Is Paramedical Tattooing Right For You?

Also known as ‘medical tattooing’ and ‘medical micropigmentation’. Skin camouflage helps improve the appearance of a person with skin disease such as vitiligo or post inflammatory hypopigmentation from skin trauma. Scar camouflage helps reduce the appearance of scars from accidents, burns, surgeries, or the repair of congenital disorders such as cleft palate. Hair simulation helps restore the appearance of missing hair lost to disease (cancer or alopecia), trauma or natural thinning within an eyebrow, mustache or scalp. That technique can also be used to simulate hair stubble. Reconstructive camouflage helps post-mastectomy patients by creating a nipple and areola on the newly reconstructed breast surgeries for augmentation, reduction, and breast lift can also be masked

Our expertise also extends into the paramedical field of scar revision, scar camouflage hair follicle replication as well as areola restoration, vitiligo, and skin pigmentation disorder camouflage and much more. We use the latest state of the art equipment and a higher grade pigments for all our procedures.

Skin or scar camouflage is tattooing of the skin with different colors of flesh tone pigments. Its purpose is to disguise a scar or skin area that is missing pigment or color. It is a specialized area of permanent cosmetic that falls under the category of medical and paramedical tattooing. This process is also called corrective pigment camouflage (CPC) Corrective camouflage, skin repigmentation, scar camouflage, scar camouflage tattooing and skin color tattooing.

The specialist performing these procedures must understand the science behind pigments and the physiology of human skin and tissue. These procedures require advanced knowledge, training, skills, and experience in permanent cosmetics as well as an artistic eye for skin tone.

Who is a good candidate for skin color repigmentation?

Even if you have a scar or skin abnormality, you may not be a candidate for skin repigmentation. You might be a candidate if you meet the criteria below

If your scar is healed and no longer pink or changing color:

Your scar should be at least nine to 12 months old with stable color. If it is red of pink, the tissue may still be healing. A reputable experienced medical tattooist will not work prematurely on scar tissue because it may cause further damage to the skin.

If your scar is smooth and relatively flat:

Camouflage tattooing cannot disguise or correct extreme changes in skin texture. If your scar or skin area is bumpy, or raised, the process may not be effective.

If your scar does not have dark edges:

Dark edges or borders around a scar indicate post inflammatory hyper pigmentation (PIHP) from the initial trauma or surgery. It is possible that the camouflage tattooing process may increase the hyperpigmentation and create a wider border (note: The risk of this happening is greater with darker skin color.)

Who is not a good candidate for skin repigmentation?

If you have any of the following you would not be a good candidate for skin color repigmentation: port wine birthmarks, spider veins, freckles, age spots, under eye circles, hyperpigmentation or unusual vitiligo (not in remission). These issues can be improved with non micropigmentation medical treatments such as lasers, or chemical peels. Please consult with a physician regarding the best course of treatment for these conditions.

What you need to know about camouflage/scar revision:

Camouflage tattooing will not completely restore skin to the way it looked before it was injured. The process will not “erase” a scar or skin abnormality so it appears completely gone and the area looks “perfect” again. It improves the color difference that helps disguise the scar and make it less noticeable to other people. So you must have realistic Expectations.

A scar camouflage tattoo will not be in a “perfect “match to the surrounding skin color. This is due to the constant changes in skin tone from blood flow, body temperature, and tanning. The pigment in the tattoo will not darken if it is exposed to sunlight or a tanning booth, the tattoo may appear lighter than the surrounding skin tans. When the tattoo color matches the tanned skin it may appear darker once the surrounding skin fades. Therefore, if you spend time outdoors, you will need to adjust your lifestyle or decide to match your tattoo to “winter” or “summer” skin and live with the changes in between.

Camouflage repigmentation is a process, not a one-time “cure”. It is performed on “unhealthy” skin that has been damaged or altered. It’s response cannot be predicted Scar or vitiligo patch may have areas that absorb pigment, reject it or both. The area will look dark and red immediately after a tattooing session, and then it takes several weeks to show the healed color (or not). This requires time and patience.

Aftercare For Your Medical Tattoo

Aftercare for any medical or cosmetic tattooing procedure is very important. After the procedure, We provide full aftercare instructions on short-term and long-term care. The aftercare is the same for all procedures. Instructions on dressing the area may vary.

Short-term Care

We advise patients to do the following for the first five to seven days after the procedure:

• Keep the treatment area moist with aftercare ointment, and apply three times per day minimum. Be mindful about not double dipping into the ointment to prevent cross contamination.

• Do not get the procedure site soaking wet for five to seven days and be careful when showering or washing hair.. Pat dry with a tissue and then reapply the ointment.

• Do not pick, peel or scratch the treatment area. This could result in pigment loss or infection, or worse, scarring. If patients really do get an uncontrollable urge to itch, a light pat to the treatment area with clean hands may help or I advise to apply more balm to lessen the tightening feeling of healing skin.

Long-term Care

After the initial seven days of healing, patients will need to use a strong SPF to protect the treatment area from fading too quickly. Once a month, We advise to check the healing of the procedure site and apply more ointment  if need be. In our experience, tattooed skin tends to be drier, so applying some balm will ensure maximum longevity for the treated area. If patients regularly swim, I advise to apply petroleum jelly over the treatment area to protect it from the chlorinated water. Chlorine can also fade the enhancement faster. Patients should inform you if they are having a chemical peel or laser procedure as these can also fade enhancements more quickly. A full four weeks in-between having a cosmetic tattoo and a peel/laser treatment should be left so the skin is given time to heal.

Case Study: Self-harm Scar Camouflage

This patient came to us for a consultation looking for somewhere she could get help covering her scars, but also somewhere where she wouldn’t feel like she was being judged. It’s often very hard for self-harm patients to talk about their problem with anyone and many manage to keep their scars hidden from friends and family for decades. This patient underwent a very successful skin graft procedure by a surgeon to cover self-harm scars to the forearms. Surgery was performed two years prior to having cosmetic tattooing. In my experience, medical tattooing can generally be done one year after having a skin graft however, depending on the case, it may take up to two years. 

Very tight scar tissue meant that the medical tattooing procedure had to be done very slowly using a fine needle, to implant pigment into the skin with a pointillism method, where you hold the needle directly above the skin to create microdots through the whole scar. This technique also helps to break down and loosen the tight scar tissue due to the penetration. Four different shades of pigment were used on this patient, two for the freckled appearance, to create more depth, and the other two shades were used over the whole area that was being treated, to match the patient’s skin color.

The freckles were done unevenly, in both small and large sizes, to mimic the appearance of true freckles. Pointillism for the freckles could have created too dense a color tone, so we used a shading needle in small, circular movements to create different sized freckles and used it to push out the pigment in some areas, so not to create a freckle that was too rounded. This allowed the freckles to blend in better with the rest of the skin. The patient was delighted with the result which took almost four hours to achieve. There was no follow up on this particular procedure as the patient was due to work abroad soon after, otherwise the patient would have come in for a follow up procedure to check the result, which can last up to five years. Complications are highly unlikely; however, the patient may have poor pigment retention which would mean that they may need to have more sessions. If the healing is delayed or the area required medical attention, I would advise the patient to visit her general practitioner.

Conclusion 

The patients that were included in both these case studies reported a confidence boost and a sense of liberation after receiving these life-changing treatments. It is important for aesthetic practitioners to consider the possibilities of medical tattooing for their patients and, in circumstances where practitioners may not be able to treat the patient but where medical tattooing may be an option, there should be the opportunity to refer them to professionals

Case Study: Areola Recreation

For this patient, we recreated an areola over a scar across a newly-inserted implant. The areola and nipple, along with breast tissue, were all removed during the patient’s mastectomy surgery and an implant was inserted by the surgeon to rebuild the breast. If patients have been referred to me from a surgeon, we ensure communication with the surgeon and work to the time frames they suggest so that the area heals well. We recreated the areola and nipple by using three different shades. 

By using a circular movement, with a five-round needle, we were able to create a ripple effect, resulting in a more textured appearance, which produced a very natural-looking areola. For the nipple, we then used some lighter shades to create a ring with a three-micro needle device, giving the illusion of an outward-projecting nipple. A eleven- flat needle was then used on the outer edge of the areola. This provided a softened edge, to ensure the areola did not look ‘too perfectly’ circular. All of these needles mentioned vary in thickness and are commonly used for shading work and to create a circle formation on the skin.

This type of procedure can take two sessions or more. If the scar tissue is dense and tight, then care is needed when inserting the needle, so that the placement of the pigment goes into skin, to achieve the desired results. If too much pressure is used, the pigment could merge out and the resulting color may appear too grey. If not enough pressure is used, then during the healing process, the pigment may be rejected and leave the skin. In my experience, a scar which is silvery white and flat, with not much tight scar tissue, would retain the most pigment and the best- looking result, however it is important to note that no scar is consistent all the way through.

After the first session, the patient was very pleased, but during healing there was some unevenness in pigment, which is completely normal. In the second session, I went over the area again and evened out the pigment. The first procedure would have broken down some of the scar tissue present in the areola and, from personal experience; it’s almost always easier to get pigment to sit correctly the second time around. The procedure usually takes around two hours. There can be some soreness or swelling to the area, which sometimes lasts up to five days. A light dressing should be applied following the procedure. I normally advise my patients to wear loose, comfortable clothing and most definitely a loose-fitting bra; they normally have their post-surgical bra. The way pigment breaks down in each patient is different but generally, most patients will not need the area retouched for about five years. Overall the patient was happy. In my experience of treating breast cancer patients, this is their chance to fully say goodbye to cancer and frequently provides patients with a sense of closure.

How Does Medical Tattooing Work?

Medical tattooing is a tattooing technique that inserts pigment into the skin with a single-use fine needle, into the chosen procedure site. In this technique, the pigment is only implanted into the upper dermal layer. From my experience, if pigment is implanted into the skin as deep as normal body art tattoos are, the colors will not be true enough to mimic traditional makeup, which is important to consider when covering up scars. Pigment is then blended to the skin tone. Several different colors may be blended to build up the skin, to create natural looking skin tones and give the appearance of a natural finish. Freckles may also be implanted to match the patient’s normal skin area.

It is very important to remember that this procedure will camouflage the patient’s scar, not make it disappear.

The idea is to make the scar less noticeable and not have the eye drawn to it immediately. The result will also depend on the severity of the scar and may take more than one session.