedure.
o Cost- How much the client spent and what method of payment was used. o Topicals- If a topical was used and what kind.
o Photos taken -This is a reminder to always take photographs.
o Remarks - This is the space to add details such as skin condition, skin reaction, sensitivity of client, special requests of the client, and any post-op phone contacts and their purpose.
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INTERPRETING CLIENT HISTORY FORMS
Section 1- Demographic information: Self explanatory.Section 11 - Allergies: We would all rather no one in our offices ever have an allergic reaction, but they do occur. This list is an effort to head off reactions to common allergens.
Tetracaine and lidocaine are anaesthetics which may cause reactions when used topically
Latex protein is found in latex gloves and can cause immediate hives (urticaria) or a more delayed contact dermatitis. Since you use gloves, your clients will be exposed to this protein.
Metals, especially nickel and foods are other common allergens. With the increased marketing of organic pigments, those allergic to fruits or vegetables could conceivably react if these plants are used as pigments.
lt is important to know the type of reaction your client has - localised hives, allergic contact dermatitis, or generalised hives with difficulty breathing and/or fainting. Obvious agents which cause reactions should be avoided.
Section -Skin: Skin issues should always be considered.
Any scar that remains pink or red has not completely matured and is therefore subject to further change. You should only work on mature, pale white scars. While rare, tattooing could result in a hypertrophic scar or keloid in a high risk
individual or body location. If you choose to work on these individuals, they should be followed closely and referred to a physician if signs of hypertrophic scarring occur.
Individuals with a history of poor healing should be followed closely. If healing is slower than normal, consider a physician referral for antibiotics to promote proper healing.
Section VI - General Medical: On every client, medical issues should be analysed.
Blood thinning drugs, clotting disorders, pregnancy and high blood pressure may cause excessive bleeding.
Diabetics and those with autoimmune disorder may manifest poor wound healing. For diabetics this is especially true if their blood sugar is poorly controlled.
25
Clients with mitral valve prolapse, artificial heart valves or artificial joints are often placed on prophylactic antibiotics during dental or surgical procedures to prevent
these valves and prosthetics from becoming infected. If your client uses
antibiotics when visiting the dentist, s/he should be on antibiotics for cosmetic
tattooing as well. If in doubt, call your client's physician and ask what they would
like to do in this situation.
"Palpitations" is a layman's term for cardiac arrhythmias. Generally, those who
have significant arrhythmias are aware of this and may be on medication. Others
may simply feel pounding in their chest, which may happen with stress or pain.
Make an extra effort to help these clients relax and minimise their level of stress.
Accutane has been reported to increase the risk of hypertrophic scar formation
after chemical peels and dermabrasion. Allow 6 months before tattooing these
clients.
26
MED
I
CATIONS THAT EFFECT BLOOD COAGULATION
DURING M
I
CROPIGMENTATION
Blood Thinners: Coumadin, Heparin, Aspirin, NSAID's 1. Anti-histamines: Bendryl, OTC Hayfever remedies, etc.
Please comment on effect on the eyes (dry eyes), driving restrictions
2. Blood Pressure Medications and diuretics: Beta Blockers (dry eyes, anaesthetic effect on eyes)
3. Diabetes Medications: Insulin, Oral Hypoglycemics
Stress diabetic problems with delayed healing, increased risk of infection and potential for hypoglycaemic attack during procedure.
4. Pain Killers: Narcotics, (can't drive; decreased awareness of symptoms of complications from semi-permanent makeup such as corneal abrasions, etc) 5. Tranquilizers:
pigmentation
Valium, Librium etc (can't drive}, Thorazine-melanin
6. Sleeping Pills: Halcion etc (Exposure keratitis if eyes don't close completely) 7. Dermatological: Accutane, any type of chemical peel
8. Hormone replacements: some side effects on skin pigmentation can occur with hormones
9. Antibiotics: Tetracycline and sunlight 10. Arthritis: Gold-chrysiasis, Plaquenil
27
THE HEALING SKIN
Whenever the surface of the skin (the epidermis) is injured, the result is compromised barrier integrity. This may be from a cut, burn, or a puncture such as the application of permanent make-up. The protective barrier for the body- the skin - has in some way been rendered impaired.
In minor wounds, such as we deal with during the process of applying colour to the client, the body's circulatory system and it's partner the lymphatic system rush to the area in response. The lymphatic system's function is to prevent infection,
while the main circulatory system is providing blood and nourishment to implement the healing process. This extra blood in the area results in mild reddening and warmth.
The first phase of this healing process is to recreate barrier integrity. This happens with scab formation. Size and extent of the scab are dependant on the injury. In tattooing these may only be lymph involved, resulting in a minute clear form of scab or there may be droplets of blood. If the client receiving the procedure is mature, the epidermis is more fragile and prone to bruise or tear easily. Greater caution must be exercised to avoid these problems.
Once the skin has reformed its surface barrier then, via some method of communication, the basal cells speed up reproduction,. The skin at and below the basal layer seems intently focused on replacing the damaged tissue. When these new cells reach the surface healing is complete.
How long this takes depends on several factors. The primary ones are the age and health of the client. Cellular rejuvenation is at its peak during the body's growth years, birth to approximately age 25. By the time a person reaches the age of 30, the speed with which cells reproduce has already started to slow.
With each additional decade of life the rate of cellular turnover continues to decrease. Instead of epidermal cells being produced on a daily basis and it taking 28 days for those cells to reach the surface of the skin, the process may extend to 55 days or more.
The permanent cosmetic practitioner can use this knowledge to plan follow-up work. Clients in their 20s heal very rapidly, so follow-up work could be scheduled in two weeks. As rejuvenation starts to slow down by the age of 30, wait at least three weeks for clients in their 30s. For each decade of age, add another week
tag time before rescheduling the follow-up visit. Four weeks is a good time
to wait.
The benefit of waiting may be you find yourself working on more thoroughly healed skin with a more accurate representation of the finished colour.
By extrat Judy Gulp
28
WOUND HEALING POST APPLICATION
Tissue repair proceeds through four stages:Coagulation
After each perforation is made in the skin, the body's platelets gather to form a clot. This is considered to be the beginning stage of the body's restorative
mechanism. As the clots dehydrate, a crust is formed that will serve as a protective covering for the wound. The degree of tissue maceration will determine the scab density, creating a potential loss of pigment in the procedure area. In the
initial hours after the C.P.C. procedure the body begins to react to the superficial
skin trauma that is caused by the tattoo application. Inflammation
The inflammatory is the second stage of the body's restorative mechanism. This response quickly and effectively destroys bacteria. Classic symptoms may range from redness, heat, swelling, pain and lymph drainage. Patient will not typical wheal and flare reaction of the procedure area much like a bee sting or mosquito bite. This tissue releases histamine, serotonin and bradykinin, which creates an
increase in blood flow to the injured tissue. Macrophages (infection fighting cells)
begin to migrate out of the capillaries and small blood vessels in the skin into the surrounding tissue. Agitation to the skin causes the macrophages to migrate to
the injured tissue, secreting a digestive enzyme to moisten and ingest dead and
irreversibly damages tissues and debris. This activity also causes increased blood
flow to the immediate area. The procedure area will be a bit sore, swell slightly to moderately within the first 24 hours, may possibly be very tender and be slightly pink to red. Infected tissue may cause inflammation, pus and swelling to the
injured site. Regeneration
The third phase is the generation of new tissue consisting of reconstruction and contraction. The basal layer cells divide and grow, which produces a continual epithelial layer beneath the crust. If there is no crusting, the epithelial tissue will appear as a raised area. To add support to the new tissue the fibroblasts multiply and produce collagen that will inflate the injured site.
Maturation
The fourth phase is the maturation of the injured tissue. To strengthen the tissue it is structurally reorganised several times over the next few years. (Scars lose about one-third of their original strength.) As scars mature they emerge to be more of a pinkish/white tone and thin out.
29
NUTRIENTS THAT AID IN THE HEALING PROCESS.
a Vitamin K is necessary for blood clotting.a Carbohydrates provide energy to the cells and aids in the antibacterial of white blood cells.
a Vitamin A helps to block anti-inflammatory impact of steroid agents on the cellular membrane.
a Zinc will help to strengthen the membranes of the cells. a B Complex helps to aid in the formation of white blood cells.
Vitamin C helps to strengthen capillaries and is essential for collagen synthesis.
30
TATTOOING AND SKIN CANCER
lt would seem obvious tattooing over a skin cancer would not be an advisable
thing to do. There are medical case reports of skin cancers, including basal cell
carcinoma, squamous cell carcinoma, and melanoma, arising within tattooed skin.
These events are coincidental and probably unrelated. In other words, tattooing
the skin did not lead to the skin cancer.
Fortunately, while skin cancers can be subtle to detect in their early stages, most
skin cancers are clearly distinct from normal skin and should be easily avoided.
Skin cancer is now the most common cancer in human beings. The American
Cancer Society estimates over 1 million new skin cancers are diagnosed in 1997.
Of these skin cancers about 75% are basal cell carcinoma, 20% squamous cell
carcinoma and 5% melanomas.
Most people know from public education programs to recognise melanoma. They
typically appear as flat or raised pigmented lesions. Melanomas usually have
irregular or notched borders, multiple colours (red, white, blue, black, brown ,
pink), are large (greater than 6mm in diameter), and asymmetrical in shape. All of
these features would make it fairly difficult not to recognise a potentially cancerous
pigmented lesion. Basal cell carcinoma is most commonly characterised by a
papule growing on the skin. The papule is usually pearly white or translucent with
fine telangiectasia growing over it. This type of tumour may frequently ulcerate in
the centre. The most common site for basal cell carcinoma is the nose, but they
also commonly occur on the head and neck, and may be anywhere on the body.
Since basal cell carcinomas are generally soft in consistency, tattooing over one
would likely cause skin breakdown and bleeding which would be obvious at the
time. Since this cancerous skin is distinctly different in character from the normal
skin, it should be reasonably straightforward to recognise basal cell carcinoma as
well.
Squamous cell carcinoma may have a variety of appearances. Frequently these
start as persistently red and scaly flat lesions. As the tumour begins to grow
deeply into the skin, the skin becomes raised versus the normal adjacent skin.
Typically the consistency is quite firm when squamous cell carcinomas become
raised. Squamous cell carcinoma may also ulcerate. Common sites for
squamous cell carcinoma are the head, neck and arms.
When in doubt about a particular skin change, it is appropriate you refer clients to
a dermatologist for diagnoses. If no specific lesion is felt to be present by the
dermatologist, they should feel comfortable writing you a letter stating this and it
would then be safe to tattoo the area. If you want to become better at recognising
skin cancers, look for an atlas of dermatology in your local library or order one on
loan from a medical facility through your public library.
Whitney Tepe, MD
31
CHAPTER 3
PIGMENT
&
COLOUR
USING PIGMENT TO CAMOUFLAGE
Basic Technique for Colour Correction and Minor Mistakes
o Use Magic or or "Skin" Double Drop. If requiring a thinner/paler look add a few drops of purified or distilled water, depending on how dark the area is to be concealed or corrected.
o Too much beige can result in white patches, and too little may require more touch ups, so it is best to really evaluate the colour and dilution.
o Use a 7 prong round needle and use a circular, shading method of blending.
o To get good coverage, concentrate on the area to be corrected by layering lightly, adding additional layers as needed. Then gradually spread out to blend in the edges with the rest of the client's skin tone.
o Concentrate on the blending! Even with conventional makeup, concealers
have a tendency to look too thick or blotchy if not blended properly. This is essential when doing correction with permanent makeup for a natural appearance.
o After the first procedure, when the skin has healed, you should see great results and coverage. However, if you determine that the camouflage is not satisfactory, it is most likely due to the following:
• Not enough pigment was used, so the original demarcation is showing through. A second application will be required.
• Too much pigment was used, causing a caked blotchy appearance. If this occurs, take an empty needle, allowing the area to bleed a little, and the patchy colour will eventually peel off.
Loss of pigmentation on the skin, whether caused by accidents, medical procedures, birthmarks, or a multitude of other skin irregularities, are frequent problems that can be helped with permanent makeup and an experienced technician. Keep in mind there are constant changes in body temperature, such as sun exposure, etc. that can cause subtle changes in the colouring in the skin. The colour you select to use for camouflage should best represent the skin tone in its most common or day-to-day colour.
32
Important Considerations:
Some considerations and corrections are best handled by a laser doctor or medical advisor. Permanent, pigment camouflage cannot disguise extremely elevated scarring, or texture of the skin, nor can it ever restore a person to what they were before the loss of pigment or scarring occurred. This would include burn victims, cancer patients, breast reconstruction or scar tissue.
Remember:
o Evaluate the skin type before using permanent pigment. o Perform a skin patch test before a procedure.
o Do NOT work on individuals with keloid formations known to have medical conditions
COLOUR CORRECTION TECHNIQUES USING:
YELLOW - lightens
ORANGE - neutralises darker shades of bluish or grey tones,
ROSE RED- neutralises medium shades of bluish or grey tones TAUPE - neutralises darker shades of purple or pink brows BEIGE - camouflages and covers small mistakes
WHITE - only mix with a pigment for a lighter shade on body only contains titanium dioxide which may turn black under laser.
NEW COLOUR CHOICE FOR CAMAFLAGE:
MAJIC- For All skin tones SKIN - For all skin tones
33
CORRECTIVE PIGMENT CAMOUFLAGE
o Evaluate each area to be re-pigmented. Discuss colour tones from consultation applications. Check patient's medical file; refer back to course of treatment from consultation day. Ask patient if any information on their Procedure and Consent or Medical Forms has changed since their initial application.
o Before application, check patient for gradient skin tones. Inspect the procedure area to ensure there are no open lesions, rashes or other irregularities. To prepare wipe with an alcohol wipe before start of procedure. o Apply correct colour. We usually wait until the 2nd or 3rd appointment to apply
any nuances ie. Beard simulation, freckles, capillaries. Adjust colour if necessary.
o Post procedure appointments should be scheduled at 4-8 week intervals. The patient may return sooner if you are re-pigmenting various areas, but you can not work on the same procedure area until it is completely healed. Touch up appointments are critical for any fine detail work the patient may request or to create any subtle additions or corrections in pigment colour. o Technicians should always be concerned about excess tissue maceration
when performing any type of cosmetic tattooing or CPC Tissue repair proceeds through four stages, coagulation, inflammation, regeneration and maturation.
• After each perforation is made in the skin, the body's platelets gather to form a clot. This is considered to be the beginning of the body's restorative mechanism. As the clots dehydrate, a crust is formed that will serve as the body's restorative covering for the wound. The degree of tissue maceration will determine the scab density, creating a potential loss of pigment in the procedure area. In the initial hours after the CPC procedure the body begins to react to the superficial skin trauma that is caused by the tattoo application.
• The inflammatory response is the second stage of the body's restorative mechanism. This stage may last from 4-6 days. This response quickly and effectively destroys bacteria. Classic symptoms may range from redness, heat, swelling, pain and lymph drainage. Patient will note typical wheal and flare reaction of the procedure area much like a bee sting or mosquito bite. This tissue releases histamine, serotonin and bradykinin, which creates an increase in blood flow to the injured tissue. Macrophages (infection fighting cells) begin to migrate out of the capillaries and small blood vessels in the skin into the surrounding tissue. Agitation to the skin causes the macrophages to migrate to the injured tissue secreting digestive enzymes to moisten and ingest dead and irreversibly damaged tissues and debris. This activity also causes increased blood flow to the immediate area. The procedure area will be
34
a bit sore, swells slightly to moderately within the first 24 hours, may possibly be very tender and be slightly pink to red.
• The third phase is the generation of new tissue consisting of reconstruction and contraction. The basal layer cells divide and grow which produces a continual epithelial layer beneath the crust. If there is no crusting, the epithelial tissue will appear as a raised inflamed area. To add support to the new tissue the fibroblasts multiply and produce collagen that will inflate the injured site.
• The fourth phase is the maturation of the injured tissue. To strengthen the tissue it is structurally reorganised several times over the next few years. (Scars lose about one-third of their original strength.) As scars mature they emerge to be more of a pinkish/white tone and thin out. a After the application is completed, apply Bepanthen cream and cover the
area to keep it exempt from free radicals and pollution for 12-24 hours. We use Bepanthen to promote rapid healing. The patient should apply a thin coating of Vaseline over the procedure area while showering I bathing to protect it from moisture. We phone the patient the next day, 2 weeks later and 4 weeks later to check on their progress and status of colour application. a Be sure to work in concert with the patient's physician. As the physician
performs ongoing surgeries, the patient's C.P.C. may need to be adjusted. One cosmetic tattooist was working with a burn specialist to reconstruct and tattoo burn patients eyebrows, eyelash enhancement and full lip colour. After a few months Or G. needed to perform a scar revision to release the bands of scar tissue in the lip area. After the patient's bottom lip vermilion healed it was very asymmetrical. The cosmetic tattooist re-tattooed skin tones on the left bottom vermilion to create a more even lip line.
a We, as technicians, fine-tune and complete the finishing touches on the work the plastic surgeon has accomplished. Cultivate relationships with plastic and reconstructive surgeons, dermatologists, oncologists and cosmetic surgeons. If you do not presently work in concert with a physician, here are a few tips to help you find one. Phone the physicians you are interested in working with, describe what services you can provide for their patients and invite them to visit your clinic. Show them your portfolio and or video of patients you have performed various procedures on. To insure you will be able to work with the physician, discuss philosophies. Also, ask yourself, would you feel comfortable asking the physician any type of question? Is the physician knowledgeable about alternative treatments? Will they work evenings and or weekends to inject patients for you? How are referrals handled? Is the office staff friendly?
a Arranging fees, renting a treatment room and or referrals with a physician can be very confusing. Many technicians rent space from the physician or pay a percentage while others may just pay various fees for services. Patients pay the physician directly for their injections and office visits while paying you (the technician) for the actual CPC procedure. We have found that in the
35
technician's best interest, agree to a 30-day trial period when first working with a new physician. After a few days or even weeks you may not like the way the physician conducts his/her business, handles the patients or other aspects of how they may even run their every day office in relationship to policy and procedures.
o Look for organisations that advocate comprehension of concerns of the
disfigured I burn patient. Support research that will impact the lives of the disfigured patient. Join burn and cancer support groups. Phone local hospitals. Talk to local fire fighters. Work pro-bono. Remember the old adage-'What goes around comes around.'
o Patient Assessment includes two phases: collection and analysis of information. This is achieved through the interview and examination. Most
burn and scar patients have lower self-esteem, social anxiety and fear of rejection. The patients past and present medical records contain data helpful to your overall assessment. These records should include a complete medical history including allergies to food, anaesthesia, drugs, chemicals,
metals, etc. and any diseases or disorders (psychological or physical). Always establish a rapport with the patient, identify their needs and agree on goals. Thoroughly discuss their perception of their present situation and what CPC can do. Clients must be made aware that this procedure is a multi-step process and final results cannot be determined until all applications are completed.
o Write out a detailed description of your treatment plan and discuss it with the patient.
o For accurate colour results, apply a patch and sensitivity test directly into the procedural area 4-8 weeks prior to the first application. Insert 7-8 implants of pigments into the epidermal tissue. To ensure an optimal outcome, perform several different colour tests for variegated skin tones. Modify the colour value as needed. Pigment should be placed into the epidermis (for minimal colour retention) so it should be sloughed off within 4-8 weeks.
o This method of application is used in case of inappropriate colour choices.
Even if the appropriate colour match is known, a patch test is still advised as changes or additions in any medication may alter the chemistry of the body rendering an earlier patch and sensitivity test inaccurate. Before inserting pigment, take the patient outside to the natural daylight, to provide optimum visual clarity of the pigment colour chosen.
o Natural daylight should be used for selecting a correct colour match for CPC application. The next best type of lighting is a daylight bulb followed by vita -lights and true white -lights.
o After every application of CPC, the pigment will revert back to its original dry state. Only then will there be accurate final colour results. All procedures are combinations of pigment colour plus the patient's skin undertones. This combination will equal the final colour result.
36
