Current Problems in Dermatology

Microblading is a rapidly expanding technique in cosmetic and medical tattooing, used for eyebrow correction and conditions of hair loss. Tattooing is performed by hand using a special blade; tiny cuts in the outer skin are filled with dark pigment to simulate a natural hair. Indications, the technique, and the microblading procedure step-by-step are considered in what follows. Details on client selection and a range of pitfalls are discussed. The leading application of microblading is cosmetic tattooing of the eyebrows adding pigmented "hairstrokes" to the natural brow area...

No abstract text is available yet for this article.

Tattooists and their customers are under special risk of airborne infection because of the short distance during the procedure and the unavoidable exchange of expired and inhaled air potentially containing droplets holding pathogenic germs. Moreover, the manual procedure involves a significant risk of contamination through physical contact. A range of personal protective equipment (PPE) is available, including three-layered disposable surgical masks, cotton masks, respirators without or with expiration valve, visors and shields, goggles, medical gloves and aprons...

Furrows, lines and wrinkles with distensibility and retractility are a biological need of skin in the service of skin integrity, plasticity and joint motion. The fundamental segmentation and linearity of skin is genetically coded, manifested early in embryonal life and remarkably constant throughout life. The basic pattern established early in embryonal life when facial segments expand and fuse is confounded by overlapping linearities of different backgrounds. Embryonal skin and skin in childhood, puberty, adult life and senescence undergo a general change in the direction of disturbed structure, nevertheless respecting the originally coded and segmented linearity...

Stretch marks (striae distensae) are common dermal scarring associated with weight gain, overweight, and pregnancy. Scarring is caused by overstretching of the skin's dermis with permanent structural alteration of the collagen network fibers. Some individuals have naturally weak connective tissue and may develop major stretch marks without being overweight. Stretch marks can develop during puberty and after physical exercise with rapid muscle growth. Cortisone treatment and anabolic steroids often cause stretch marks...

Cosmetic and medical tattooing is miniaturized tattooing of high precision and thus requires many dedicated utensils including advanced devices for marking and anatomical delineation. Symmetry is a special demand, as is aesthetic outcome, building on perfectionated detail. The artist shall master design and strategy along with advanced technical performance helped by having and using the right tools. This article reviews and illustrates the many special utensils involved in good-practice cosmetic and medical tattooing, exemplified by selected tools used for cleansing, disinfection, pre-operative measurement and marking, and special tattoo machines, cartridges, microblades and needles...

Medical tattoos are used for camouflage of a wide range of disfiguring skin pathologies and conditions. Recently, tattooing of the nipple and areola of the breast has been introduced as a corrective treatment of sequelae from breast cancer surgery and radiotherapy. The psychologic impact of a disfigured nipple and areola can invalidate self-esteem of the sufferer lifelong with major consequences for social life. Medical tattooing can often restore the visual appearance of the nipple-areolar complex back to normality and even improve the 3D impression of the entire breast...

Needles, machines, and techniques used for professional cosmetic and medical tattooing have reached a high level of sophistication. Best utensils are combined with operator's insight - the key to best results. Nowadays, a broad range of different tattoo needles serving different purposes are available. The chapter reviews round, flat, triangular, magnum, nano, polished, textured needles, etc. and their coding and preferred use in practice. The chapter is intended to be the vade mecum for practitioners in the field, the newcomer as well as the experienced, in private setting as well as in hospital...

Cutaneous scars are permanent and the result of physiological wound healing with formation of disorganized collagen instead of the normally structured connective tissue network (or "textile") of the dermis. A scar restores the physical and tensile integrity of skin; skin is a vital protective layer on the body. Scars are of many types and with a broad spectrum of individual variations of color, texture, thickness, furrowing, tension, and contraction. Scars can be red and hypertrophic and, moreover, aggressive and manifested as keloids...

Perception of skin color in the natural state, or with tattoo pigment installed in the dermis is highly complex and includes both optical requisites and eye and brain functions connected to advanced cognitive and psychological functions. Permanent makeup (PMU) is miniaturized tattooing on critical anatomical location aiming at fulfilment of a person's esthetic ideal. It is a special challenge since a satisfactory outcome depends on perfectionated technique and very critical selection of pigments. The eye can be compared to a digital camera, and the center of central vision in the brain to a computer and color integrator...

Medical tattooing aims to restore the normality of skin structures in patients who have skin diseases or suffer sequelae after surgical interventions or hazards. There are numerous applications, with tattooing of vitiligo and the nipple areola complex after breast cancer surgery as leading fields. The use of 3D or realistic tattoo techniques has increased the potential of medical tattooing and improved the aesthetic results. The tattooist must have good technical training combined with artistic and creative talents...

Cosmetic tattooing and medical tattooing of the face share basic principles and to some degree types and spectrum of technical and clinical complications known from decorative tattooing of other parts of the body. Cosmetic tattoos recently have grown exponentially in popularity in industrialized countries all over the world. The different complications and their clinical symptoms, pathophysiology, diagnosis, treatment, and prevention are analyzed versus culprit pigments and updated. Eyeliner tattooing is associated with special complications because of the subtle anatomy and the closeness to the eye, and the risk of meibomian gland damage...

Cosmetic tattooing of eyebrow and lips has become very popular and is expected to be paralleled by more frequent complications. We present 4 cases of granulomas in cosmetic tattoos complicated by regional or systemic manifestations of sarcoidosis including affection of the lungs in 2 cases, the activity triggered by the tattoo. Three cases of traditional decorative tattoos on extremities serve as reference. It is noteworthy that cosmetic tattoos despite small size and thereby low relative dose of pigment injected in the skin can trigger fully developed systemic sarcoidosis...

This chapter reviews our present knowledge about equipment used for cosmetic (decorative) and medical tattooing and its function with respect to installation of tattoo ink into the skin. In the following text, the word "tattooing" refers to body tattooing, permanent makeup (PMU), microblading, and medical micropigmentation. The major consumer risks related to unsafe tattoo and PMU equipment are reconsidered. Such health risks mainly include the danger of non-sterile needles or needle cartridges, cross contamination of equipment and lack of biocompatibility...

Cosmetic tattooing dedicated to beautifying the normal anatomy such as the eyebrows, the eyelines, or the lips is in a remarkable growth all over the world. Medical tattooing with reconstruction of the areola and the nipple after breast surgery, correction of the lost color of vitiligo and scars is a spin-off, which has made tattooing cross the barrier and become accepted and used in clinics and hospitals in service of the quality of life of patients. The last years have seen a major development of machinery, inks, techniques, experiences, and services...

Lip tattooing for cosmetic or medical purposes is a difficult operation with indications and contraindications. Lips have a refined microanatomy and many functions ranging from aesthetics and mimics supporting facial expressions to entirely biological functions such as supporting oral functions and servicing sound expression as part of linguistic performance. The anatomy of the lip is explained and illustrated. In lip tattooing, the outlining and enhancement of contour particularly towards the philtrum is important along with keeping symmetry and shape right and as intended...

Cosmetic and medical tattooing are in rapid growth on all continents. The tattoos contribute to self-esteem and quality of life. Clients and patients have many different backgrounds and often highest aesthetic expectations, which the professionals shall meet. In this situation, correct, relevant, and personalized information on effectiveness, technique, procedures, and risks is highly important to reach a shared goal without misunderstanding and conflict. Information and agreement between provider and client are crystalized in the informed consent document...

The definition of the task in the medical aesthetics field and good practice requires social, professional, and institutional agreements. A few aspects that are expected to be present in the professional and commercial practice of aesthetic and oncological medical tattoos may define this path. To achieve this goal, we aim to make it essential that what has been stated above becomes a profession and thus our crusade becomes effective. While all technical aspects are not intended to be addressed, we will focus on those associated with good practice, those based on adequate ethics in the practice exercise...

Tattooing of the eyeline is an utmost delicate procedure because of the subtle structure and the thin skin of the eyeline and the closeness to the eye. The esthetic outcome and customer satisfaction also have a narrow range. The artist therefore must be both talented and experienced. Indication, contraindication, customer information, and customer preparation and involvement throughout the procedure is reviewed along with the technical aspects of safe procedure and precautions taken. Examples of the many challenges of eyeliner tattooing both regarding the practical setting and the esthetic result are illustrated with many figures...

Permanent makeup (PMU) is a descendant of tattoo ink products and used with the intention of giving the face more advantageous contours. PMU makes it possible to condense eyelashes and eyebrows with fine lines or to visually correct them with cleverly placed contour lines. Even the correction of most subtle irregularities on the skin is possible through skillful pigmentation. Microblading describes a special technique in which the skin is carved with a certain "needle blade." The ink is then applied on the fresh wound and massaged into the cuts in order to depose the pigments in the skin...