Scar Color and Skin Camouflage

How People Can Benefit from Skin Camouflage

Skin color ( pigmentation) can be lost through medical procedures, trauma from burns or accidents, congenital anomalies, or different types of skin diseases. Many surgical procedures can restore, correct, or improve the appearance of people with scars and skin abnormalities. However, those patients often need the skin color of the reshaped area to be “re-applied” so that it appears more “normal”. In addition, some people with skin conditions such as Vitiligo cannot benefit from surgery, but they can benefit from skin color tattooing. Psychological studies have shown that self confidence can increase when a person’s appearance and body image is restored to “normal” or “almost normal.”

What is Skin Camouflage or Scar Camouflage?

Skin or scar camouflage is tattooing of the skin with different colors of flesh tone pigments. Its purpose is to disguise a scar or skin area that is missing pigment or color. It is a specialized area of permanent cosmetics that falls under the category of Medical or Paramedical Tattooing. This process is also called Corrective Pigment Camouflage (CPC), Corrective Camouflage, Skin Color Repigmentation, Skin Repigmentation, Camouflage Skin Repigmentation, Scar Color Camouflage, Scar Camouflage, Camouflage Tattooing, and Skin Color Tattooing. These procedures require advanced knowledge, training, skills, and experience in permanent cosmetics. They also require an artistic eye for color and skin tones. The science behind pigments and the physiology of human skin and tissue must also be understood by the specialist performing these procedures.

Are You a Candidate for Skin Color Repigmentation?

If you have a scar or skin abnormality, you are not automatically a candidate for skin repigmentation. You may be a candidate if you meet the following criteria:

• Your scar is smooth and relatively flat: Camouflage tattooing cannot disguise or correct extreme changes in skin texture. If the scar or area is bumpy, raised, or elevated, the process will not be effective. (Note: If you have any skin surface irregularity, please consult with a Dermatologist or Plastic Surgeon first to see if any type of pre-treatments can improve the skin texture.)

• Your scar is healed and no longer pink or changing color: A scar should be at least 9 to 12 months old and its color should be stable. If it is red or pink or still changing color, the tissue may still be healing. A well-trained and reputable medical tattooist will not work prematurely on scar tissue because it may cause further damage to the skin. (Note: If you were or are still under a physician’s care, ask him or her when you may undergo the skin color tattooing. Dr. Reed often requires a medical clearance so you should ask your doctor before seeing her.)

• Your scar does not have dark edges: A scar with darker edges is an indication of Post Inflammatory Hyper-pigmentation (PIHP) from the initial trauma or surgery. It is possible that the camouflage tattooing process may increase the hyper-pigmentation and create a wider, darker edge. (Note: The risk of this happening is usually greater with ethnic or darker skin tones.)

• Your scar is NOT one of the following: Port Wine birthmarks; spider veins; freckles; age spots; under eye circles; hyper-pigmentation; or Vitiligo that is unstable (not in remission). All of these conditions can be improved with non-tattooing treatments such as lasers, sclerotherapy, or medical grade chemical peels. You should consult with a physician regarding the best course of treatment for these conditions.

Examples of Poor Candidates for Scar Camouflage

Keloid Scar	Raised, Dark Edges	Hyperpigmentation (PIHP)

You may be a candidate if you also meet the following criteria:

• You have realistic expectations: Scar camouflage will not restore skin to the way it looked before it was injured. Camouflaging will not “erase” a scar so it appears completely gone and the area looks “perfect” again. But the process can minimize color differences to help disguise the scar and make it less noticeable to other people.

• You do not spend time tanning: A scar camouflage tattoo will never be a perfect match to the surrounding skin color. This is due to the constant changes in skin tones from blood flow, body temperature, and tanning. The pigment in the tattoo will not change color if it is exposed to sunlight or tanning booths. Since the tattoo color will not change, it may appear lighter when the surrounding skin tans. If the tattoo color matches tanned skin, it may appear darker once the surrounding skin fades. Therefore, you may need to adjust your lifestyle or decide whether to match the scar tattoo to “winter” or “summer” skin and live with the changes.

• You do not expect results in one session: Camouflage repigmentation is a process, not a one-time procedure. It is performed on “unhealthy” skin that has been damaged or altered somehow. It is better to use a conservative approach when applying color because the skin’s behavior during the tattooing process cannot be predicted. A scar may have areas that either reject pigment or absorb too much. Also, how the scar will heal cannot be predicted. Immediately after the tattooing session the area will be dark and red. The healed color may take weeks or even months to show the final result. All of this requires time and patience.

Examples of Good Candidates for Skin Camouflage

Depigmentation from Injury	Vitiligo Depigmentation	Vitiligo Depigmentation

Before Your Camouflage Procedure

The first step is to obtain a clearance from your physician (please refer to the guidelines above). Then you can make an appointment with Dr. Reed for a consultation. At the consultation she will determine if you are a candidate for scar camouflage tattooing and discuss your options. If you are a candidate, the next step will be to set an appointment for a “Spot Color Test”. Other permanent cosmetics professionals sometimes refer to this test as a “Patch Test.”

What is a Spot Color or Patch Test?

Scar and skin color camouflage is an unpredictable process. Therefore, a spot color test is the starting point for determining an appropriate combination of pigments to match the skin. In all cosmetic tattooing, including permanent makeup, the final healed color looks very different from when the pigment was initially implanted. The healed result equals the pigment color formula that was inserted under the skin plus the patient’s skin color and tones. The healed spot will indicate if that same formula can be used for the first tattooing session or if it will need to be modified.

At your spot color test appointment, Dr. Reed will analyze your skin tones. She will mix several combinations of pigments to determine what appears to be a good match. She will then tattoo at least one spot about the size of a pea using at least one “formula.” All pigments that have been used will be recorded in your chart for future reference. Although the tattooing process is brief, the mixing process can be very time consuming so you should allow at least one hour for this appointment. When finished, you must wait 4 to 8 weeks to see how the healed color will look. Your tattooing sessions can then begin after healing and color stabilization of the spot tattoo.

Example of Spot Color Test on Vitiligo Patient

Before Spot Test	Immediately After Spot Test	Healed Test Result

Corrective Camouflage Tattoo Sessions

Once the spot test has healed and the color stabilizes, the damaged skin can be tattooed. As an artist, Dr. Reed has a sharp eye for colors. If she determines that the spot formula should be adjusted, she can do so at that time. She believes that cosmetic tattooing is a “partnership” with her patients because it is a multi-step process. Therefore, she will freely ask your opinion about colors and results as she works. The results after the first tattooing session may be very good. However, due to the “unpredictable” nature of most scars and skin abnormalities, a second, third, or even fourth session may be necessary for the best outcome. Fortunately, the color formula or technique can be modified at each session to improve results. Sessions should be scheduled approximately 6 to 8 weeks apart to allow for complete healing and color stabilization.

Hypo-pigmentation (De-pigmentation) Skin Camouflage
Before	After

Vitiligo Depigmentation Skin Camouflage
Before	After (2 Sessions)

Cleft Lip Surgery Scar Camouflage
Before	After (2 Sessions)