Types of scars: where is the "red line" for the PM master?

Scars and the work of the PM master on scar tissue is an ever-relevant topic, in which there are a lot of nuances and, accordingly, on which the masters have endless questions. Let's talk about the nature of scars and the technical features of working on fibrous tissue.

The presented article is an exclusive translation of the material published on the website of the international journal for micropigmentation specialists PMU International. Magazine of Permanent Makeup. Original article - link

Permanent makeup used as a corrective camouflage can serve a variety of purposes. It can effectively hide imperfections, some skin conditions such as vitiligo, and is most effective when dealing with various types of scars. However, not all types of scars are eligible for micropigmentation. It is very important for the PM master to determine the type of scar before the procedure and to be sure of the indications and contraindications for working with a particular patient.

Scarring is the body's natural way of healing and rebuilding after skin is lost or damaged. Scars are made up of fibrous tissue that is thicker than normal due to the increased amount of collagen. Skin repair is possible thanks to the activity of special cells called fibroblasts. Fibroblasts are the most typical resident cells of regular connective tissue. They form its matrix by secreting collagen as well as some other vital components. However, fibroblasts retain their ability to enter the active phase when necessary and multiply - for example, during tissue repair. The increased amount of collagen produced by fibroblasts forms scar tissue that remains even after re-epithelialization of the skin surface.

Although the composition of scar tissue does not differ significantly, its histology and physiology may differ.

Scar types

Keloids are tough, thick clumps of scar tissue that rise above the surrounding skin. They are more common in patients with ethnic skin and appear at the site of a previous injury or wound (incision, vaccination, piercing, etc.). Keloids continue to grow after the injury has healed due to increased collagen production and thus can extend far beyond the site of the original skin injury.

It is strongly not recommended for patients prone to keloid formation to undergo permanent makeup procedures. Although micro-punctures made by tattoo needles do not penetrate deep into the layers of the skin, they pose a certain risk for patients with above-average sensitivity. It is difficult for the PM master to determine if his patient is in a high-risk group. The easiest way to find out if a permanent makeup procedure is possible in a particular case is to check if the patient has a piercing. Otherwise, a scratch test should be performed. This should then be followed closely for several months to determine if keloid formation occurs.

It is strictly forbidden to carry out the micropigmentation procedure on an existing keloid scar.

Hypertrophic scars appear red and lumpy, raised. They resemble keloids, and their formation also reveals an imbalance in collagen production, however, they are usually limited to the boundaries of the damaged area. Although hypertrophied scars do not extend beyond the wound, they may continue to thicken up to 5 years. However, these scars tend to flatten and lighten over time. The results of micropigmentation treatment of hypertrophic scars are considered unpredictable, since there is a high probability of their recurrence. However, some clinics carry out such procedures.

For safety reasons, patients prone to hypertrophic scarring are advised to refrain from performing micropigmentation procedures. The master must warn in advance of the possible consequences. However, the decision is up to the patient. The informed consent form must be signed prior to any procedure.