PERMANENT MAKEUP: PIGMENT MICROIMPLANTS

Victoria Morante (1), Betty Sandoval (2) Patricia Chávez De Paz (3)

(1) Assistant Physician of the Dermatology Service of Dos de Mayo Hospital. Assistant Professor of Dermatology UNMSM. UP
(2) Assistant Physician of the Dermatology Service of Hospital Grau. ESSALUD. Pro, guest professor of dermatology UPCH. Associate Professor UNMSM.
(3) Resident of third year of Dermatology of Dos de Mayo Hospital.
INTRODUCTION

Micropigmentation is a technology that is developing and requires years of experience and training. Permanent Makeup is a micro pigment implant in the skin (epidermis) that can be applied to the eyebrows, edge of the eyes and edge of the lips, with a device designed for this purpose.
The most important aspect of micropigmentation is to obtain a uniformity of tones.
The purpose of micropigmentation in medicine is to correct pigment loss or discoloration (Vitiligo) (1, 1, 6).

HISTORY

Permanent Makeup originated in East Asia, mainly in Hong Kong and Taiwan. The procedure was modified from the tattoo, in China and Japan. The difference is that the tattoo requires a deeper penetration of the pigment into the skin (dermis) and the colors are not removable.
The Permanent Makeup pigment is implanted in the epidermis, 0.07 mm, so the color can be removable. Color lasts approximately 5 to 7 years

GENERAL CONSIDERATIONS

Micropigmentation is the introduction of pigment granules, of different shades, into the dermal tissue, with the aid of very thin needles, which are connected to a Dermograph (electric or electronic), responsible for provoking the necessary back and forth movements. That the pigment is deposited in the r

HISTOLOGY

From the histopathological point of view, the skin undergoing a dermopigmentation process passes through four stages (ZWERLING, 1986).

First stage: After the treatment is carried out, there is inflammation secondary to trauma, caused by repeated penetration of the needles to deposit the pigment. In this phase there is an increase in vascular permeability and serous exudate, with an increase in the migration of leucocytes and macrophages by chynotaxis. Free pigment particles can be seen in the epidermis and dermis.

Second stage: The process of healing begins, with the formation of a small crust on a superficial level.

Leukocytes are replaced by lymphocytes, cosinophils, giant cells, and plasma cells. At this stage, the macrophages begin ingesting pigment particles. The formation of the sample, which lasts about 4-5 days, gives the impression that the color has darkened; This deceptive appreciation disappears when the crust falls.

Third phase: It starts around day 10 post treatment. In this period the repair of the epidermis, remodeling of the collagen of the dermis and redistribution of the pigment particles takes place, being eliminated the granules that had been deposited in the upper layers of the epidermis by cellular renewal.
In this phase there is a decrease in the tonality for two reasons:
Loss of crust.
Removal of the pigment from the first layers of the epidermis by cell renewal,

Fourth stage: Total dermis repair occurs. The pigment particles are distributed between the collagen fibers and around the capillaries of the dermis. The granules located near the hair bulbs are quickly removed by sebaceous secretion, resulting in a greater loss of color, just at the hair margins. Few macrophages are observed.

INDICATIONS

Vitiligo and leucodennia localized Alopecia of eyebrows or eyelashes.
Correction of scars.
Pigmentation of bowels after mastectomies, etc. Lip augmentation technique.
Demarcation of cleft lip.
Blepharopigmentation in people with excessive bleeding. Comfort.
Pigmentation of dark circles, etc.

PROCESS

MATERIAL

The devices used in Dermopigmentación consist of an engine, which transmits movements of reciprocating to the tip, in which the needles are inserted.
The needles usually have a diameters ranging from 0.25 to 1.75 mm (depending on the device). You can use heads for 1, 3.5 and 8 needles, depending on the work to be performed
The depth of penetration of the needle should be between 0.8 and 1.6 nim, to avoid permanent tattoos in the Jeaso of purely decorative dermopigmentations.

MICROPIGMENT

According to current legislation, Pigments for Mieropigmentation must meet the following requirements: on the labeling must be specified the composition, which must be known, batch, expiration date, company and manufacturer

CHEMICAL PROPERTIES:
– Do not be toxic.
– Do not irritate the tissues.
– Sterile of origin.
– Made up of inert ingredients (iron oxide).
– No density changes.
– Particles larger than 6 microns, so that the
Macrophages are more difficult to ingest and
Stay longer in the treated area.
– Low solubility (greater stability).

CLASSIFICATION OF PIGMENTS ACCORDING TO YOUR
COMPOSITION:
– Organic Pigments
– Inorganic Pigments

The organic pigment has as fundamental element in its composition the Carbon. They have some advantages but the drawbacks are larger (higher incidence of reactions – they are less stable – risk of migrations are formed by particles of different sizes). For this reason, inorganic pigments, whose fundamental composition is iron oxide (DELUALLE, 1997) (1, ‘, 1), are more advisable.

Benefits of inorganic pigments:

– Possibility of allergies, practically nil. However, it is
Prudent to practice an allergy test behind the ear.
– Particulates of large particles, thus avoiding degradation. ?? Greater fixation, the color is degraded foriria more uniform.

Disadvantages of inorganic pigments:
– Less bright and intense colors.
– Be careful with the colors white and beige because they contain in their composition titanium oxide, zinc oxide and the particles are large (more than 15 microns); Both reasons make difficult its elimination.

BASIC NOTIONS ABOUT COLOIZZIMETRU

It is essential, to be a good technician in Dermopigmentation, to know the basic rules by which colors are governed; So we will avoid long-term surprises, with changes in the color chosen primarily.

APPLICATION OF THE MICROPIGMENT

ANESTHETIC
Some people require anesthesia and some do not.
– Anesthesia jelly, 4% lidocaine gel. The skin achieves
A numbness within 15 minutes of its application.
– Anesthesia by injection in the area to work
– Anesthesia due to trunk block (infraorbital,
Supraorbital, etc.).

TECHNIQUE
When we want to obtain a more intense, marked and fine line we will use less pointed needles, whereas if we want a thick but less dense tracing, we will get it with needles with a greater number of points.

The eyebrow, eyelid or lip are then drawn with a pencil, after which, after obtaining the shape of the outline, the nucropigments are applied, with a machine having a needle for the penetration of the pigment; The excess material will be wiped with a wet cotton swab; Will reapply until the desired color is achieved. The final color will appear approximately 7 to 15 days, after the crusting (1,4,5).
It is important to keep the skin very tight to avoid pinching it with the needle.
The angle of access to the skin at 90 degrees allows a well delimited tracing.
The pigment is on the surface of the skin; In the epidermis the depth may range from 0.07 to 0, 12 mm.
When using organic pigments, it is recommended to perform a patch test on the skin 30 days before its application; The area to be tested is behind the ear, where the pigment will be applied; This will show if the area where the implant will be made has some susceptibility to an adverse reaction. Since the ingredients of the organic pigments are different, it is necessary to perform a patch test separately for each pigment.
The apparatus for the penetration of the micropigments carries a needle attachment, which is disposable, so that the needle and the packaging for the needle; Therefore, it prevents some infection like AIDS, hepatitis, etc.

Summarizing the postoperative:
– In the first week there is an increase of the chosen tone. ?? In the 2 nd week there is a decrease.
– In the Y week stabilizes the color.
This is why it is not recommended to touch up before 21 days.

The use of the micropigment implant in Vitiligo is suggested when it comes to small lesions and when there is a stabilization of the process; The color is achieved by combining shades of light brown with peach color.

CONTRAINDICATIONS
– Active dermatoses.
– History or evidence of keloids.
– Pregnancy.
– Psychiatric disorders (hypochondria, depression, etc.)? Blood dyscrasias

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