Scarring and needle direction

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1. Background

For many artists specializing in eyebrow procedures, the direction of the needle when holding the handpiece has emerged as a significant consideration. Various trainers have advocated diverse approaches regarding the optimal angle for holding the handpiece. The insights for this article were gathered from interviews with 37 artists, primarily from EU countries, alongside five from the UK and three from the US. All these artists specialize in the Powder Brows procedure as their main service.

Additionally, it's noteworthy that 24 of these artists also have extensive experience in other semi-permanent makeup techniques. Furthermore, this article has been reviewed by two dermatologists, a professional with higher education in cellular biology, and a chemist. This article aims to provide more precise information on choosing the correct needle angle for performing the Powder Brows procedure, as well as other semi-permanent pigmentation procedures.

2. Perpendicular entry

A needle enters the skin at 90 degrees on the left, many needles at various angles starting with 45 in the center and an attractive female face on the right.

Technical Perspective: Needle Angle and Skin Penetration

When a needle penetrates the skin at an angle less than 90 degrees (perpendicular), the path it travels through the tissue is longer than a perpendicular entry. This increased path length causes more disruption in the skin layers, particularly in the papillary and reticular dermis.

In a pendulum movement or whipping, where the needle enters the skin at an oblique angle, the motion creates elongated incisions rather than precise dots. This is because the trajectory of the needle slices through the skin rather than puncturing it perpendicularly. As a result, the wound is more of a slit than a dot, which affects how the pigment is deposited.

It is easy to imagine the difference when we take a close look from above to the needle's entry point. The smaller the angle of the needle is, the longer the actual slit in the skin will be, and the less chance there is that the result could heal to a desired do as a “pixel.”

Biological Perspective: Skin Structure and Healing Response

The skin has multiple layers, with the epidermis on the outside and the dermis beneath. The dermis is further divided into the papillary and reticular layers. The papillary dermis is thinner and contains fine collagen fibers, while the reticular dermis is thicker with denser collagen.

Wound creation in different dermis layers

A perpendicular (90-degree) needle penetration primarily affects the epidermis and the superficial part of the dermis, minimizing damage. When the angle is reduced, the needle trajectory is more likely to disturb the deeper reticular dermis. This layer is denser and more fibrous, leading to more significant tissue disruption.

Pigment Dispersion and Scarring

The more significant the tissue disruption, the greater the body's healing response. This response includes inflammation and potential collagen deposition during the healing process. When the pigment is deposited in a line (as with an oblique needle), it's more spread out and can become less defined as the wound heals. The healing process can cause pigment migration, leading to blurring and spreading of the pigment beyond the intended area.

Risk of Scarring

Additionally, deeper penetration and increased tissue trauma heighten the risk of scarring. Scarring can trap pigment in unwanted patterns and disrupt the evenness of pigment distribution.

Maintaining the needle at a perpendicular angle during semi-permanent pigmentation is crucial for minimizing tissue damage, ensuring precise pigment deposition, and reducing the risk of pigment spreading and scarring. The angle of needle entry significantly influences the nature of the wound created, the subsequent healing process, and the final appearance of the pigment in the skin.

4. “No room” problem

Scar tissue formation is critical to the skin's healing process, particularly noticeable in procedures like Powder Brows creation or microblading. When the skin is injured during such procedures, it initiates a healing response, one aspect of which is scar tissue formation. This scar tissue primarily comprises collagen, produced by cells known as fibroblasts. Collagen is a structural protein that lends strength and structure to the scar, playing a vital role in the repair process.

On a microscopic level, the physical interaction between pigment particles and the surrounding tissue matrix is complex. In normal skin, there's a balance between the size of pigment particles, their distribution, and the surrounding tissue architecture. In scar tissue, this balance is disrupted, potentially leading to uneven pigment distribution and lesser overall deposition. In scar tissue, there is a higher chance of pigment particles being more densely packed or encapsulated in certain areas, potentially leading to uneven pigmentation.

Implanting pigment

In the specific context of creating Powder Brows, pigments are introduced into the skin's dermal layer. Here, fibroblasts play a crucial role. They encapsulate these pigment particles, a process integral to healing. Fibroblasts effectively "wrap around" or incorporate the pigment particles into the developing scar tissue during encapsulation. This encapsulation is essential for the stability and longevity of the pigment in the skin.

However, the process can become complicated when there is excessive scar tissue formation. Normally, fibroblasts produce an optimal amount of collagen to form healthy scar tissue, effectively encapsulating the pigment particles. But, factors like excessive trauma from the procedure, infection, or an overactive healing response can lead to an overproduction of collagen. This results in excessive scar tissue characterized by its dense and thick nature.

The effects of too much scarring

Such density in the scar tissue can pose significant challenges. It may impede the fibroblasts' ability to encapsulate the pigment particles properly. In a dense collagen network, there is limited space and reduced flexibility, making it difficult for fibroblasts to interact with and effectively encapsulate the pigment. Consequently, this can lead to uneven distribution of the pigment or instability in its placement, ultimately affecting the quality and appearance of the semi-permanent makeup or tattoo. Thus, there are fewer normal skin cells and structures in scarred or fibrotic tissue. The dense collagen matrix of scar tissue may provide fewer sites for pigment particles to adhere to or be encapsulated by the surrounding cells and tissues.

In simple terms, think of fibroblasts as workers trying to organize and store items (pigment particles) in a warehouse (the scar tissue). If the warehouse is properly sized, they can store the items neatly. But suppose the warehouse is overly packed and cluttered (like in excessive scar tissue). In that case, the workers find it hard to store the items properly, leading to a disorganized and less effective storage system.

5. “Bad neighborhood” problem

In some cases, more excessive scarring is often accompanied by a more robust inflammatory response. Inflammation can lead to increased tissue turnover and changes in the local microenvironment, which may hinder the stable deposition and retention of pigment particles.

The chemical composition of scar tissue might alter the stability of the pigment. For instance, a more acidic or alkaline environment, which can occur in inflamed or healing tissues, might affect the chemical stability of certain pigments, leading to color changes or decreased retention.

While the particle size of pigments is a physical property and the pH level of colorants is a chemical property, empirical studies have indicated that for many pigment particles with a size of around 500 nm, the wound healing process and subsequent scarring can create a skin environment that is more alkaline. This shift in pH can potentially impact the stability and appearance of these pigments in scarred tissue.

Consider the skin as a city and the pigment particles as tourists looking for a place to settle. In normal conditions, the skin (the city) offers a welcoming and stable environment, akin to a city with good living conditions, where tourists (pigment particles) can comfortably settle down, making their stay long-lasting and pleasant.

When the skin undergoes a procedure like powder brows, it's like the city undergoing construction or development. Usually, this is managed well, and the tourists still find it a good place to settle. However, excessive scarring and inflammation from the procedure can drastically change the skin's environment, making it more alkaline. This is akin to the city suddenly experiencing a surge in crime rate or becoming less hospitable.

In such a scenario, the tourists (pigment particles) find the environment (the skin) unfavorable for settling down. The high 'crime rate' (representing the hostile, alkaline, and scarred environment) discourages them from staying. They prefer to move through quickly and go elsewhere, searching for a more stable and welcoming environment. In the context of the skin, this means the pigment particles don’t get encapsulated effectively in the scarred tissue; they are either unevenly distributed or migrate to other areas, leading to less optimal results in the powder brows procedure.

Blood Supply Alterations

Scar tissue typically has a reduced blood supply compared to normal skin. This decreased vascularity can influence the delivery and maintenance of pigments, as the vascular network in the skin plays a role in sustaining the cells and tissues where pigments are deposited.

6. Scarring and inorganic pigments

Misconceptions about Inorganic and Organic Pigments

In the realm of semi-permanent makeup, particularly in powder brows procedures, there exists a nuanced interplay between the physical and chemical properties of the pigments used and the biological responses of the skin. A common misconception is the blanket categorization of inorganic pigments as inherently 'good' due to their perceived naturalness, compared to organic pigments, often labeled as 'bad' due to their carbon-based structure and perceived permanence in the skin. However, this oversimplification overlooks the complex dynamics of how pigments interact with skin tissue, especially in the context of scarring and pigment removal.

Balancing Biological and Chemical Considerations

The process of creating powder brows is a delicate exercise in balancing two potential negative effects: the biological traumatization caused by the procedure and the chemical imperfection of the colorant in terms of its natural removal from the skin. This balance is critical and nuanced, depending on a variety of factors.

The Double-Edged Sword of Inorganic Pigments

Inorganic and mineral pigments are often lauded for their compatibility with the skin, presumably offering a more “natural” option. However, this perspective fails to consider the entire scenario. If the implantation of these pigments results in excessive scarring, it can lead to more significant long-term damage. The scarring process can alter the skin's collagen structure, impacting not only the appearance of the pigment but also the overall health and texture of the skin.

On the other hand, organic pigments may present a different set of challenges and benefits while sometimes causing the brows to appear grayish and remain in the skin for longer periods. When it comes to removal, such as through laser procedures, the response of organic pigments can be more favorable. If the laser removal is performed correctly, it may cause lesser overall damage to the skin compared to the scarring induced by an inexperienced artist using inorganic pigments.

The Crucial Role of the Artist's Technique and Expertise

The crux of the matter lies in the skill and expertise of the artist performing the powder brows procedure. The choice between using organic or inorganic pigments should not be made in isolation but should be considered in tandem with the artist's proficiency. It is a misconception to consider inorganic pigments as safer and “less damaging reflexively.” If the application of these pigments results in permanent, albeit not always visible, changes in the skin's collagen structure and scars the dermis, the long-term effects can be detrimental.

A Holistic Approach to creating Powder brows

Thus, the selection of organic or inorganic pigments should be made with a thorough understanding of not only the pigments' properties but also the technique and skill level of the artist. The impact of these procedures extends beyond the immediate visual results, influencing the structural integrity and health of the skin. Therefore, a holistic approach, considering both the skin's biological responses and the pigments' chemical nature, is essential for optimal outcomes in semi-permanent makeup applications.

7. Renewal of dermis

As we discussed in this article, scarring is a natural part of the healing process, where the body forms new collagen fibers to mend the damage caused by the needle.

The longevity of such scarring in the dermis is variable. It can be influenced by several factors, including the depth and aggressiveness of the needle penetration, the individual's skin type, and the body's healing response. In general, scars in the dermis can be long-lasting. Unlike the epidermis, which regularly sheds and renews itself, the dermis undergoes much slower cellular turnover and regeneration.

Dermal Renewal and Age Factors

The dermis does not "renew" itself in the same way or as quickly as the epidermis. While there is some degree of cellular turnover and collagen remodeling over time, complete renewal of the dermis is not a process that typically occurs. The collagen turnover rate and the skin’s ability to repair itself diminish with age. Younger skin tends to be more resilient and may heal more effectively, leading to less noticeable scarring. In contrast, older skin may scar more easily and take longer to heal, and the scars can be more prominent or longer-lasting. This means that the traces of traumatization can exist for years.

Visibility of Scarring

It's important to note that not all scarring is visibly apparent to the naked eye. Microscopic scarring, which involves subtle changes in the skin's collagen structure, can occur without any visible signs on the skin's surface. This type of scarring can still affect the skin’s texture and how it responds to future treatments, including how it holds the pigment. Factors like the technician's skill, technique, and post-procedure care can influence the extent of visible and microscopic scarring.

Thus, the scarring in the dermis caused by powder brows procedures can potentially be a long-term change in the skin's structure. The extent and visibility of this scarring depend on various factors, including the individual's age, skin type, and the specifics of the procedure and aftercare.

While younger individuals may experience less prominent scarring due to better skin resilience and healing capabilities, older individuals may have more pronounced and enduring scars. This underlines the importance of skilled technicians and proper techniques in minimizing unwanted outcomes in semi-permanent makeup procedures. An inexperienced artist may cause far more damage all things considered, trying to implant inorganic pigments than a more experienced artist with organic pigments.

8. Practical Tactics

In the practice of semi-permanent makeup, particularly powder brows, the interplay of scarring, pigment characteristics, and needle angle plays a pivotal role in both the aesthetic outcome and the integrity of the skin. Understanding these factors is essential for achieving optimal results while minimizing skin trauma.

Pigment implantation and skin damage risk

Pigments' physical and chemical properties significantly influence their ease of implantation into the skin. Harder pigments, which may be more challenging to implant due to their consistency, can increase the risk of skin damage. This is because the effort to embed these pigments into the dermal layer often requires more passes or increased pressure, which can lead to heightened skin trauma and potentially more scarring.

Optimizing needle angle for effective pigmentation

While maintaining a 90-degree needle angle is often recommended for minimizing skin damage, many experienced artists adapt this angle, particularly when working with thicker pigments. Adjusting the needle to an angle between 70 to 90 degrees can enhance pigment flow into the skin. This adjustment allows for a more efficient pigment transfer, potentially reducing the number of passes needed and thereby decreasing overall skin trauma.

Using a slightly adjusted needle angle can be advantageous in specific scenarios, such as creating the lower line of powder brows where a pixelated effect is not necessary. By employing angles within the 70 to 90-degree range, an artist may achieve the desired intensity and precision with fewer passes, ultimately lessening the cumulative damage to the skin.

The risks of lower needle angles

Notably, needle angles lower than 60 degrees are generally not recommended in powder brow procedures. Angles in this range significantly increase the risk of skin damage, as they tend to create more pronounced and elongated incisions in the skin. This can lead to excessive trauma, increased scarring, and uneven pigment distribution. There are no viable cases in powder brow techniques where such low angles would be beneficial or necessary.

The Role of Skin Butters and Lubricants

Using skin butter and lubricants enhances the overall powder brows procedure's efficacy and safety. These products serve to moisturize the skin, reducing friction between the needle and the skin's surface. This lubrication facilitates smoother needle movement and aids in the more efficient transfer of pigment into the skin. These butters and lubricants can help minimize the risk of skin trauma and scarring by creating a less abrasive environment. Furthermore, well-moisturized skin can better receive and hold pigment, potentially improving the longevity and vibrancy of the results. Therefore, incorporating skin butter and lubricants into the procedure is a practice that aligns to reduce skin damage while enhancing pigment deposition.

What can be concluded

The successful application of semi-permanent makeup, particularly in powder brows, requires a careful balance between pigment characteristics, needle angle, technique, and the judicious use of skin butter and lubricants. By understanding and respecting the skin's response to those factors, an artist can effectively minimize skin trauma while achieving the desired aesthetic effect. The key is a tailored approach that considers the unique properties of the pigments used, the specific needs of each procedure, and the importance of maintaining the health and integrity of the client's skin. This holistic view ensures that every aspect of the procedure contributes positively to the final outcome.

9. Conclusions

The smaller the needle angle, the greater the potential damage to the skin, and it becomes increasingly difficult to achieve the “perfect pixel” shape necessary for creating the pixelated look of powder brows.

Scarring is an inevitable aspect of the powder brows procedure. However, excessive scarring hinders the actual implantation of pigment particles. This leads to problems such as the “No Room” issue, where the collagen in scars lacks the space for encapsulating pigment particle aggregates, and the “Bad Neighbourhood” problem, associated with inflammation and scarring leading to an alkaline skin pH level, which is unfavorable for the retention of pigments in the skin.

Scarring is caused largely by the needle angle, excessive pressure, and the number of passes, even if these are carried out perpendicularly (at 90 degrees). This is often related to inexperienced artists implanting inorganic pigments. Multiple attempts to push the pigment in can result in greater overall damage and scarring compared to potential laser removal of organic pigments. Therefore, scarring must always be considered in the context of the pigment used and the artist's skill set.

When it comes to thicker (often inorganic or mineral) pigments, many artists tilt the needle to 70-90 degrees, rarely less. In parts of powder brows that do not require pixels, the pigment can be implanted at a slightly smaller angle but never less than 60 degrees. Using skin butters and lubricants can help lessen the overall damage to the skin. One should always adhere to the principle: “Primum non nocere” (First, do no harm) and understand that each component (needle angle, pigment, skin type, and artist skill) is just one factor in a complex interplay. The ultimate goal should always be to minimize damage to the skin.