To treat or not to treat: Different scar types. Chapter I

Permanent makeup used as a means of corrective camouflage can serve various purposes. It can effectively conceal imperfections, some skin diseases like vitiligo and is most effective when dealing with various types of scars. However, not all scar types qualify for micropigmentation. It is critical for the artist to identify the scar type before the procedure and be certain about indications and contraindications of the treatment on the particular patient.

The formation of a scar is the body’s natural way of healing and recovering from skin loss or damage. Scars are composed of fibrosis tissue which is thicker than normal skin due to the increased amount of collagen. Skin reparation is possible because of the activity of special cells called fibroblasts. Resting fibroblasts are most typical resident cells of regular connective tissue. They form its matrix by secreting collagen as well as some other vital components. However, fibroblasts preserve their ability to move to the active phase and multiply when needed, for example during tissue repair. The increased amount of collagen produced by fibroblasts makes up scar tissue that remains even after the skin surface has re-epithelialized.

Although the composition of the scar tissue cannot vary significantly, its histology and physiology may differ.

Thus several types of scars are known:


Keloids are firm, thick clusters of scar tissue that rise above the surrounding skin. They are more common in patients of ethnic skin and appear at the site of previous skin damage or wounds (incision, vaccination, piercing etc.) Apart from other types of scars, keloids keep growing after the injury has healed due to the increased collagen production and thus may extend far beyond the spot of the initial skin damage.

It is highly not recommended for the patients prone to keloid formation to have micropigmentation treatment done. Although microperforations made by tattoo needles do not go deep into the skin layers, they pose certain risks to the patients with above average susceptibility. It’s a challenging process for the artist to define if their patient is a high-risk one. The easiest way to determine if the permanent makeup procedure is feasible in a particular case is to check if the patient has piercings. In case they do not, a scratch test should be performed and/or a color line should be applied behind the patient’s ear. It should be then watched closely for several months to ascertain if the keloid formation should occur.

It is strongly prohibited to perform a micropigmentation procedure on the existent keloid scar.

hypertrophic_scarHypertrophic scars appear red and lumpy, elevated. They resemble keloid scars and their formation also reveals a disbalance in collagen production, however they are usually confined within the boundaries of the damaged area. Although hypertrophic scars do not extend beyond the wound, they may continue to thicken for up to 5 years. However, these scars tend to flatten and whiten overtime. The results of a micropigmentation treatment performed on hypertrophic scars are deemed unpredictable, as there is a high probability for them to reappear. Certain clinics, however, do perform such treatments.

In the interest of safety, patients prone to hypertrophic scars are advised to refrain from getting a micropigmentation procedure performed. The artist should warn the patient against the possible consequences beforehand. However, the decision remains up to the patient. The informed consent form should be signed prior to any procedure.

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