Scarring and needle directions are explained

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1. Background

In the realm of eyebrow procedures, the direction in which the needle is held while using the handpiece has become an area of significant focus for many artists. Various schools of thought advocate for different angles and techniques for holding the handpiece optimally during the Powder Brows and Hairstrokes procedure, among other semi-permanent pigmentation techniques.

This article draws insights from interviews conducted with 37 specialized artists predominantly from EU countries, complemented by insights from five UK and three US practitioners. These artists primarily offer Powder Brows and Hairstrokes as their main service. Additionally, 24 of these artists bring a wealth of experience from other semi-permanent makeup techniques, enriching the diversity of perspectives.

To ensure the accuracy and depth of the information provided, this article has also been reviewed by two dermatologists, a professional with an advanced degree in cellular biology and a chemist. The goal is to offer precise and comprehensive guidance on selecting the correct needle angle for performing Powder Brows, Hairstrokes, and other semi-permanent pigmentation procedures. This information aims to enhance the technique and outcomes for artists and ensure a safer, more effective application for clients.

2. Perpendicular entry

Technical Perspective: Needle Angle and Skin Penetration

When a needle enters the skin at an angle less than 90 degrees (perpendicular), it travels a longer path through the tissue, causing more disruption, especially in the papillary and reticular dermis. Elongated incisions are created rather than precise dots in motions like a pendulum or whipping, where the needle enters at an oblique angle. This happens because the needle slices through the skin, leading to a slit-like wound rather than a dot, affecting pigment deposition. Visualizing this from above, the smaller the needle's angle, the longer the slit in the skin, reducing the likelihood of the pigment healing into a desired dot or "pixel."

Biological Perspective: Skin Structure and Healing Response

The skin comprises multiple layers, including the outer epidermis and the underlying dermis, which is further divided into the papillary and reticular layers. The papillary dermis is thinner with fine collagen fibers, while the reticular dermis is thicker and denser. A perpendicular needle penetration primarily impacts the epidermis and the superficial part of the dermis, minimizing damage. An oblique angle increases the likelihood of disturbing the deeper reticular dermis, causing more significant tissue disruption.

Pigment Dispersion and Scarring

Greater tissue disruption triggers a more robust healing response, including inflammation and potential collagen deposition. When pigment is deposited in a line (due to an oblique needle), it spreads out and may become less defined as the wound heals, causing pigment migration, blurring, and spreading beyond the intended area.

Risk of Scarring

Deeper penetration and increased tissue trauma raise the risk of scarring, which can trap pigment in unwanted patterns and disrupt even pigment distribution.

Maintaining the needle at a perpendicular angle during semi-permanent pigmentation procedures is essential. It minimizes tissue damage, ensures precise pigment deposition, and reduces the risk of pigment spreading and scarring. The angle of needle entry significantly influences the wound's nature, the healing process, and the final appearance of the pigment in the skin. Therefore, understanding and applying the correct needle angle is crucial for achieving optimal results and client satisfaction.

3. The scarring effect

Scarring significantly impacts the effectiveness of pigment deposition during the Powder Brows and Hairstrokes procedure. Essentially, the more scarring there is, the less likely the pigment will settle in the skin as intended. This issue is primarily due to two significant problems: the "No Room" problem and the "Bad Neighborhood" problem. These challenges highlight that scarring does not provide an ideal environment for pigment particles to be encapsulated in the skin. Insights from biological, chemical, physical, and dermatological analyses support this understanding.

The "No Room" Problem

When scarring occurs, the skin's normal structure is replaced by scar tissue, which is denser and less receptive to new substances, including pigment. Scar tissue lacks the open spaces and natural receptiveness of healthy skin, leaving "no room" for the pigment to settle as it would in unscarred skin. Even if the pigment is inserted, it may not stay where intended, leading to less effective or uneven results.

The "Bad Neighborhood" Problem

Scarring doesn't just reduce space for the pigment; it also changes the skin's environment, creating a "bad neighborhood" for the pigment particles. Scar tissue is biologically different from normal skin, with variations in blood supply, collagen structure, and cellular composition. These differences can lead to unpredictable pigment behavior. Pigment may migrate, fade unevenly, or appear blurry as it interacts with the scar tissue's irregular and often more rigid environment.

4. ”No Room" problem

Formation of Scar Tissue

Scar tissue formation is fundamental to skin healing, especially in Powder Brows, Hairstrokes, or microblading procedures. When the skin undergoes these procedures, it initiates a healing response that includes scar tissue formation, largely made of collagen produced by fibroblasts. Collagen is crucial for lending strength and structure to the scar and is essential in the repair process.

Microscopic Interaction

The interaction between pigment particles and the tissue matrix is intricate on a microscopic level. Normal skin has a harmonious balance between pigment size, distribution, and surrounding tissue architecture. Scar tissue disrupts this balance, potentially leading to uneven pigment distribution and lesser overall deposition. This is often due to pigment particles being more densely packed or encapsulated in specific areas within the scar tissue, leading to uneven pigmentation.

Implanting Pigment in powder and strokes

In Powder Brows and Hairstrokes, pigments are implanted into the skin's dermal layer, where fibroblasts are crucial. They encapsulate these pigment particles in the healing process, effectively incorporating them into the developing scar tissue. This encapsulation is vital for the pigment's stability and longevity in the skin.

Complications from Excessive Scar Tissue

However, issues arise with excessive scar tissue formation. Normally, fibroblasts produce optimal collagen for healthy scar tissue and effective pigment encapsulation. However, excessive trauma, infection, or an overactive healing response can lead to an overproduction of collagen and excessive scar tissue, which is dense and thick.

Challenges of Dense Scar Tissue

This density can hinder the fibroblasts' ability to encapsulate pigment particles properly. In a tight collagen network, limited space and flexibility make it difficult for fibroblasts to effectively interact with and encapsulate the pigment. This leads to uneven pigment distribution or instability in its placement, affecting the semi-permanent makeup's quality and appearance.

The Warehouse Analogy

To simplify, imagine fibroblasts as workers organizing and storing items (pigment particles) in a warehouse (the scar tissue). In a well-sized warehouse, they can store items neatly. However, suppose the warehouse is overly packed and cluttered (like in excessive scar tissue). In that case, the workers struggle to store the items properly, leading to a disorganized and less effective storage system.

5. ”Bad Neighborhood" problem

Excessive Scarring and Inflammation

In cases of excessive scarring, a more robust inflammatory response is often observed. This inflammation can lead to increased tissue turnover and changes in the local microenvironment, potentially hindering pigment particles' stable deposition and retention. The chemical composition of scar tissue might also change, affecting the stability of the pigment. For instance, a more acidic or alkaline environment, which can occur in inflamed or healing tissues, might impact the chemical stability of certain pigments, leading to color changes or decreased retention.

Impact of Alkaline Environment on Pigment Stability

While the particle size of pigments is a physical property, and the pH level of colorants is a chemical property, empirical studies have suggested that wound healing and subsequent scarring can create a more alkaline skin environment. This shift in pH can impact the stability and appearance of pigments in scarred tissue, particularly for pigment particles around 500 nm in size.

The City and Tourist Analogy

Imagine the skin as a city and pigment particles as tourists looking for a place to settle. Normally, the skin offers a welcoming and stable environment, like a city with good living conditions. However, excessive scarring and inflammation from procedures like powder brows and hairstrokes can drastically change the skin's environment, making it more alkaline and less hospitable - akin to a city experiencing a surge in crime or becoming less hospitable. As a result, the pigment particles may not encapsulate effectively in the scarred tissue. They might be unevenly distributed or migrate to other areas, leading to suboptimal results in the powder brows and hairstrokes procedure.

Blood Supply Alterations

Scar tissue typically has reduced blood supply compared to normal skin. This decreased vascularity can influence the delivery and maintenance of pigments, as the vascular network plays a role in sustaining the cells and tissues where pigments are deposited. The altered blood supply in scar tissue can further complicate pigment particles' stable placement and longevity.

6. Scarring and inorganic pigments

Misconceptions about Inorganic and Organic Pigments

In the world of semi-permanent makeup, especially in powder brows and hairstrokes procedures, there's a nuanced relationship between the physical and chemical properties of the pigments used and the skin's biological responses. A common misconception is that inorganic pigments are inherently 'good' due to their perceived naturalness. In contrast, organic pigments are often labeled 'bad' due to their carbon-based structure and perceived permanence. However, this oversimplification doesn't account for the complex dynamics of pigment interaction with skin tissue, particularly in scarring and removal.

Balancing Biological and Chemical Considerations

Creating powder brows and Hairstrokes involves delicately balancing the biological trauma caused by the procedure with the chemical nature of the colorant, especially regarding its removal from the skin. This balance is critical and varies depending on several factors.

The Double-Edged Sword of Inorganic Pigments

Inorganic and mineral pigments are often favored for compatibility and "natural" options. However, this view doesn't consider the full picture. Excessive scarring from implanting these pigments can cause long-term damage by altering the skin's collagen structure, affecting pigment appearance, skin health, and texture.

Organic Pigments: A Different Set of Challenges and Benefits

Conversely, organic pigments may pose different challenges and benefits, sometimes causing brows to appear grayish and stay longer in the skin. Regarding removal, such as through laser procedures, organic pigments can respond more favorably, potentially causing less overall skin damage than the scarring from inorganic pigments used by inexperienced artists.

The Crucial Role of the Artist's Technique and Expertise

The key lies in the skill and expertise of the artist. The choice between organic or inorganic pigments should be made while considering the artist's proficiency. Reflexively considering inorganic pigments as safer and "less damaging" is a misconception. The long-term effects can be harmful if their application permanently changes the skin's collagen structure and scarring.

A Holistic Approach to Powder Brows and Hairstrokes

Therefore, selecting organic or inorganic pigments should be informed by thoroughly understanding the pigments' properties and the artist's technique and skill level. The impact of these procedures goes beyond the immediate visual results, affecting the skin's structural integrity and health. A holistic approach considering the skin's biological responses and the pigments' chemical nature is vital for achieving the best outcomes in semi-permanent makeup applications.

7. Renewal of dermis

Natural Healing and Scarring

As discussed, scarring is an inherent part of the healing process, where the body produces new collagen fibers to repair the damage caused by the needle during procedures like powder brows and hairstrokes.

Longevity of Dermal Scars

The persistence of scarring within the dermis varies and is influenced by factors such as the needle's penetration depth, the individual's skin type, and their healing response. Generally, dermal scars are long-lasting. Unlike the epidermis, which regularly sheds and renews, the dermis experiences much slower cellular turnover and regeneration. Dermal Renewal and Age Factors

The dermis does not renew itself as quickly or in the same manner as the epidermis. Although some degree of cellular turnover and collagen remodeling occurs over time, complete renewal of the dermis is rare. The collagen turnover rate and the skin's reparative capacity diminish with age. Younger skin typically heals more effectively, potentially leading to less noticeable scarring. Conversely, older skin may scar more readily and heal slower, resulting in more prominent or persistent scars. Visibility of Scarring

Not all scarring is visibly apparent. Microscopic scarring involves subtle changes in the skin's collagen structure and can occur without visible signs on the skin's surface. This type of scarring can still affect the skin's texture and response to future treatments, including pigment retention. The extent of visible and microscopic scarring is influenced by factors such as the technician's skill, technique, and post-procedure care. Long-Term Implications

Scarring in the dermis caused by powder brows and hairstrokes procedures can lead to long-term skin structure changes. The extent and visibility of this scarring depend on various factors, including age, skin type, procedure specifics, and aftercare. While younger individuals may experience less pronounced scarring due to better skin resilience and healing capabilities, older individuals may have more noticeable and enduring scars.

8. Practical techniques

In semi-permanent makeup, especially in powder brows and hairstrokes, understanding the interaction between scarring, pigment characteristics, and needle angle is crucial for aesthetic outcomes and skin integrity.

Pigment Implantation and Skin Damage Risk

The physical and chemical properties of pigments significantly affect their implantation ease. Harder pigments might be more challenging to implant, possibly increasing skin damage risk. More effort or pressure to embed these pigments can lead to increased skin trauma and potential scarring.

Optimizing Needle Angle for Effective Pigmentation

A 90-degree needle angle is commonly recommended to minimize skin damage. However, experienced artists may adjust this angle, especially with thicker pigments, to enhance pigment flow. An angle between 70 to 90 degrees can facilitate more efficient pigment transfer, reducing the number of passes and overall skin trauma. However, angles lower than 60 degrees are generally discouraged as they can lead to excessive trauma, increased scarring, and uneven pigment distribution.

The Risks of Lower Needle Angles

Lower angles (below 60 degrees) can create more pronounced incisions, leading to excessive trauma and uneven pigment distribution. There are no beneficial cases in powder brow and hairstroke techniques where such low angles would be advantageous.

The Role of Skin Butters and Lubricants

Skin butter and lubricants moisturize the skin, reducing friction between the needle and the skin's surface. This facilitates smoother needle movement and more efficient pigment transfer. Well-moisturized skin can better receive and hold pigment, improving results' longevity and vibrancy. Therefore, incorporating these products can help minimize skin trauma and scarring while enhancing pigment deposition.

9. Conclusions

The angle at which the needle is used during the powder brows and hairstrokes procedure plays a crucial role in the outcome and the skin's integrity. Smaller needle angles increase the potential for skin damage and make it challenging to achieve the precise "perfect pixel" necessary for the pixelated look characteristic of powder brows and parts of hairstrokes.

Scarring as an Inevitable Aspect

Scarring is an unavoidable part of the powder brows and hairstrokes process. However, excessive scarring hinders the effective implantation of pigment particles. This leads to issues like the "No Room" problem, where the dense collagen in scars doesn't provide adequate space for pigment encapsulation, and the "Bad Neighbourhood" problem, where inflammation and scarring create an alkaline pH level in the skin that's unfavorable for pigment retention.

Factors Contributing to Scarring

Scarring results mainly from the needle's angle, the pressure applied, and the number of passes — even when performed perpendicularly (at 90 degrees). This issue is often associated with inexperienced artists using inorganic pigments, where multiple attempts to embed the pigment result in greater overall damage and scarring than organic pigments' potential laser removal. Thus, the type of scarring must be considered alongside the pigment used and the artist's expertise.

Tactics for Thicker Pigments and Skin Protection

For thicker (often inorganic or mineral) pigments, many artists adjust the needle to a 70-90 degree angle, seldom lower. For areas of powder brows and hairstrokes that don't require pixels, the pigment can be implanted at a slightly smaller angle but never less than 60 degrees. Employing skin butter and lubricants can also mitigate the damage to the skin.

Adhering to Medical Ethics

The principle "Primum non nocere" (First, not harm) should always be at the forefront of any procedure. Each component - needle angle, pigment type, skin condition, or artist's skill - is a complex interplay. The ultimate aim should always be to minimize damage to the skin, ensuring the client's health and the aesthetic quality of the work.