Fundamentals Training Manual - Digital Brows, Eyes, Lips & Microblading - Tracie Giles
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Digital Brows, Eyes, Lips & Microblading
Fundamentals Training Manual
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Welcome | From the ID Liner® Training Team
Welcome to the ID Liner® Training School! Our dedicated training team are excited to work with
you and to help kick-start your career in one of the most challenging but rewarding professions in
the beauty industry. A career in Permanent Make Up is not only exciting, varied and financially
lucrative, but it is also incredibly fulfilling. Being a skilled technician, you have the power to make a
positive difference every single day both to the lives of your clients and to yourself, by advancing
your own personal journey of growth and development. In order to be successful in this highly
competitive industry, you need to learn from the best. Our highly progressive training courses will
equip you with the knowledge, skills and support that you need to excel in Micropigmentation as
well as providing you with a national accreditation.
Teaching for us means sharing knowledge, experience and a genuine passion for an art that we have
dedicated our lives to. It means supporting you to develop technical skills and trying to get the best
out of you. While some students learn quickly, others will need more time; you should not compare
yourself to your colleagues during the first few weeks of your learning as everyone learns differently.
You may not have been in a classroom situation for a very long time, or you may be a perfectionist
who becomes frustrated when you cannot grasp something new immediately. Going through a
rollercoaster of emotions during this course is totally normal! We are here to offer you guidance
and support and to help you become the very best technicians in the world. Work hard, be patient
and embrace the team spirit of learning with others to become colleagues and not competitors.
We would like to thank you for choosing to train with us and have no doubt that this first platform
to permanent make up will provide you with the foundations to build a long, skilled and successful
career in this wonderful industry.
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ID Liner Training Course | Code of Conduct
1. Leave your ego at the door! It’s easy to become frustrated and angry when you aren’t
immediately perfect at something that initially may appear to be very easy. Listen to your
trainers and be totally open to their suggestions. Don’t take offence at their critique as this is
just to help you be the very best you can be. Don’t be afraid to ask for help when you need it.
2. Our experienced trainers will not let you perform any element of the treatment on a client if
they feel that you’re not ready. If you aren’t ready, watch the trainer take over, and use any
free moment to practice on the mats provided – practice really does make perfect.
3. It is essential that you complete your 120 hours pre-study before entering the classroom. If you
haven’t got to grips with the fundamental theory of Permanent Make Up, you won’t be ready
to work in a practical environment where knowledge of hygiene and legislation is vital. Safety
is paramount.
4. The models on the course are real clients and you should treat them with the same respect,
courtesy and understanding that you would a regular client in your own clinic. If you feel
nervous, if an issue arises that you feel uncomfortable with (such as they are
bleeding a lot or you can’t get the colour into the skin) or if there is something that you need to
say to your trainer that may be inappropriate for your client to hear, ask to speak to your trainer
privately and do not have the conversation in front of the model.
5. Whilst a totally sterile environment cannot be achieved, it is essential that:
a. Hands are washed before entering the classroom and sanitizer is used
b. Coats and bags are left in the communal area
c. Hair is tied back and out of your face
d. Gloves are worn at all times when working with models/on skin
e. No food or drink is bought into the classroom
f. No jewellery is worn
g. No smoking permitted on the premises
h. Mobile phones may only be used in the communal break-out area or to photograph the
client
6. Swearing, discriminatory and offensive language/behaviour will not be tolerated.
7. While we provide you with the tools and methods to start your own business in Permanent
Make Up, it is forbidden to plagiarise or copy any literature/images belonging to Tracie Giles
Ltd.
8. Have fun and make the most of the opportunity to learn with some of the very best and most
experienced Permanent Make Up trainers in the world!
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ID Liner Training Course Manual | Contents
PAGE 8 | Health and Safety
1. The Importance of Hygienic Practices
2. Infection
3. Sanitation and Sterilisation
4. Waste Disposal
5. Workplace Hygiene Checklist
6. First Aid (inc. Needle Stick Injury)
PAGE 13 | Pre-Procedure
1. Preliminary Consultation
2. Patch Test
3. Contraindications
4. Consent Forms and Eligibility
5. Client Questions
6. Does it Hurt?
7. Pre-Procedural Advice
8. Contra-actions and Allergic Reactions
PAGE 20 | Main Theory
1. Anatomy
a. The Skin
b. Inflammation and Healing
c. Conditions and Disorders
d. The Skeletal System: Bones of the Skull
e. The Muscular System: Muscles of the Face
f. The Eye
g. The Eyebrows
h. The Lips
2. Colour Theory
3. Fitzpatrick Skin Type
4. Anaesthetic
5. Needle Grouping and Technique
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PAGE 69 | Performing the Treatment
1. Trolley Checklist
a. Treatment Checklist
2. Predrawing (General)
3. Stretching Technique
4. The Procedure
5. Professional PMU Products
PAGE 77 | Additional Material for VTCT Level 4 Micropigmentation Qualification
1. Additional Health, Safety and Security in the Clinic/Salon
a. Risk Assessments
b. Compliance
2. Quality Management
a. The Importance of Quality Management
b. Client Satisfaction Surveys
Appendix A: Medical History and Consent Forms
Appendix B: Pre-Procedural Advice
Appendix C: Aftercare Advice
Appendix D: Risk Assessment
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What is Permanent Make Up?
Permanent Make Up (Micropigmentation) is a cosmetic tattooing technique which implants
minute amounts of pigment into the outer layers of the skin, most commonly using EC safety
regulated cartridges or a single acupuncture needle. The pigments consist of organic and
inorganic minerals in a glycerin base, all selected specifically for their hypo-allergenic qualities. It
is sometimes described as a ‘cosmedic’ procedure, owing to the fact that not only it can be used
to create perfectly realistic hair-by-hair brows, beautifully shaped lips and defined eyes for
cosmetic purposes but also as a treatment for medical reconstruction and enhancement, for
example, following reconstructive surgery after breast cancer or breast surgery where the areola
has been removed/distorted.
The stages involved in a Permanent Make Up treatment:
• Preliminary Consultation
• Patch Test
• Pre-Drawing
• Procedure
• Retouch
• Annual Retouch
We would recommend that the client is seen for a preliminary consultation prior to starting the
Permanent Make Up procedure. This time should be spent listening to what the client wants to
achieve and for you to decide firstly whether your client is a suitable candidate for treatment (for
example, a lip treatment is not suitable for darker skin tones) secondly whether what they want to
achieve is appropriate, and thirdly that you believe that you can successfully manage and achieve
your clients expectations. If there is any chance that the final outcome of the treatment will not be
an improvement, we would never recommend carrying out the procedure. A consultation will also
allow for you to give the client a patch test (usually a small dot of pigment behind the ear) to ensure
that they are not allergic to the pigment when they come in for their treatment.
The next stage is carrying out the actual treatment which is comprised of the initial pre-drawing and
the actual cosmetic tattooing procedure, this will be discussed in more depth later during this course
Page|7 pack. When you are in the early stages of your Permanent Make Up career, it is important that you allow yourself enough time to carry out the treatment so that you do not feel under pressure or rushed. We generally recommend that you block out a minimum 2-hour interval for the initial treatment to make sure that you have enough time to achieve optimum results. As a beginner it should certainly not take you any less than 2 hours, and you may find that you require a longer period of time to produce the desired outcome. The client will be required to return after 2-12 weeks (depending on the treatment method) to complete the process, otherwise known as their retouch. The process will not necessarily be finished until the client has had this retouch as some skins will not sufficiently retain the pigment from the initial session. It is advisable to start off ‘lighter’ in the first treatment as it is much easier to intensify and add to the colour in the second treatment than to remove a colour that is too dark for the client. Any minor shape changes or additions can also be made at this stage. Some clients may even need 2 retouches, although this is not common for experienced technicians. To keep the colour looking fresh and fabulous we would suggest that on average your client returns every 12 months for a yearly retouch. If it is correctional/medical work that has been carried out this time period may vary. What is the difference between Permanent Make Up & Microblading? We get asked this question a lot by our trainees and it is really important that you know the difference between the two so that you can explain this to your clients and use the correct method to achieve the desired results. Both Permanent Make Up (also known as digital or cosmetic tattooing) and Microblading are forms of tattooing following the stages outlined above but are different methods of implanting the pigment into the skin at the procedure stage. With Microblading, we manually use a super fine blade (a microblade) to create cuts in the skin which look like hair strokes. Pigment is then implanted into these cuts in the skin. For Permanent Make Up, we use an electronically powered machine and a needle to implant the pigment, which is more similar to a conventional tattoo (but less aggressive and the pigment does not go as deep). A wider range of effects can be achieved with Digital Permanent Make Up including shading, whipshading and ombré. Some individuals will be better suited to a specific method, and some to a combination of the two.
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Health and Safety
1. PAGE 8 | The Importance of Hygienic Practices
2. PAGE 8 | Infection
3. PAGE 9 | Sanitation and Sterilisation
4. PAGE 10 | Waste Disposal
5. PAGE 11 | Workplace Hygiene Checklist
6. PAGE 12 | First Aid (inc. Needle Stick Injury)
1. The Importance of Hygienic Practices
Effective use of hygiene practices is necessary in the salon to prevent cross-infection. We are
surrounded by ‘germs’. Some germs are harmless, some are even beneficial, but others cause
disease and therefore present a danger to us. Cross-infection occurs when microorganisms capable
of causing disease and/or infection are transferred through personal contact or by contact with
infected tools that have not been properly cleaned and sterilised.
Contraindication - A contraindication is a reason to not carrying out a service. When you carry out
your consultation it is important to check for any type of contraindication or signs of infection. If a
contraindication is evident or suspected, advise that your client goes to their GP and gets written
confirmation that it is safe to carry out the treatment (attach this letter to their client record card).
Contra-action - A contra-action is an adverse reaction to a treatment or product. This can happen
even when all the necessary safety precautions have been taken. It is important that contra- actions
are recognised and dealt with appropriately.
2. Infection
Infection occurs when the body becomes contaminated by micro-organisms, these usually include
bacteria, fungal or viral causes. The reaction to the infection will depend on its cause and the part
of the body which is infected. The general signs of infection are inflammation, swelling and pus.
Secondary infection can occur if bacteria penetrate an existing injury or compromised skin that is
already infected by a viral or a fungal infection.
The germs which cause disease are usually spread by:
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• Unclean hands
• Contaminated tools/instruments
• Sores and pus
• Discharges from the nose and mouth
• Shared use of items such as towels and cups
• Close contact with infected skin cells
• Contaminated blood and tissue fluid
Infectious diseases that are contagious are a contraindication to beauty treatments and clients
presenting with a contraindication of this nature should be referred for medical attention. Clients with
skin disorders that have caused the skin to crack and inflame should also not be treated as they are
more susceptible to secondary infection.
Hygiene practices must always be strictly adhered to for every service offered as sometimes people
have a contraindication they are not aware of. If hygiene practices are not followed there could be a
risk of contamination from blood-borne viruses such as Hepatitis B and C, and HIV/Aids.
3. Sanitisation and Sterilisation
Sanitisation refers to any procedure undertaken in the salon to remove contamination and reduce the
risk of infection. Specific methods are required to ensure effective sanitisation of tools, equipment and
implements has taken place. As a permanent make up practitioner, you have a duty of care and it is
absolutely imperative that you provide a clean and sanitised environment and equipment for your
client.
Sterilisation is the total destruction of all micro-organisms. It is very difficult to maintain sterile
conditions as once the items have been exposed to the air they are no longer classed as sterile. Only
articles that have been cleaned, sterilised and stored hygienically are safe to use on clients.
Methods of cleaning tools and equipment:
• Disinfectant inhibits the growth of disease-causing organisms (except spores) using chemical
agents. Disinfectants only reduce the number of organisms but this is usually sufficient for
maintaining hygienic conditions. Disinfectant is mostly used for wiping down work surfaces
and equipment. Disinfectants should only be used under manufacturer's instructions and
following the correct COSHH guidelines. Do not use directly on the skin.
• Antiseptic is a diluted disinfectant designed for safe use on the skin. It prevents the
multiplication of microorganisms by making the conditions unfavourable for growth.
P a g e | 10
• UV Light Radiation is a method of sterilisation that
can be used but has limitations. The object being
sterilised must be turned regularly as only the
surface being exposed to the light rays will be
effectively treated. If there is debris or product
residue on the instruments this will act as a barrier
to the light penetration so effective sterilisation will
be slowed down. The UV light must be contained
within a closed cabinet as the light is dangerous
especially to the eyes. Records of usage should be kept
as the ultraviolet light source will decrease in its
effectiveness over time and new bulbs will need to be
installed (follow manufacturer's guidelines).
• Glass Bead Steriliseri can be used for sterilising small
metal tools such as scissors and tweezers. The heat
from the beads transfers to the objects effectively
killing off microorganisms. All tools must be cleaned
before placing in the unit to remove dirt and debris. It
is important to follow the correct timing guidelines
from the manufacturer's instructions to ensure
efficient sterilisation has taken place.
• Autoclaveii is the most effective method for killing
bacteria and their spores, however it has its limitations
as the temperature needed for this level of
effectiveness is 121 -134°C. It works similar to a
pressure cooker using high pressure steam to clean
the objects. Due to the higher levels of heat it is only
suitable for certain objects and these should be
cleaned before being placed in the autoclave. Always
ensure you have been trained for use and follow
manufacturer's instructions when using equipment of
this nature.
4. Waste disposal
Disposal of waste should be in a sealed bin lined with a durable polythene bin liner. The bin should be
cleaned regularly with disinfectant (this should only be done in a well-ventilated area) following
manufacturers’ guidelines to ensure no risk from potential hazards.
Hazardous waste must be disposed of following the correct COSHH procedures and the member of
staff responsible for the disposal must be fully trained.P a g e | 11
Clinical contaminated waste usually by blood and tissue fluid should be disposed of as recommended
by the environment agency in accordance with the controlled waste regulations 1992.
Any sharp implements that have been used to penetrate or pierce
the skin should be placed in a sharps box. The local environmental
health department will be able to advise you on disposal
arrangements. All disposable waste matter following Permanent
Make Up application is contaminated as it will contain blood and
tissue fluid. There is a risk of transfer of blood borne infections such
as Hepatitis B and C, and HIV.
All staff should be trained in the risks of handling this waste. The
waste should be placed in an orange sack which indicates its level
of risk and should be kept separate from all other general waste.
Yellow bags are now provided to medical establishments as they
are classed as clinical waste and are hazardous. Orange bags are generally provided to salons as they
are classed as a potential hazard. However, both are disposed of in the same way. Your local
environmental health office can give up to date guidance on disposal of such waste.
5. Workplace Hygiene Checklist
To maintain acceptable levels of hygiene:
• Maintain high standards of personal hygiene.
• Wash hands before and after every treatment using a detergent containing chlorhexidine
which is recognised medically as an effective ingredient for skin sanitation.
• Follow all health and safety policies identified during your workplace induction and regular
work place reviews.
• Check all equipment is in good repair and fit for purpose, identify any concerns by labelling
and isolating equipment and report to manager for follow up action.
• Regularly clean all working surfaces with an appropriate cleaning solution following
manufacturers’ guidelines.
• Cover any cuts on yourself or client with a suitable waterproof dressing.
• Ensure all tools have been effectively sterilised or disinfected according to their
manufacturer’s instructions, for example using Trigene solution and an autoclave to disinfect
callipers, tweezers, metal sharpeners.P a g e | 12
• Prevent the risk of cross infection by checking for contraindications during the consultation.
• Where possible use disposable products and dispose of correctly following use.
• All gowns and towels should be washed at a minimum of 60°C and clean towels and gowns
provided for each client. The dirty laundry should then be placed in a covered laundry bin.
• Waste should be placed in correct bags or sharps containers depending on their nature and
disposed of in accordance with local government legislation. Pigment caps and all
contaminated usable items, including the barrier film wrapping should be disposed of in the
yellow waste bags.
6. First Aid
It is imperative that as a semi-permanent make up
practitioner, you know basic first aid techniques
acquired through a relevant course (such as those
run by St. Johns Ambulance or at local colleges etc.).
Many people are nervous prior to their procedure
and allergies, although rare, can occur. You should
know how to deal with fainting and blackouts, panic
attacks, heart palpitations and anaphylaxis, as well
as cuts, burns and sprains.
For Needle Stick Injuries you must react
immediately, as diseases such as HIV/Aids and
Hepatitis are transmitted through the blood. You
should remove your gloves and squeeze the injured
area hard so that it bleeds, and then run the area under cold water. You should apply a disinfectant
such as neat Dettol and put a plaster on the broken skin. The needle cartridge should be changed and
gloves should be reapplied. You may wish to carry out a risk-assessment on your client and visit the
doctor if you feel you need. All practitioners should have had a Tetanus and Hepatitis B vaccination
prior to entering the industry.P a g e | 13
Pre-Procedure
1. PAGE 13 | Preliminary Consultation
2. PAGE 13 | Patch Test
3. PAGE 13 | Contraindications
4. PAGE 14 | Consent Forms and Eligibility
5. PAGE 14 | Client Questions
6. PAGE 15 | Does it Hurt?
7. PAGE 16 | Pre-Procedural Advice
8. PAGE 17 | Contra-actions and Allergic Reactions
1. Preliminary Consultation
The preliminary consultation is used to understand what your client wants to achieve and to determine
whether they are a suitable candidate for Micropigmentation. Their colourings will be assessed as well
as any contraindications they may have that will prohibit them from having the treatment. It is during
this consultation that you should be able to answer any questions that your client has and they should
be given a patch test. Either at this point, or at the beginning of their procedure the client should be
given a consent form to sign, giving you permission to carry out the treatment.
2. Patch Test
A patch test should be given to the client at least 24 hours prior to them having
their treatment to help determine whether they have an allergy to either the
pigment or anaesthetic. If the client comes to the clinic, a small dot of pigment
and anaesthetic should be applied to an inconspicuous part of their body, for
example behind the ear. If you are posting their patch test to them, you may
wish to send a cotton bud that has some of the pigment and anaesthetic on it
which they can rehydrate and apply to themselves.
3. Contraindications
As has previously been mentioned, a contraindication to micropigmentation is a condition that serves
as a purpose for a person not undergoing the semi-permanent make up treatment. If your client admits
to having one of these conditions, you should not carry out the treatment. This list below is not
exhaustive, but these are the most common contraindications preventing a client from having
treatment. You should also check with your insurance company as they may put exclusion clauses in
your public and product liability insurance relating to certain conditions.
• Auto-immune conditions (these require doctors’ consent prior to treatment)
• Antabuse (must have finished course of medication)P a g e | 14
• Insulin dependent diabetes
• Epilepsy
• Haemophilia HIV/Aids Hepatitis B and C
• Pregnancy and Breastfeeding Problems with skin healing
• Roaccutane – Must allow 6 months after completing the course before having treatment
Lupus
• Undergoing chemotherapy – Need doctors’ consent prior to treatment
• Keloid scarring
4. Consent Forms and Eligibility
Your client must declare their medical history and give their signed consent to you carrying out the
treatment before you begin. They should also:
• Be over the age of 18
• Not be pregnant of breastfeeding
• Have obtained a doctors’ written consent if they are currently undergoing chemotherapy
or suffer from an immune condition
• Be aware that they will not be able to give blood for one year following their treatment
• Be aware that if they are to have an MRI, the individual giving the MRI should be made
aware that they have permanent make up
See Appendix A for an example medical history and consent forms that should be given to the client.
5. Client Questions
Here are typical answers that we give to our clients frequently asked questions:
How long will my Permanent Make Up last?
The majority of clients require 2 initial Permanent Make Up treatments after which you will require at
least one treatment per year to ensure that your make-up stays fresh and fabulous looking for the
whole year.
What factors may affect the results?
Pigment implantation is partially affected by differing skin types and by the following:
• Medication
• Natural skin overtones
• Skin characteristics (dryness, oil, sun damage, thickness and or colour)P a g e | 15 • pH balance of the skin • Scarring from previous surgery How long will a treatment take? Depending on the treatment, we recommend at least 2 hours for each new procedure to ensure that the client receives a detailed and personalised consultation and treatment. Is it permanent? Micro-pigmentation procedures can leave residue pigment in the skin permanently. However, it cannot be truly classed in the same category as a tattoo as in many cases the pigment will fade and may even disappear completely. If the procedure was classed as semi-permanent this would imply that the skin will return to its pre- tattooed stage at some point (this usually would not be the case). The procedure would only be truly classed as semi-permanent if the penetration of pigment only affected the epidermal layers. The layers of the epidermis are constantly renewing themselves so therefore any pigmentation implantation to this level only, would be desquamated out of the skin within a 4 - 6 week period. Traditional tattooing procedures are practiced using inks and dyes which are dissolved in a wetting agent and implanted at a deeper level into the lower reticular layer of the dermis. Micro-pigmentation procedures implant iron oxides into the upper reticular layer of the dermis, therefore there may be a degree of colour visible in the skin for a lifetime. However, the degree of colour will usually fade and maintenance procedures are required every 12-18 months to ensure clarity of colour and design. Clients should be informed that the procedure will leave a degree of pigmentation in the skin that is likely to fade over time. NB. There is an exception to this rule when discussing lip tissue type 1 in comparison to the vermilion border or peri-oral skin. Due to the vascular nature of lip tissue type 1, infused pigment will usually only last about 2-3 years maximum before they need re-treating. The vermilion border and peri-oral skin are more likely to retain pigment and therefore a definite lip line may become apparent as the body of the lip tissue pigment colour fades. Any area of enhancement can have colour changes as the pigments fade over time, although this is more obvious in eye and eyebrow procedures. Reviewing the clarity and colour every 12 -18 months
P a g e | 16
will ensure the client is satisfied with the overall results and allow for any changes that need to be
made.
6. Does it Hurt?
Remember that pain is experienced at differing levels with each individual client and that it is felt as a
result of causing damage to the tissues of the body. During the permanent cosmetic procedure, pain
can be derived in a number of ways:
• The continuous rapid needle penetration damages the tissue and may present itself as a
sharp/scratchy pain.
• Stretching the skin. While it is necessary to stretch the skin for good practice, it could cause
the client some discomfort, especially as the tissue has been damaged.
• The anaesthetics and cleansers used are chemical irritants and can cause what some may
consider to be a painful sensation, especially when used around the eyes for example.
It is likely that your client will experience some level of pain and, while you should use anaesthetic to
minimise this, your client should not be deluded into thinking that this is a pain- free procedure nor
should they be made to worry that this painful sensation is abnormal. You may wish to mention to
your client that she will be more sensitive during her period and also that it is normal to experience
pain more on one side of the body than the other because of the positioning of our nerve endings.
You will minimise the pain by:
• Application of anaesthetic (although by law the client must buy their own anaesthetic and
apply it themselves)
• Scheduling appointments around the client’s monthly cycle
• Working accurately and with speed
• Giving necessary breaks at the client’s request
• Use cooling antiseptic products throughout the treatment to ease discomfort
• Adopting the correct stretching technique
7. Pre-Procedural Advice
See Appendix B for document of pre-procedural advice.P a g e | 17
8. Contra-actions and Allergic Reactions
Certain contra-actions are expected in the first week following micropigmentation procedures:
• Inflammation - erythema, swelling and increased skin temperature on and around the
treatment site is expected for the first 72 hours post treatment. Severe swelling and
blistering within in this timescale would indicate allergic reaction to the healing balm. Once
application of this product is ceased symptoms would begin to disappear
• Pain - lips are the most sensitive regarding pain and this symptom can last up to 2 weeks
post procedure. Eyelid procedures can cause discomfort for around 72 hours post
treatment in line with the normal inflammatory response period. Eyebrows are usually a little
tender post procedure but are not generally painful.
• Peeling/Flaking Skiniii - increased
shedding of the skin will occur following
trauma, this is all part of the natural
healing process. However prolonged
dryness beyond 2 weeks on the eyebrow
and eyelid area is not normal and the
client should visit their GP. Lips can
require the application of moisture balm
for up to a month post procedure as they
do not contain sweat or sebaceous glands
to provide natural lubrication to the area.
• Bruising - this can commonly affect the eyelids and lips but is only superficial and normally
subsides within 3-5 days.
• Herpes Simplex Type 1iv – a herpes
outbreak will only occur if the client is
already carrying the virus. It would
normally manifest itself around day 3 post
procedure. The client should be advised to
use topical anti-viral creams as a
precautionary method for a week
following micro-pigmentation
enhancement to the lips. However, someP a g e | 18
GP's will prescribe a course of oral anti- viral medication pre and post treatment (Acyclovir).
Acyclovir is an antiviral drug. It slows the growth and spread of the herpes virus so that the body can
fight off the infection. Acyclovir will not cure herpes, but it can lessen the symptoms of the infection.
• Impetigov - impetigo is a skin infection
caused by the bacterium Staphylococcus
aureus or Streptococcus pyogenes and
causes fluid-filled spots or blisters. The
bacterium enters into a cut or opening in the
skin and is a common secondary infection
following on from herpes simplex. Good
hygiene and aftercare practice can minimise
the chances of contracting this infection
It is not possible to predict whether a client is likely to be allergic to pigments which may be Organic,
Inorganic, Synthetic Organic or Synthetic Inorganic. You should always ask for the safety data sheets
on any pigment range which you are using from the manufacturer to prove that the pigment is from
a sterile source and the ingredients are safe to be introduced into the human body. Please note that
these approved ingredients may vary from one country to another. If you are using monodose
pigments, they should not be reused. If you are using multi use bottles of pigment please ensure that
they are used within their 'use by' date and once opened kept as clean as possible with regular wiping
over.
Allergy testing pre-treatment is mandatory. However it does not guarantee that a reaction will not
take place at a later date even if the result is negative. There have been reports of delayed reactions
occurring up to 2 years following the procedure. Your client should be made aware of this prior to
procedure.
True allergic reaction symptoms to iron oxide pigments would not usually manifest themselves until
3 months and up to 2 years post procedure. The following symptoms on the treatment site following
several years could be observed:
• Swelling
• Blisters
• Pain
• Burning sensation
• Urticaria
• Flakiness/scabbing
• Oozing lymphviP a g e | 19 Allergic reaction of this nature is rare however if you suspect your client has pigment allergy, they should be referred to a dermatologist immediately. Note: All British insurance companies covering micro-pigmentation presently insist on sensitivity testing for pigment prior to treatment. Please refer to your insurers for their patch testing guidelines.
P a g e | 20
Main Theory
1. PAGE 20 | Anatomy
a. PAGE 20 | The Skin
b. PAGE 26 | Inflammation and Healing
c. PAGE 37 | Conditions and Disorders
d. PAGE 49 | The Skeletal System: Bones of the Skull
e. PAGE 51 | The Muscular System: Muscles of the Face
f. PAGE 53 | The Eye
g. PAGE 56 | The Eyebrows
h. PAGE 57 | The Lips
2. PAGE 58 | Colour Theory
3. PAGE 60 | Fitzpatrick Skin Type
4. PAGE 62 | Anaesthetic
5. PAGE 65 | Needle Grouping and Technique
1. Anatomy
As a Permanent Make Up practitioner, it is essential that you have an in depth knowledge of the
anatomy of the face, the way certain parts of the face will typically and atypically react to treatment
and also conditions and disorders that are known to affect it. You must have an understanding of this
before you can learn the main theories of permanent make up.
a. The Skin
The skin is made up of 3 main layers: a thin
epidermis at the surface a thicker dermis
beneath, and below that a fatty layer known
as the subcutaneous layer.
The epidermis is made up of 5 layers of cells,
these are structured like a brick wall. New
cells are constantly being formed in the
bottom most layer and they push the older
cells towards the surface. As the cells get
pushed upwards, they become flat, hard and
eventually die (keratinisation), forming a
dead layer at the surface.P a g e | 21 The cells on the surface of the epidermis are like overlapping tiles and are constantly being shed (desquamation)vii. These cells contain the protein Keratin, the same substance that the scales of reptiles and feathers of birds are made of. Keratin makes the skin waterproof and tough and adds to its protective function. The epidermis contains a dark pigment called melanin. Ethnic skins contain higher levels of melanin than Caucasian skins. Oriental skins have an additional pigment called carotene which gives their skin a yellowish tone. Although Caucasian skins do not have such high levels of melanin, the amount is increased by the action of ultra-violet light on the skin which stimulates pigment producing cells called melanocytes to produce more protective pigment. The dermis is composed of a network of tough connective tissue fibres, blood, lymph capillaries and sense organs. Towards the bottom of the dermis there are sweat glands from which narrow sweat ducts run to the surface of the skin. Projecting out of the skin are hairs. Each hair projects from a hair follicle and its root is situated deep in the dermis. Opening into the hair follicles are glands which produce oil, they are known as sebaceous glands, the oil they produce is known as sebum, this keeps the hair supple and helps make the skin waterproof. A muscle runs from the side of each hair follicle to the base of the epidermis. When this muscle contracts it causes the hair to stand upright and when it relaxes the hair lies flat. This is known as the erector pili muscle and is important in temperature control. Below the dermis is a layer of cells containing fat which varies in thickness from one part of the body to another. This layer is known as the subcutaneous layer, the fat in this layer acts as insulation to preserve body heat and acts as a cushion to protect underlying bones and organs.
P a g e | 22 The 5 layers of the epidermis are known as: Stratum Germinativum (Germinating Layer) - This is a single layer of soft cuboid cells. These cells divide to form new cells which push the adjacent ones nearer the surface. The cells also divide to repair surface damage to the skin. Smaller cells called melonocytes are also present in this layer, they produce granules or melanosomes. These contain the yellow, brown or black pigment melanin which is the main pigment agent in skins. Stratum Spinosum (Prickle Cell Layer) - This layer contains living cells with spiny outgrowths which form bridges between the cells. This layer receives the pigmentation caused by melanin production from the melanocytes situated within the germinating layer. The Stratum Germinativum and the Stratum Spinosum together form the living layer of the epidermis known as the Malpighian layer. Stratum Granulosum (Granular Layer) - This is an area where a lot of change takes place in the cells. The nuclei of the cells break down leading to the death of the cells. Keratin is produced in this layer and the cells become harder and flatter. Stratum Lucidium (Clear Layer) - This is a very shallow layer in facial skin but is thicker on the soles of feet and palms of the hands. The Stratum Lucidium will increase in these areas to form protection against friction. The flattened cells in this layer are completely filled with keratin and are translucent in appearance. Stratum Corneum (Horny Layer) - This is the outer layer of the epidermis and consists of flat dead cells of keratin. The cells are constantly being shed (desquamated) from the surface of the skin.
P a g e | 23
The Dermisviii
The average thickness of the dermis is 3mm and it is made up of 2 regions:
1. The Papillary Layer - This region interlocks with the epidermis in series of ridges sometimes
referred to as the dermal papillae. This layer is continuous around each hair follicle forming a
connective tissue sheath. The papillary layer contains a network of blood capillaries to supply
the needs of the living cells in this region. The papillary region is made up of collagen fibres,
with non-elastic protein fibres and some yellow elastic fibres.
2. The Reticular Layer - This lies beneath the papillary layer and is made up of a dense network
of collagen fibres that are arranged in layers and between which there are many elastic fibres.
This arrangement allows the skin to stretch but return to its original form when the stretching forces
are removed. A jelly-like ground material of mucopolysaccharides absorbs considerable amounts of
water making the skin turgid or taut.
Dermal Cells
There are 3 main types of cells in the dermis:
1. Mast Cells - When the skin is damaged, they secrete histamine which results in dilation
of the blood vessels, increasing blood flow and aiding healing.
2. Leucocytes - These cells are white blood corpuscles that can deal with bacteria or foreign
material present in the skin which could lead to infection.
3. Fibroblasts - These are involved in collagen fibre production as well as producing the
ground material of the dermis.
Pain Receptors
Any changes in the internal or external environment can be relayed through the varied nerve endings
to the brain. There are also motor nerve endings responsible for secretion of sweat, raising of the
hairs and dilation of blood vessels.
Skin's Blood Supply
Blood supplies the skin cells with nutrients, oxygen and hormones and removes waste materials or
products from the capillary networks. Tissue fluid is formed which bathes the cells and allows theP a g e | 24 cells to exchange materials. In the skin there are 2 plexuses. The dermal plexus runs parallel to the skins surface and small vessels extend from this plexus to form papillary networks around the hairs and glands. These then join to form the sub-papillary plexus just below the papillary layer of the dermis and from these the capillary network of the upper part of the dermis is formed. Temperature Regulation Blood carries heat and through the large surface area of the skin heat can be readily lost. If our internal temperature falls below normal and heat needs to be conserved then constriction of the arterioles will occur to reduce blood flow into the capillary networks of the papillary layer. Conversely if the temperature rises above normal then dilation of these same vessels occur to increase blood flow. Heat is lost from the skin through radiation, conduction and by being used in the evaporation of sweat. Skin Glands There are 2 main types of glands in the body exocrine and endocrine. Exocrine glands have a tube or duct which takes the secretion from the gland and passes it through a pore either into or onto the body surface. All skin glands are of this type. Endocrine glands have no duct (are ductless) but are surrounded by blood capillaries. Their secretions pass directly into the blood stream and the blood is the transport medium. Hormones are produced in endocrine glands. Sweat Glands There are 2 types of sweat glands in our body: Eccrine – concentrated in the palms of the hands and soles of the feet, these are the most numerous of the whole skin. They are formed prior to birth so their number is fixed. They produce a watery secretion, made up of 98% water 2% sodium chloride (salt) with traces of urea and lactic acid. They secrete throughout an individual’s life, secreting up to 1 litre of sweat daily in insensible perspiration. The main purpose of sweating is to cool the skin. Sweat uses the heat of the skin’s surface to change its state and evaporates. Sweat production increases with a rise in external temperature, nervous tension or physical activity. Apocrine Glands or Odoriferous - these glands are found only in certain body areas i.e. armpits, the pubic region and the nipples. They produce an oily secretion which can even be "milky" in colour. It
P a g e | 25
is these glands that can give rise to unpleasant body odours as our resident bacteria attack the fat in
the secretion. Gland development takes place at puberty and the secretion is under nervous as well
as hormonal control. They differ from eccrine glands in that they are normally associated with hair
follicles and open above the level of the sebaceous gland.
Sebaceous Glands - Found in all areas of the skin except the soles of feet, palms of hand or between
the fingers and toes. They are most numerous in the scalp, forehead, nose and beard areas as well
as on the back between the shoulder blades.
The outer epidermis of the skin is concerned mainly with protection:
Protection against invasion by micro-organisms:
• The dead stratum corneum acts as a physical barrier when intact, as the dead cells do not
provide any food or moisture for micro-organisms to live on.
• The "acid mantle" (pH 5.5) formed by the combined secretions of sebum and eccrine sweat
produce unfavourable conditions for bacteria to reproduce in.
• The fungicidal properties of sebum helps to prevent fungal growth.
Protection against ultra-violet rays:
• Melanocytes present in the basale layer of the epidermis produce the pigment melanin, which
prevents the sun’s ultra-violet rays from penetrating into the dermis beneath.
Protection against undue water gain or loss:
• As the cells flatten and die on leaving the stratum spinosum layer, they become impregnated
with keratin. This protein along with the physical properties of the dead cells forms a
waterproof barrier.
Repair:
• The stratum basale or germinative layer can replace and repair damaged areas of the skin.
Normal epidermal loss due to friction is also replaced by cell division in this region. Excess
friction as on the soles of the feet and palms of the hands can lead to a greater increase in
the thickness of the stratum lucidium and stratum corneum for protective purposes.
Additional Functions of the Skin:
• Acts as a sense organ through its complex network of nerve endings. The skin can detect
changes in the environment both favourable and unfavourable and by communication with
the nervous system the correct action can be taken.P a g e | 26
• Synthesis of Vitamin D through the action of the ultraviolet rays of the sun on steroids present
in the upper skin layers.
• Storage depot for water and fat.
b. Inflammation and Healing
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as
pathogens, damaged cells or irritants. Inflammation is a protective attempt by the body to remove
the injurious stimuli and to initiate the healing process.
When tissue cells become injured, they release a number of chemicals that initiate the inflammatory
response. Inflammation is characterized by 5 distinct signs, each of which is due to a physiological
response to tissue injury. The area becomes painful (dolar), swelling occurs (tumor), vasodilation
causes redness (rubor), temperature increases within the tissues (calor), and as pain and swelling
intensify impairment of function occurs (functio laesa).
It is important to understand how the skin reacts to inflammation following the superficial wounding
caused by micro-pigmentation. With this understanding you will be able to properly advise your
clients on appropriate aftercare during the expected downtime period following micro-pigmentation
treatment.
Acute Skin Inflammation Following Micro-Pigmentation
Acute inflammation is a short-
term process, usually appearing
within a few minutes of the cell
trauma being induced by micro-
pigmentation.
Damage occurs from the initial
trauma to the cells and tissues,
where the local network of
ruptured blood vessels bleeds
into the tissue spaces and the cell
walls rupture. Cellular damage
occurs leaving dead and dying
cells disrupted by the trauma.
Within seconds of and up to 10
minutes after the initial trauma,
local blood vessel constriction
occurs. This vasoconstriction minimises blood loss from the area and initiates clotting (haematoma).P a g e | 27 However, the resulting hypoxia causes tissue necrosis at the primary injury site. This triggers the lysosomes (the waste disposal unit within a cell) found within the dead and damaged cells to start to leak digestive enzymes through their ruptured membranes. These enzymes act as inflammatory mediators causing surrounding arterioles and capillaries to dilate (calor and rubor) and cause stimulation of surrounding pain receptors (dolar). Pain receptors are specialised nerve endings located throughout the body in most body tissues. Once the nerve endings are stimulated, they begin firing the nerves that are connected to them and send pain signals to the spinal cord and brain. As blood vessels dilate, they become more permeable and within a few hours exudation increases. As the vessel walls enlarge the speed of flow decreases due to vessels being packed with cells. The stasis of blood allows leukocytes to move along the endothelium and escape through the capillary wall to the site of the injury, along with plasma and other circulating defensive substances such as antibodies, phagocytes, and fibrinogen. The arrival of these specialised cells (antibodies, phagocytes) lead to the engulfing of dead cells, foreign material or infectious agents. As fluid moves out of the capillaries, stagnation of flow and clotting of blood in the small capillaries occurs at the site of injury. This process is caused as fibrinogen produces fibrin which forms a mesh of fibres creating a collection site for red blood cells (haematoma) and also traps micro-organisms preventing their movement further from the injury site. This increased collection of fluid into the tissue spaces causes it to swell (tumor). This expansion of chemical activity in surrounding tissues produces the zone of secondary injury. Normally, lymphatic vessels drain the area of excess fluid and cells. However the lymph vessels become blocked following trauma within the tissue. The excess fluid and cells collect in the spaces between the tissues around the site of the trauma and oedema occurs. As fluid and cells try to occupy a limited amount of space, the pressure caused on nerve endings is perceived as pain. A large number of lymphatic channels lie directly beneath the skin.ix Oedema which is the swelling or natural splinting process of the body has 2 basic components. The first is a liquid, which can be evacuated by the circulatory system and the second is comprised of proteins which have to be evacuated by the lymphatic system. The lymph vessel diameter and the decreased flow of the lymph system causes swelling to occur in the first 24 hours following micro-pigmentation. Within 12 hours of injury macrophages move in to digest tissue debris to clear the way for peripheral cells to begin the process of mitosis. Fibrocytes also move into the area to start the process of fibroplasia. Tissue repair overlaps the inflammatory process and within 48 to 72 hours the haematoma is sufficiently diminished to allow for this new tissue growth.
P a g e | 28 As the damaged skin within the epidermal layers begins to regenerate, the deeper soft tissues will replace damaged cells with scar tissue. The fibroblasts release collagen, elastin and reticulin fibres forming a mesh network to reconnect tissues. Over the next 3 day’s mitosis continues and capillary loops develop all around the injured area (angiogenesis). These sprouting vessels originate from pre-existing vessels and appear as minute red granules, hence the name granulation tissue. Circulation is increased by these additional blood vessels replacing damaged ones, so more oxygen and nutrients become readily available to these cells to aid in speeding up the healing process. When circulation is increased it automatically increases lymphatic flow with the movement of tissue fluid between the 2 systems, allowing the excess build- up of lymph to be drained, reducing swelling. Inflammation is the important first stage of healing damaged tissue. Healing cannot occur until inflammation has come and gone. We cannot prevent inflammation however we can speed up the
P a g e | 29
processes involved by applying cold therapies in the first 72 hours following a micro-pigmentation
treatment.
Whenever trauma occurs to the surface of the epidermis the protective barrier will be impaired. The
application of a micro-pigmentation treatment will cause a burn, cut or puncture wound to the area
infused with pigment.
The epidermis will protect this impairment by
forming of a scab. The size and extent of this scab
will be proportional to the trauma caused (please
note: the scab in picture ass not caused by a PMU
treatment).x The scab may be minute and clearer
in colour if only lymph vessels have been
disturbed, however if capillary damage was
involved there will also be droplets of blood in the
scab formation.
When treating more mature clients or clients with
more sensitive skin, there is a higher tendency to
bruise and tear the skin, resulting in a greater
inflammatory response. In turn this will result in a slightly longer healing process.
The healing process can differ from one client to another; there are several factors to consider such
as the client’s:
• Age
• Health
• Lifestyle
As a general rule the older you are (once passed 25 years) the slower the expected healing rate.
Remember that the superficial tissues will display signs of healed skin long before the internal layers
have completed the full healing process. The following is a general guideline to expected healing
rates:
Eyeliner & Eyebrow Procedures Lip Procedures
• 0 – 40 4 weeks • Full 6 week healing period
• 40 – 60 4 weeks required whatever the age of
• 60 + 6 weeks the client.P a g e | 30
Common Skin Conditions:
Papule xi – A small, solid raised area of unbroken skin which often develops
into a pustule.
Pustule xii – A small collection of pus which is visible through a raised
portion of the epidermis.
Vesicle – A small blister raised above the
skin’s surface and containing Serum (a
pale yellow liquid
similar to blood plasma). Vesicles usually
disappear without forming a scar.
Bulla – A blister more than 0.5cm in
diameter. Similar to a vesicle but larger.xiii
Nodulexiv- A small round swelling which extends both above and below
the surface of the skin.
Tumor – A swelling of the skin larger than a nodule, consisting of hard or soft tissue.
Weal – A white raised area of the skin containing fluid surrounded by a red area. A weal may appear
and disappear quite quickly e.g urticaria (see urticaria image).P a g e | 31 Bruise xv – An area of unbroken skin discoloured by blood from damaged blood vessels in the dermis. Scales xvi – Flakes of easily detached Keratin, eg. scales of dry skin / psoriasis. Skin Tag xvii – These are common in the neck of the elderly, but can also be found in areas of skin folds such as underarms, beneath breasts, eyelids and groin areas. They are small growths of fibrous tissue which stand away from the skin. Sometimes they are pigmented black or brown which makes them more obvious. A doctor may remove them if they prove to be a nuisance or a therapist qualified in advanced electrolysis. Miliaxviii – This is a small sub-epidermal cyst containing keratin and producing a small white papule. They are common on the face of all age groups. In adults the contents are easily expressed after cutting the overlaying epidermis with a cutting-edge needle.
P a g e | 32
Xanthomasxix – Yellow plaques around the skin of
the eyelids. These are thought to be connected
with certain medical conditions such as high
cholesterol, diabetes and blood pressure
disorders.
Allergies – Abnormal reaction of sensitivity of the body tissue to an individual substance which does
not affect the majority of people.
Urticariaxx – A skin reaction following contact with
an allergen. Erythema combined with raised skin
weals and intense itching (pruritis). The condition
usually subsides over time with no trace following
removal of the allergen, Antihistamines can
relieve symptoms.
Keloid Scarxxi – Overgrowth of abnormal scar
tissue, characterised by an excessive build-up of
collagen fibres. The scar is raised, red and ridged
in appearance and sensitive to UV exposure.
More common in black skins. Skins with a
tendency towards keloid formation should avoid
procedures where the skin is pierced or damaged
leading to the laying down the scar tissue.Some
medical treatments are available to reduce
scaring however results vary and are limited.P a g e | 33 Pigmentation Disorders: Maculexxii – Small abnormally coloured area of skin which is level with the skin’s surface so may be seen but not felt e.g. Freckle. The Macule may be darker or lighter than the surrounding skin. A Macule larger than 1cm is called a Patch. Freckles (Ephelides) xxiii – Small brown macules, common on blonde or red haired people. Lentigenes (Liver Spots)xxiv - Hyper-pigmented areas of skin larger than freckles. In childhood Lentigo Simplex can occur. In adulthood Actinic Lentigenes can develop due to UV exposure. Chloasma xxv– Patchy pigmentation usually found on the cheek area, nose and forehead, lower arms, back of hands and chest. Stimulation occurs from exposure to UV light and is more common in women and darker pigmented skins. The condition is common in pregnancy usually disappearing shortly after the birth but can also be triggered by the use of oral contraceptives. There is thought to be a connection with raised levels of oestrogen triggering the melanin production.
P a g e | 34 Dermatosis Pupulosa Nigraxxvi – Commonly known as flesh moles, these raised pigmented papules are benign growths that are commonly seen on black skins. Common sites are forehead, cheeks, neck, upper chest and back. Leuoderma (Vitiligo)xxvii - Patches of un- pigmented skin that can occur anywhere on the face or body due to an autoimmune trigger which causes the breakdown of melanocytes in certain areas of the skin. Once the pigment has been lost the patches are permanent. If vitiligo occurs in areas that are hairy, the pigment in the hair is also affected causing the hair to grow through white. Albinismxxviii- The skin is unable to produce melanin and the hair and eyes lack colour. Hair is usually white blonde in appearance and eyes will be pink and extremely sensitive to light. There is no effective treatment for albinism, however protection from UV light for skin and eyes is essential. Pre-Malignant Skin Conditions: Cutaneous Horn – A warty looking growth protruding from the skin. Found in the elderly and can indicate malignant change in lower layers. Excision and histological examination are advised.
P a g e | 35 Keratonacanthomaxxix - Rapidly growing skin tumour on sun exposed areas. Grows up to 20mm within weeks. Characterised by a central horny plug. This lesion can spontaneously heal. Solar Keratosisxxx - Found on sun exposed areas on older clients. Red, scaly, lesions that have been entirely sun induced. Slow growing. Actinic Cheilitisxxxi – Grey, scaly areas on lower lip or corners of mouth which are the result of sun exposure or smoking. Can lead to squamous cell carcinom Dysplastic Naevixxxii – An inherited trait involving multiple large naevi that carry risk of becoming malignant. Irregular shape, size and pigmentation. Regular mole checks needed.
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