Inaccuracy in PMU Training Graphics

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1. Research and Expert Reviews

Numerous professional artists have highlighted inaccuracies in training materials, especially regarding the proportions and thicknesses of skin layers. This analysis is based on extensive research, including interviews with 49 professional pigmentation artists. These interviews were part of ongoing research projects that began in 2019. The majority of these artists, 38 in total, are from the European Union, with six from the United Kingdom and five from the United States.

The material was rigorously reviewed to ensure this article's accuracy and scientific validity. Two dermatologists and an expert in cellular biology provided insights and feedback. Notably, these professional artists' practical experiences support this analysis's conclusions, emphasizing our findings' real-world applicability and relevance.

2. The Structure of the Argument

We start by discussing the portrayal of skin layers by many pigmentation trainers, focusing on the relationship between the epidermis, dermis, and a typical pigmentation needle. This needle usually enters and often pierces through the epidermis. We then analyze proportional measurements that depict the relationship between the needle's diameter and the thickness of the epidermis in such cross-sections.

Next, we present scientifically accurate measurements of human skin layer thicknesses in the facial area. This includes a significant margin of error and considers the skin in the brow area, providing a critical range for the epidermis thickness. We compare this with the thickness of a standard 1 RL 0.3 needle with a medium taper, approximately 1.5mm, to ascertain the ratio of needle diameter to epidermis thickness.

Finally, we aim to synthesize these elements to understand this phenomenon comprehensively. Our goal is to provide practical insights for artists in semi-permanent pigmentation, enhancing their knowledge of skin and needle interactions. Additionally, we propose a possible explanation for the origin of such misleading graphics grounded in available scientific material.

3. Mistakes in Training Materials

Examining Inaccuracies in PMU Training Materials

We analyzed cross-section drawings and graphics from five training materials commonly used in courses for powder brows, microblading, and hairstroke techniques. These materials come from training providers who have been active for at least five years, establishing them as credible sources in the field.

We researched the academies distributing these materials to their students. Our findings show that these academies and trainers are experienced and capable of offering quality training. While the overall program quality varies, the information provided is generally accurate.

Cross-Section Images in PMU Training Materials

We conducted a detailed analysis of 12 cross-section images from the training materials of the five academies. We focused on three key criteria in each image.

Needle Thickness vs. Epidermis Thickness. We assessed how the needle's thickness in the images compares to the epidermis thickness, which is vital for understanding the scale and impact of needle penetration.
Epidermis vs. Dermis Thickness. We examined the relative thickness of the epidermis compared to the dermis to assess the accuracy of skin structure representation.
Needle Length about Skin Layers. We analyzed the needle length relative to the thickness of the dermis and epidermis, important for understanding the depth of needle penetration as depicted in these resources.

Limitations in Depicting Dermis Thickness

Many drawings were overly simplified, making it challenging to determine the accurate thickness of the dermis. Therefore, we focused on graphics showing the dermis-hypodermis boundary. While any proportional inaccuracies in depicting the dermis thickness compared to the epidermis are noted, they don't significantly impact our primary focus on needle diameter versus epidermis thickness and are considered secondary.

Drawings vs. Microscope Photos

Medical and popular science graphics often emphasize internal skin elements rather than accurate proportions. When pigmentation trainers use these drawings to create images incorporating needles, it can lead to misunderstandings. In contrast, microscope photos provide a clearer understanding of the skin layers' proportional differences and thickness compared to needle diameters. However, interpreting these photos accurately requires specialized dermatology, biology, and anatomy knowledge.

4. Graphics in PMU Training Materials

Depiction of Needle and Skin Interaction

In the graphics we examined, the needle cartridge is typically shown above the skin, with the needle extending downwards into the epidermis. These images often depict the needle emerging significantly from the cartridge and entering the epidermis. The needle is shown piercing through the epidermis into the upper dermis in three materials. In one material, the needle stops at the bottom of the epidermis, while another shows it penetrating the basal membrane of the epidermis.

Measured Proportions in the Graphics

Our focus was on the illustrated needle diameter compared to the epidermis thickness. We observed that the epidermis is often portrayed as being 30-50 times thicker than the needle's diameter. This creates a visual of a long, slender needle piercing a skin layer that is, on average, over 40 times thicker than the needle.

5. The reality

How Are Skin Layer Thicknesses Measured?

Measuring the thickness of the epidermis, particularly in the facial area, requires precise techniques and specialized equipment. Common methods include the following.

Biopsy and Histological Analysis
Procedure. A small skin biopsy is taken from the facial area under local anesthesia.
Analysis. The skin sample is stained for histological examination, which enables visualization of skin layers, including the epidermis, under a microscope.
Measurement. Epidermis thickness is measured using a micrometer from the top of the stratum corneum to the basal layer.

Ultrasound Imaging

Technique. A non-invasive method using high-frequency sound waves.
Procedure. An ultrasound probe creates images of the skin layers.
Analysis. The epidermis is identified and measured from the ultrasound images.
Optical Coherence Tomography (OCT)
Principle: A non-invasive test using light waves to produce cross-section pictures.
Procedure. A device emits and captures light waves, creating detailed skin layer images.
Measurement. Software measures epidermis thickness from these images.

Confocal Laser Scanning Microscopy

Technique. A non-invasive method using laser light for optical sections of the skin.
Procedure. Laser scans create detailed images of the skin's microstructure.
Analysis. Enables visualization and measurement of the epidermis layer.
Considerations in Measurement
Accuracy. Histological analysis is the most accurate but invasive.
Variability. Skin thickness varies based on location, age, gender, and health.
Ethical and Practical Aspects. Non-invasive methods are preferred outside research settings for their safety and practicality. The choice in clinical or research settings depends on accuracy needs.

6. Dermis Thickness in the Brow Area

The thickness of the dermis varies across the body and is influenced by age, gender, ethnicity, and health. While specific measurements for the brow area are not standardized, general scientific knowledge about the facial dermis can infer its thickness.

Variation in Brow Area

At Brow's Start. The dermis can be thick, possibly exceeding 1 mm (1000 micrometers).
Range. Depending on individual factors, thickness may vary between 1000-2000 micrometers (1-2mm).
Towards the Tail. The thickness decreases significantly towards the brow's tail.

Considerations in Dermatological Literature

It's important to acknowledge that specific measurements for the brow area are less frequently detailed in dermatological literature. Most references concern broader facial regions rather than particular areas like the eyebrows. Nevertheless, we use data about the “healthier and thicker” version of the dermis for our analysis, which allows us to make valid conclusions relevant to our study.

Epidermis Thickness in the Eyebrow Area

The epidermis in the eyebrow area shows less thickness variation than other skin areas. Considering diverse skin properties, the epidermis thickness typically ranges from 50 to 100 micrometers (0.05 to 0.1 mm).

Consistency with Dermatological Knowledge. This range aligns with established dermatological insights. The epidermis is significantly thinner than the dermis beneath it.
Variation Across the Body. Epidermis thickness varies less than dermis thickness across different body parts.
Comparison with Other Body Parts. The facial epidermis, including the brow area, is generally thinner than areas experiencing more mechanical stress, like the palms or soles.

This understanding is crucial when discussing "Thin skin" versus "Thick skin" later in this article, especially regarding the source of incorrect graphics in training materials.

Needle Diameter vs. Epidermal Depth Analysis

We selected a 1 RL 0.3 needle with a medium taper for our study. The taper length typically ranges from 1.5 to 2mm, with slight variations among manufacturers.

Penetration Depth and Resulting Wound Diameter. Half Taper Penetration: When this needle penetrates half its taper length, the resulting circular wound's diameter is about 150,000 nanometers (150 micrometers or 0.15 mm).
Full Taper Penetration. Replicating a cross-section image from the training materials, where the needle penetrates fully, the wound diameter would be 300,000 nanometers (300 micrometers or 0.3 mm).

7. The real proportions

Graphics Representation

Training materials often show the needle entering the skin at its full diameter, 300,000 nanometers. This depiction can vary greatly from the wound created when a needle enters at half its taper length.

Actual Hole Made in the Epidermis by the Needle

The diameter of the hole made by the needle in semi-permanent makeup procedures is much larger than the depth of the epidermis in the brow area. The epidermal thickness in this region typically ranges from 50,000 to 100,000 nanometers (0.05 to 0.1 mm). This indicates that graphics commonly used in semi-permanent makeup training often misrepresent the relative thickness of the epidermis, portraying it as thicker than it is.

Epidermis Resistance to Needle Penetration

Despite its relative thinness, the epidermis, particularly the Stratum Corneum, plays a crucial role in resisting needle penetration. The Stratum Corneum, also known as the "Horny Layer," has a tough structure similar to an animal's horn, significantly contributing to the skin's defense against mechanical intrusion, such as needle penetration in semi-permanent makeup.

8. Conclusions about errors

Our analysis leads to an important conclusion regarding the depiction of skin layers in semi-permanent makeup training materials. When accurately representing a cross-section of facial skin layers, the epidermis should be shown as approximately 3-6 times thinner than the diameter of a typical needle used in pigmentation procedures. This challenges the accuracy of images commonly used in training materials. Even when considering individuals with the thickest epidermis and the thinnest needles, the proportions depicted are significantly off from reality.

This discrepancy underlines the necessity for more realistic portrayals of skin structure in training materials. Accurate depictions are crucial for practitioners to understand their work's true scale and impact, ensuring the effectiveness and safety of semi-permanent makeup procedures.

The Extent of Misrepresentation in Graphics

Upon analyzing the training materials, a significant discrepancy is apparent. The depicted needle diameter to epidermis ratio is approximately 1:50. In contrast, the actual, more accurate ratio is closer to 5:1. This means the graphics in these materials are off by 250 times, which has considerable implications, especially for beginners in the field.

Consequences for Starting Artists

Such a vast misrepresentation leads to a false belief among new artists that the epidermis is much thicker than it truly is. This misunderstanding might prompt them to insert the needle deeper than necessary, believing there is sufficient space in the epidermis. Unfortunately, this can result in the pigment being implanted too deep, sometimes even reaching the hypodermis, leading to pigment migration or a “blowout.”

Empirical Support from Professional Artists

The idea that the epidermis is thinner than often shown in training materials is not merely theoretical. It is supported by the experiences of many professional artists in semi-permanent makeup. These experts confirm that the epidermis is thinner than portrayed, highlighting the ease of unintentionally reaching the dermis during procedures.

Visualizing Epidermis Thickness

To understand the actual thinness of the epidermis, especially on the face, it can be compared to the thickness of a sheet of paper. This analogy emphasizes the epidermis layer's delicacy, sharply contrasting with the exaggerated representations in some training graphics. This knowledge is essential for practitioners, particularly newcomers, to avoid overly deep pigment implantation and associated complications.

A Fascinating Sidenote (For Those Who Appreciate Humor)

If the training graphics we've discussed were accurate, with their portrayal of epidermal thickness as truth, a typical pigmentation artist would be as small as a grain of rice or a pea. In this scenario, they would be dwarfed by a standard paperclip about 3-4 centimeters long. If they maintained human proportions at this scale, everything, including their organs and skeletal structures, would need to be dramatically downsized.

In this miniature world, everyday objects would seem enormous. A pencil or coin would appear massive and hard to handle. The physical properties of materials, such as surface tension and air resistance, would present unique challenges. Even insects, often similar or larger, could pose significant threats, potentially seeing such a tiny human as prey or danger. This miniature person would be vulnerable to creatures like ants, spiders, or wasps, facing challenges in safety and self-defense.

Living in this proportionally altered reality would require a completely customized environment. Everything from clothing to tools would need to be specially made. Their nutritional needs would also significantly differ in quantity and consumption methods.

While this is a highly theoretical and imaginative scenario, it's an interesting exploration of scale and how size affects interactions with our environment. Of course, human anatomy and physiology principles make such a size implausible for a human being. Still, this thought experiment is useful for understanding the importance of accurate scale representation.

9. Implantation into Basal Membrane

Additional Typical Errors in Training Materials

Many training materials contain three errors to be noted: “Pigment implantation into basal membrane,” “Sweet spot theory”, and “Epidermis thickness and resistance theory”. “

This approach erroneously implies that pigmentation can be done "into the Basal" membrane between the epidermis and dermis. However, it's crucial to understand that the basal membrane is part of the epidermis, and it is dermatologically impractical to implant pigment precisely into this layer.

Basal Membrane Thickness

The basal or basement membrane is a thin, fibrous structure separating the epidermis from the dermis. It is essential for cellular adhesion and signaling and measures 10-50 nanometers (0.01-0.05 micrometers), or approximately 0.00001 to 0.00005 mm.

Size of Pigment Particles in Pigmentation

Pigment particles used in tattoo inks typically range from 100 to 500 nanometers. This size balances the ease of skin insertion and retention within the dermis, evading immune system removal. Van der Waals forces also affect these particles' behavior.

Conclusion on Implantation Depth

Given the size of pigment particles and the basal membrane's thinness, depositing pigment solely into the basal membrane is anatomically unfeasible in microblading and semi-permanent pigmentation. In microblading, blade incisions penetrate the epidermis, basal membrane, and upper dermis layers, especially the papillary dermis. Similarly, the needle in semi-permanent pigmentation reaches the same depth, ensuring pigment deposition within the dermis.

In both microblading and semi-permanent pigmentation, pigment likely reaches all dermis layers, and often, the hypodermis is also penetrated.

10. Hitting the “Sweet Spot” Theory

The idea of targeting a “sweet spot” in the papillary dermis is a common misconception in pigmentation techniques, such as microblading, powder brows, and Hairstrokes. Understanding this concept involves considering the dermatological, physical, and biological aspects, especially the thinness of the skin layers.

Epidermis Thickness Revisited

As mentioned earlier, the epidermis in the brow area typically measures between 50 and 100 micrometers (0.05 and 0.1 mm), significantly thinner than the dermis. This is particularly true for the facial epidermis, including the brow area, which is thinner than areas subjected to more wear, like the palms or soles.

Conclusions about the “Sweet Spot”

Implanting pigment into the papillary dermis might be sound in theory, but achieving such precision is practically challenging. The practitioner must insert the needle or blade accurately to a depth of about 0.2-0.5 millimeters, which varies across brow parts.

Analysis of Implantation Possibility into the “Sweet Spot”

The theory implies a precision in needle penetration that is difficult to attain. Human senses, like sight, cannot consistently discern such minor depth differences. While the human eye can detect differences as small as 0.1 mm, visually assessing needle depth during rapid penetration is not feasible. Other senses, such as hearing the needle prick or feeling its vibration, also lack precision. While one might feel the needle piercing the epidermis, differentiating between the depths of the papillary and reticular dermis is beyond our sensory capabilities, leading to pigment often being deposited in both layers.

Experienced and novice pigmentation artists frequently penetrate the hypodermis due to challenges in controlling the exact depth of pigment placement. The skin's varying thickness and human perception limits make this precision hard to achieve. Therefore, the main focus in practice should be on managing pigment distribution across the skin layers rather than fixating on the elusive “sweet spot.”

11. “Thick” Epidermis Theory

The claim that a longer needle is needed to penetrate a thicker epidermis or that epidermis resistance depends on its thickness is largely unfounded.

Scientific research does not support a linear correlation between the thickness of the epidermis and dermis, nor does it confirm that a thicker epidermis is harder to penetrate. The resistance skin layers offer to needle penetration involves more than just their thickness. Factors like the density and composition of these layers are crucial. The epidermis resistance is primarily influenced by the thickness and density of its upper layer, the Stratum Corneum.

Stratum Corneum: The Primary Barrier

The outermost layer of the epidermis, the stratum corneum, is the main barrier to mechanical penetration, such as needle piercing. Its resistance is largely due to the high concentration of keratin in the keratinocytes, making it particularly resistant to physical intrusions.

Contrast with the Papillary Dermis

Beneath the epidermis lies the papillary dermis, composed of a less dense connective tissue matrix including collagen and elastin fibers. Its looser and more pliable nature offers less resistance to needle penetration compared to the stratum corneum.

Factors Affecting Stratum Corneum Resistance

Age and Hormonal Changes. It can alter the skin's turnover rate and texture, affecting the stratum corneum.

Genetics. Influence skin characteristics, including stratum corneum thickness.
Environmental Exposure. Sun exposure can thicken the stratum corneum; harsh weather conditions also impact its thickness.
Hydration Levels. Affects skin elasticity and pliability.
Skin Care Practices: Influence skin cell turnover and stratum corneum thickness.
Health and Nutrition. Impact overall skin health and stratum corneum characteristics.
Occupational Factors. Repeated mechanical friction can cause the stratum corneum to thicken.

Skin Conditions Affecting Resistance

Various skin conditions like calluses, corns, psoriasis, eczema, ichthyosis, actinic keratosis, lichen planus, chronic sun exposure, and diabetes can affect the thickness and density of the stratum corneum, influencing the ease of needle penetration.

The stratum corneum's resistance is a complex interplay of biological, environmental, and lifestyle factors. This complexity transcends mere dermal thickness, highlighting the need for a nuanced understanding of skin resistance in pigmentation procedures.

12. Potential Explanation for the Mistake

Our analysis points to a potential explanation for the inaccurate depiction of skin layers in some pigmentation training materials: confusion between "Thick" and "Thin" skin.

Thick Skin vs Thin Skin: A Comparison

Skin, the body's largest organ, consists of three main layers: epidermis, dermis, and hypodermis. The key difference between thick and thin skin lies in the epidermis and dermis thickness.

Characteristics of Thin Skin

Location. Covers most of the body, except soles and palms.
Epidermis Thickness. Ranges from 0.07–0.15 mm.
Structure. Features hair follicles, sweat glands, and sebaceous glands.
Layers. Has four layers in the epidermis.
Function. Provides protection, sensation, and thermoregulation.
Characteristics of Thick Skin
Location. Found on soles and palms.
Epidermis Thickness. Up to 1.5 mm, including the stratum lucidum.
Structure. Lacks hair follicles, sebaceous glands, and arrector pili muscles.
Layers. Has an additional fifth layer, the stratum lucidum.
Function. Offers enhanced protection in high-friction areas.

Layer Analysis and Dermis Comparison

Stratum Basale to Stratum Corneum. Each layer has distinct characteristics, with the stratum corneum being the outermost layer in both skin types.
Dermis Variation. The dermis in thin skin is thicker and contains sweat glands and sebaceous glands, unlike in thick skin.

Conclusion on the Thick-Thin Skin Mix-Up Hypothesis

This analysis leads to the hypothesis that misrepresentation of epidermis thickness in training materials may result from a mix-up between thick and thin skin images. The epidermis in thick skin, found on palms and soles, is thicker due to the stratum lucidum layer, while the dermis is thinner. This contrast can lead to misconceptions about the actual thickness of facial skin layers, which is vital for precision in semi-permanent pigmentation procedures.

To prevent misinterpretations, pigmentation training materials must accurately depict thin skin, especially regarding facial pigmentation techniques.

13. Conclusions

Significant Discrepancies in Graphics

Graphics in many pigmentation training materials significantly misrepresent the relationship between epidermis thickness and needle diameter. On average, they depict the epidermis as being 30-50 times thicker than the typical needle used for penetration. Consequently, the needle's penetration hole appears 50 times smaller than the portrayed thickness of the epidermis.

Reality vs. Representation

In reality, the diameter of a standard needle is about five times larger than the epidermis thickness. This means the graphics are off by 250, leading new artists to incorrectly believe there is sufficient space within the epidermis for needle insertion. Such misconceptions can result in the needle going too deep into the hypodermis, causing pigment migration and “blowout."

Three Common Misconceptions Debunked

Implantation into the Basal Membrane. Implanting pigment into the basal membrane is biologically and dermatologically implausible. The membrane's thickness is much thinner than typical pigment particles, rendering such implantation impossible.

Hitting the “Sweet Spot”

Consistently targeting the papillary dermis's uppermost part is beyond our sensory abilities. In practice, pigment often extends into all dermis layers and sometimes the hypodermis.

Adjusting Needle Length for “Thicker Dermis.” The belief that a thicker dermis requires longer needles or offers more resistance is scientifically unfounded. The epidermis's resistance is largely due to the Stratum Corneum's density, which is influenced by various factors, from lifestyle to genetics, rather than dermis thickness.

Potential Cause of Inaccurate Graphics

A probable cause for these inaccuracies is the use of images depicting “Thick” skin, which has an epidermis over ten times thicker and a disproportionately thinner dermis than actual facial skin. Using such images as a basis for facial skin cross-sections leads to further inaccuracies. However, this "Thick" skin is not typical of facial areas, resulting in substantial errors in training materials.