Scar camouflage is the field of micropigmentation that is probably the most difficult to work in as scars do not retain pigment well, are hard to penetrate with the needle due to the thickness of the fibrosis tissue and can even grow further as the result of secondary scarring. As challenging as this work can be, there is an even more difficult part – performing the procedure on burn survivors.
Working with burn scars is complicated due to a number of reasons:
-burn scars usually cover a large area and often occur on the face;
-burn survivors have usually undergone a number of surgeries prior to the micropigmentation treatment and their skin can become extremely sensitive that requires more careful approach with anesthetics;
-Psychological aspect of the procedure may be challenging since some patients might build their hopes too high and develop unrealistic expectations of the results of the procedure. The artist should remind the patient that scar camouflage is the treatment that takes a multiple preparatory steps and thus can be extended in time. It is also vital to show the pictures of your previous works on burn scars and to write down the goals and the treatment plan discussed with the patient to create more realistic expectations.
-Changes in food and medications regimen can influence the appearance of the patient’s skin undertone; therefore it is crucial to discuss this point with the patient. The pre-treatment diet does not have strong limitations though except for the proper hydration and avoiding caffeine, alcohol and aspirin for 5 days prior to each procedure.
The initial step in planning a micropigmentation camouflage treatment on a burn scar is to refer the patient to the exfoliation procedure with the use of glycolic or other acid – this will remove dead cells from the surface of the epidermis and provide better pigment retention. The time between the exfoliation procedure and the micropigmentation treatment will vary in different age groups considering the speed of skin renewal. Thus, for young skin it takes 21-28 days, for mature skin 28-49 days, and for aging skin 49-84 days and longer. In case of a facial burn scar the examination of facial symmetry and morphology is essential.
Before performing any camouflaging treatments on the scar it is crucial to do a patch and sensitivity test. The final color will be a blend of the pigment color and the patient’s skin undertone color, so it’s important to evaluate the latter using special charts or schemes, it also pays to take the patient out to the daylight or at least to use daylight bulbs.
Since the scar tissue is thick and difficult to penetrate, it is recommended to use coil machines for pigment insertion rather than rotary machines which are not powerful enough and thus fail to provide consistent and smooth pigment application. The choice of needles is always up to the artist, but the best results have been observed with the use of 14 round needles and 6 flat needles combined together. Each application should start with the examination of the patient’s skin to ensure there is no rash or other irregularities
All the procedures, including tests and touch-up visits, should be scheduled in 4-8 weeks intervals to allow for skin healing, unless various areas are treated at each appointment.