SKIN FUNDAMENTALS FOR PMU ARTISTS

PERMANENT MAKEUP: THE SKIN - FUNDAMENTALS

We are going to take a virtual tour of our canvas to affirm some fundamental concepts that will always be useful when doing a permanent cosmetic procedure.

From a histological point of view, the skin is divided into two main components: the epidermis and the dermis.  

The dermis is the deepest layer of the skin; it constitutes a support structure, because it is made up of connective tissue and elastic fibers; and it contains blood vessels and nerve endings, providing the skin with nutrition and sensitivity. In addition, the dermis is the seat of the appendages or annexes of the skin, such as: hair follicles, sweat glands, sebaceous glands, hair and nails.

The dermis is the deepest layer of the skin; it constitutes a support structure, because it is made up of connective tissue and elastic fibers; and it contains blood vessels and nerve endings, providing the skin with nutrition and sensitivity. In addition, the dermis is the seat of the appendages or annexes of the skin, such as: hair follicles, sweat glands, sebaceous glands, hair and nails.

Below the dermis is a thick layer of fat cells, or adipocytes, called skin muscle tissue.

EPIDERMIS
The epidermis constitutes a barrier or covering, so its function is primarily protective. Since it does not have its own irrigation, it depends for its nutrition on the blood flow of the capillary plexuses of the dermis. The epidermis is made up of 4 layers or strata, in which keratinocytes can be seen in different stages of maturation.

What about the epidermis cells?

The epidermis is also made up of other cell lines, which are different from keratinocytes, such as melanocytes, Langerhans cells and Merkel cells.

Melanocytes are found in the basal layer, interspersed with keratinocytes and are the cells that are responsible for producing melanin, the dark pigment that gives skin its color and is responsible for ethnic variations in skin tone. Melanin also helps protect the skin from ultraviolet radiation in sunlight.

Melanin is produced in the cytoplasm of the cell and packed into structures called melanosomes. The melanosomes are then distributed, by dendrite-like cell processes, to the keratinocytes adjacent to the melanocyte. A single melanocyte can distribute melanin to approximately 36 surrounding keratinocytes. They have strong correlation with the Fitzpatrick scale.

Langerhans cells.

These cells are permanent ready in the skin, waiting to recognize foreign substances and materials to the body. They are considered accessory cells of the immune system, since they are capable of encompassing, processing and presenting particles, wastes or any other type of substances, to the immunocompetent cells, thus favoring the induction of an immune response, or, where appropriate, a reaction. allergic They move through the dermis, subcutaneous tissue, and even regional lymph nodes. When we introduce pigments to the skin these cells are activated, so it is important that these pigments do not cause adverse reactions on the skin of clients.

Merkel cells

These cells are in the deep layers of the epidermis, connect with keratinocytes through intercellular bridges or desmosomes, and are closely associated with myelinated nerve endings in the papillary dermis, which is why they are thought to have sensory functions, especially tactile ones. So, it´s very important to have a good anesthetic technique to avoid harming the Merkel cells.

Between the epidermis and the dermis is the dermo epidermal junction, which is a thin membrane that is vital to maintain cohesion between these two structures.

But I know that your real interest is in the dermis, which is the layer in which the pigment is deposited.

Below the dermis is a thick layer of fat cells, or adipocytes, called skin muscle tissue.

DERMIS
It is a complex structure made up of cellular and non-cellular elements, blood vessels, nerve endings, and epidermal or appendages (hair, nails, sweat glands, and sebaceous glands).

The dermis gives body to the skin and provides it with cohesion power. It controls the growth and differentiation of the epidermis, to which it also provides blood supply; and gives the skin an extraordinary sensitivity to different types of physical stimulus, through specialized nerve endings.

The dermis is divided into two areas: the papillary dermis and the reticular dermis.

The papillary dermis has small-caliber type III collagen fibers. It is much more cellular than the deep dermis, from which it is separated by a horizontal network of blood vessels. This is where tattoo pigments reside.

The deep portion or reticular dermis is formed by large bands of type I collagen. Although this part of the dermis is less cellular, it is larger and includes the epidermal appendages.

The dermis is made up of different types of fibers, such as: collagen, reticulin, elastin and smooth muscle fibers; various cell lines, such as: fibroblasts and fibrocytes; mast cells, adipocytes, macrophages and T lymphocytes.

It is also endowed with two vascular plexuses and nerve endings for tactile, thermal, pressure and pain perception. All these structures are embedded in the ground substance or extracellular matrix.

The dermis provides blood supply, lymphatic drainage and innervation to the epidermis; and largely regulates their rate of growth and differentiation.

The dermis is extremely important and can be considered as the supporting structure of the epidermis and the dermal-epidermal junction.

You already know in more detail the skin of your customers and its components. They all take part in your PMU work. 

How the sun affects our skin:

Sunburn is a radiation burn, caused when the ultraviolet (UV) rays of sunlight damage DNA in the upper layer of skin cells. The sun emits three kinds of UV radiation – UVA, B and C.

UVC is mostly absorbed by the earth’s atmosphere, but UVA and B rays reach the ground and can penetrate unprotected skin. UVB penetrates the epidermis, the top layer of the skin, while UVA goes deeper.
The skin of people who are sensitive to light can't protect itself from UV radiation for long. In very fair-skinned people, UV radiation starts becoming harmful after only about 5 to 10 minutes. All types of sunburn, whether serious or mild, can cause permanent and irreversible skin damage. 

Once the cells of the top layer of skin (called keratinocytes) detect DNA damage in themselves, they begin producing molecules to attract immune cells into the skin. This causes the skin’s blood vessels to leak into the spaces between cells and other skin structures. It’s this extra fluid and the swelling it causes that lead to the red skin, hot sensation, and painful sensitivity of freshly sunburnt skin.

Immune cell invasion begins while you’re still sitting on the beach but increases about an hour after you come in from the sun. The process peaks 24 to 48 hours later, which is why the redness and painfulness of a sunburn can keep developing for a couple of days. Some of the immune cells start cleaning up skin cells in self-destruct mode, while others release chemicals that further damage weakened cells. Their actions may also trigger a kind of allergic reaction that makes the skin itchy.

How does this affect PMU and other tattoos?

Permanent makeup colors are a powder pigment (iron oxides, organics, etc.) in a liquid carrier (water, alcohol, glycerin) after the carrier is absorbed by the body the powder pigment is left in the cells. The body will always recognize these pigments as foreign bodies, and therefore you are always at risk of the immune system attempting to “cleanse” the invader.  For the most part, the pigment is trapped in the dermal cells and remain relatively permanent due to the perpetual nature of dermal cell regeneration, however when the skin is damaged (due to UV exposure) the body’s immune system activates and removes the pigment containing cells.

What about sunscreen?

Sunscreen, which contains organic chemical compounds such as octyl methoxycinnamate, octyl salicylate, and ecamsule, relies on a chemical reaction to absorb UV light and convert it into heat, which is then released from the skin, On the other hand, sunblock contains mineral ingredients like titanium dioxide or zinc oxide that physically block UV rays. So, the main difference in sunscreen and sunblock lies is the way they protect the skin from UV rays.

Sunblock is so named because it literally blocks UV rays by forming a physical shield, while a sunscreen contains chemicals that absorb UV rays before your skin can.

Sunscreen only works when it’s absorbed by the skin, therefore it needs to be rubbed in. But you can simply slather sunblock on since it acts as a physical barrier. You do have to apply sunblock evenly, though, since UV light can hit any exposed parts of the skin, no matter how small. Since sunblock isn’t rubbed in, it normally leaves a white cast on the skin, while sunscreen disappears completely. 

Since sunblock completely blocks the sun’s rays it is effective in protecting the skin from damage and pigments from lightening - but most people are not going to walk around with solid white cream all over themselves all the time they are outdoors.  Sunscreen helps however any exposure to the sun will affect pigment color.

So even if I'm wearing sunscreen my tattoos will still fade?

Unfortunately, yes. The technical term for color fading is photodegradation. There are light absorbing color bodies called chromophores that are present in colors. The colors we see are based upon these chemical bonds and the amount of light that is absorbed in a particular wavelength.

Ultraviolet rays are one of the causes of fading because they can break down chemical bonds and fade the color in an object. Other major contributors to fading include visible light and solar heat.   Pigments have a rating called colorfastness which in short is how resistant the pigment is to fade.  In a good quality formula, the manufacturer will look to blend colors that have similar colorfastness to ensure that the color fades evenly and doesn’t shift (meaning one color fades first leaving an unwanted undertone color like green or orange behind).

When pigments have similar colorfastness, they will fade at similar rates, however the actual pigment particle will remain in the skin making future retention more difficult.  I can’t stress enough how important this is when discussing sun exposure with your clients.

So, what can you do?

First, you need to decide if you are even going to accept clients that sun worship at this level.  It is going to affect the quality of your work, and some artists simply refuse to work with a compromised canvas. Next, you must insist that your sunworshippers do not tan or burn prior to their appointments because you need good, healthy skin to tattoo into, otherwise the body's immune system will remove pigment as it cleans up the damaged cells. I typically make my sun ladies touch up in the spring.

Educate your clients on the effects of sun on their tattoos.  Insist that they wear sunscreen at a minimum and suggest big sunglasses and a hat when outdoors. (And then cross your fingers that they will listen).

Set reasonable expectations.  When I have a client who has been tattooing her brows yearly for the last eight years that are heavily saturated, and now has very damaged skin...and then asks me for “natural hairstrokes” I do my best to explain how and why that’s not possible and lay out some options for how to come to a compromise. This often includes removal of previous tattooing and abstinence from the sun. If she is unwilling to do this and she doesn’t have a realistic expectation of results, I will politely tell her that I am not the artist for her.

If they insist on tattooing in the summer and I think they are going to be out in the sun a lot, I give them a travel size baby sunblock and ask them to put it on their brows when outdoors. This is something I GIVE them, because if you simply tell them to use something they will likely “forget” so I give all the aftercare items I want my clients to use.

Helpful tip:

I get small lip sunblock sticks (they look like Chapstick) and give them out to my clients to keep in their bag, so that if they are going to be outdoors and forget to put sunscreen on, they have a handy stick they can use on their PMU. And again, cross my fingers that they will use it.

What is summer like in your area?  Do you have an increase or decrease in PMU services?

If you have a decrease, what services do you offer to supplement the lost income?

If you have an increase, what strategies do you use to keep clients dedicated to their aftercare?

Let me know on the comments section down here. I am really curios to hear from you about this subject