Areola tattoo: about the technique and nuances of the procedure

Anna Zabolotnaya, head of the Biotek International Academy of PM and Aesthetic Dermo-Pigmentation (Russia), certified artist, international class master teacher in permanent make-up, aesthetic dermopigmentation and trichopigmentation, winner of the first Contour of the Century competition (2003), judge of permanent make-up championships in Russia and abroad, lecturer at the International University of PM (Milan, Italy) (Russia)

Aesthetic dermopigmentation can mask almost any scar. And in order to facilitate the work of a specialist and save your own nerves, after the operation, you should strictly follow the recommendations of the doctor ⎼ minimize the impact on the healing wound, including sunlight, and use special healing agents

Aesthetic dermopigmentation is a modern and effective method of visual correction of the areolar zone by introducing (implanting) pigment into the dermal layers of the skin to a depth of 0.3⎼0.8 mm. The technique is well tolerated by patients, does not require a long recovery period, does not cause pain and severe discomfort.

The procedure of aesthetic dermopigmentation allows not only to restore an aesthetically acceptable appearance of the areola after surgery, but also to camouflage the scars at the junctions of the dissected breast tissues.

Areola restoration after surgery. Photos provided by the author

It should be noted that, although the vast majority of clients with areola problems come to us after mammoplasty, aesthetic dermopigmentation has proven itself well in other cases, for example, if necessary, change the color of the areola or its size. Such a short rehabilitation period is due to the low degree of trauma of the procedure.

Of course, the pigment introduced into the dermal layers of the skin is perceived by the body as a foreign body, as a result of which regenerative processes are activated. And the body, trying to “neutralize the invading enemy” as quickly as possible, intensively produces collagen, which envelops the pigment particles, forming a kind of capsule around them. At the end of this process, excessive color saturation disappears, the pigmented area acquires that softness and pastelness that is characteristic of natural shades. On average, the process takes two to three weeks, and a month after the procedure, the pigment is completely encapsulated and physically stabilized in the skin.

The result lasts for three to five years, in pigmented areas it can “live” much longer, and in some cases lasts a lifetime.

Vitiligo correction. Photos provided by the author

In order for the procedure to be as comfortable as possible for both the client and the master, anesthesia should not be neglected. Unless, of course, the patient requires otherwise. It must be remembered that the areola is a very sensitive area.

To anesthetize the areola area, local anesthesia applications are used, such as MesoNUMB, Emla, which are applied under occlusion and kept for 25⎼30 minutes, after which you can safely start working.

When sensation returns, additional anesthesia is applied. To do this, an aqueous solution of lidocaine 2⎼5% or Blue Ice, Sustaine gels are applied to the pigmented area.

About technology

To achieve the most natural look of the areola, it is recommended to combine several pigment application techniques. For painting the areola, spiral, dashed and reciprocating movements are optimal, for simulating Montgomery's glands - spiral and point movements, for simulating capillaries - lingering linear movements.

Montgomery's glands are small tubercles located around the nipple along the areola. Their purpose is still unknown for sure. There is a hypothesis that the secret secreted by these glands affects the sense of smell of an infant, simplifying the process of finding the mother's breast.

To mask the periareolar scar, it is painted over to match the color of the areola, and the edges are shaded, slightly capturing healthy skin. It should be remembered that the natural areola does not have clear edges, just as the areola in the form of a perfect circle does not occur in nature, so it is better not to draw the outline at all, smoothly shading the edges of the painted area. However, if the client insists that the outline be clear, aesthetic dermopigmentation should be performed with a highly diluted pigment. In the latter case, the contour will be noticeable only during work and during the period of tissue repair, and after rejection of the crusts, it will take on a completely natural look.

The fact that a normal areola never has a perfectly defined perimeter should be remembered even when the specialist is faced with the task of correcting the shape of the areola, that is, giving its border a more rounded appearance.

The pigment for shading should be chosen a tone or half a tone darker than the color of the areola itself, since after the crust comes off, it will become slightly lighter than the original.

It should not be forgotten that a denser paint is used to paint over the scar, that is, it is not diluted in any way, but the area itself is shaded with a pigment diluted with a mix. If the scar has a different density, then in some areas the pigmentation will look darker, while in others it will look lighter. In this case, correction of the areola will be required (preferably not earlier than a month after the first procedure, since during this period the epidermis is restored and the physiological stabilization of pigments in the dermis of the skin and connective tissue of the scar occurs).

The most obvious possibility of aesthetic dermopigmentation opens up in the case when the patient has lost the nipple or nipples and areola as a result of mastectomy. Needless to say, for any woman this is a serious test. And although the traditional method of restoring the areolar complex is considered to be transplantation of skin flaps from pigmented areas of the patient's body (it is assumed that these tissues most reliably reproduce the structure and color of the areola), modern techniques of aesthetic dermopigmentation and the widest choice of coloring pigments make possible complications after transplantation of skin flaps and trauma donor zones unjustified. Moreover, the results of the EAF are no worse, and sometimes even better.

Creating an areola from scratch

Unfortunately, not only the pursuit of beauty brings women to the operating table. Breast cancer continues to dominate the world, and EDP is an effective means of psychological rehabilitation for women who have undergone a mastectomy, as this method allows you to completely recreate the areola and even the nipple.

In this case, the master will have to create an areola from scratch. That is, draw a nipple, a pigmented circle, tubercles. Everything is as it should be. And to do it in such a way that the painted areola is visually impossible to distinguish from the natural one.

In the visual arts, a technique that creates the illusion that the depicted object is real is called "trompe-l'oil" (from the French trompe-l'oil ⎼ "deceive the eye" or "deception of the eye"). It requires not only perfect mastery of the brush and color, but also knowledge of the laws of perspective.

Here, more than ever, talent, and knowledge of anatomy, and a sense of color, and an experienced hand, and even the ability to foresee will be required, because, as was said, the final result of the work appears no earlier than a month after the procedure.

When drawing the areola, almost all colors can be used, including those that we do not associate with skin color at all, for example, green. At the same time, depending on which element of the areola is drawn, the master uses nozzles of different types and with a different number of needles. Experience shows that it is almost impossible to achieve the desired result in one procedure. The number of corrective procedures is individual and depends on the specific case: age, skin type, metabolic rate in the body, thickness and density of scar tissue.

Repeated correction to achieve the ideal result is a common practice that allows not only to eliminate errors in the choice of paint or a particular technique, but also to trace the result of the procedure in development, taking into account the reaction of the skin.

The fact that corrective procedures are possible in aesthetic dermopigmentation makes it much more effective.