How Not to Damage the Lips with the Pigmentation Procedure (Experts' Advice)
Author: Holistic PMU Research Center, fact-checked and reviewed by an expert panel.
Contributor: Siiri Tabri
First, Do No Harm…
Achieving optimal results in lip procedures like Aquarelle Lips often hinges on carefully treating delicate lip skin. In this article, we'll explore essential practices that artists can adopt to minimize skin damage and elevate the final outcome.
“In lip pigmentation, the mantra ‘less is more’ rings true. The goal is to subtly accentuate the client’s natural beauty without exceeding their lips’ natural shape or color variations.”
Background
This article draws upon the insights of 32 leading Permanent Makeup (PMU) artists, predominantly from European Union countries, focusing on Scandinavia. A handful of these professionals are also based in the United States. What binds these artists together is their extensive experience—over five years in the field of pigmentation, with a specialization in Aquarelle Lips. In this article, we zero in on the Aquarelle Lips technique, emphasizing best practices to prevent excessive skin damage during the procedure.
Skin on Lips
Compared to skin elsewhere on the body, understanding lip skin's unique characteristics is vital for professionals involved in Permanent Makeup (PMU) pigmentation procedures.
Exceptionally Thin Layer of Skin
First and foremost, the skin on the lips is markedly thinner than the skin on the face and body. Lip skin has only three to five cellular layers, while facial and body skin can contain up to 16 layers. This reduced thickness renders the lips more sensitive and vulnerable to external factors like UV rays, dryness, and physical trauma.
Additionally, lips have a rich blood supply. This not only imparts their characteristic red or pink color but also makes them susceptible to swelling and bleeding. Due to this high vascularity, PMU artists must exercise caution to prevent excessive bleeding and uneven pigment distribution during procedures.
Challenges in Pigment Absorption
Lip skin lacks both hair follicles and sweat glands, which play a role in natural pigment absorption and retention in other body parts. This absence often leads to faster pigment fading, requiring more frequent touch-up sessions.
Sensitivity and Moisture Levels
The lips have a high density of nerve endings, making them far more sensitive than other body areas. For PMU practitioners, this often necessitates using numbing agents, although these can alter the skin’s texture and make pigment implantation more challenging.
Furthermore, lip skin lacks sebaceous glands, which produce oils to moisturize the skin. This absence often leads to quicker drying, complicating the post-PMU pigmentation healing process.
Given these factors, the approach to lip pigmentation must differ substantially from other body areas, including the eyebrows. As such, artists transitioning from brow to lip pigmentation often make mistakes due to these critical differences.
Numbing and Potential Skin Damage
Though numbing itself is not inherently damaging to lip skin, understanding how it operates can shed light on how it may contribute to unnecessary damage during PMU procedures.
Pre-Numbing: Nerve Cell Blockage
Most numbing agents contain active ingredients, such as lidocaine, designed to block nerve cells from transmitting pain signals. This action desensitizes the skin, making it less responsive to the discomfort associated with PMU procedures. These pre-numbing agents are generally milder and typically do not possess vasoconstrictive properties.
Numbing with Epinephrine: Vasoconstriction
Topical anesthetics with epinephrine (also known as adrenaline) can temporarily alter the skin's cellular structure, primarily through vasoconstriction or the narrowing of blood vessels. In some cases, the vasoconstriction is so pronounced that it essentially blocks smaller blood vessels. Epinephrine is a potent vasoconstrictor, significantly reducing blood flow to the area where it's applied. This effect often leads to visible changes in skin tone; the skin around the Vermilion border lightens when the gel is applied there, whereas the tone on the inner part of the lips can change when the gel is used during the procedure.
This temporary alteration in blood flow and cellular structure can be important for PMU professionals to consider, as it can affect both the procedure's immediate outcomes and the longer-term healing process.
Diminished Sensory Feedback
Numbing the skin can dampen the natural sensitivity that typically serves as a guide for PMU artists. This lack of tactile feedback makes it challenging to accurately gauge the depth and pressure used during pigmentation. Consequently, working too intensively is risky, causing unnecessary skin trauma. This is further exacerbated by the skin's diminished natural resistance to needle penetration, which may result in increased scarring, bleeding, and uneven pigment application.
Vasoconstriction and Altered Visual Feedback
Epinephrine-containing numbing agents induce vasoconstriction, which can alter the lip skin's natural color. When smaller blood vessels are constricted but blood flow continues, the PMU artist may find it challenging to gauge the actual color of the area being worked on. This lack of visual feedback can result in overworking the skin, leading to additional unintended damage.
The Timing of Numbing and Pigmentation
If epinephrine is involved, the body responds to skin damage by increasing the production of lymph and blood in the treated area. When numbing cream remains on the lips for an extended period—longer than 2-3 minutes—subsequent pigmentation often leads to excessive bleeding. This makes the pigmentation process more challenging and heightens the risk of additional, unnecessary trauma to the skin.
Questioning the Need for Numbing
Contrary to the standard protocols many young artists rigidly adhere to, assessing whether numbing is necessary is crucial. To make an informed decision, it's essential to understand the factors contributing to pain during lip pigmentation. Specifically, one must consider the differences in sensitivity between scar tissue and undamaged skin.
Scar Tissue and Increased Sensitivity
Scar tissue is generally more sensitive than undamaged skin, making pigmentation on the lips potentially more painful in these instances. This heightened sensitivity often arises from damaged or compressed nerves within the scar tissue, causing nerve endings to be hypersensitive and to react more strongly to external stimuli like needle penetration.
Reduced Elasticity in Scar Tissue
Scar tissue is also less elastic than healthy skin. It contains densely packed collagen fibers aligned in a unidirectional pattern, limiting its ability to stretch. This reduced elasticity can make the tissue less receptive to needle penetration, thus heightening discomfort during the procedure. Furthermore, if the scar has resulted from a previous lip procedure or a herpes outbreak, that skin area may already be more sensitive and receptive to pain signals.
In addition to that, scar tissue often has a different blood supply than adjacent, healthy tissue. These changes in blood flow can influence how the tissue reacts during PMU procedures, potentially magnifying its sensitivity.
Healthy Skin Often Requires No Numbing
Given these considerations, it's often unnecessary to use numbing agents on the healthy skin of clients who have never had a lip procedure and do not suffer from herpes. If numbing is deemed essential, especially during procedures involving scar tissue, it's crucial to minimize using epinephrine-containing numbing agents. Should these be used, the time between applying the numbing gel and commencing pigmentation should not exceed 2-3 minutes to mitigate potential complications.
Stretching and pinching
There are various procedural techniques that not only reduce the potential for skin damage on the lips but also improve pigment application and its long-term retention.
Limiting Skin Stretching
Many novice artists are trained to stretch the skin as much as possible for a smoother surface, which is effective for the brow area or for thicker, oily skin resembling an "orange peel" texture. However, this approach is less suitable for the delicate skin of the lips. Excessive stretching can cause the lip tissue to tear, leading to unnecessary and significant damage.
Adopting Pinching Techniques
A more effective alternative is to pinch the area of the skin where you're working. Seasoned artists often use this technique on soft and delicate skin, achieving better results than stretching. Pinching also allows the artist to feel the needle's vibration against the skin, providing an intuitive guide for proper pigmentation. Artists can attain better results by feeling the vibration and listening to ensure the needle doesn't penetrate too deeply.
The working area on skin and blood
Optimizing Needle Penetration Depth
Artists familiar with pigmenting other body areas often make the error of penetrating the lip skin too deeply. As previously discussed, the delicate nature of lip skin makes deep penetration risky, leading to unnecessary damage, swelling, and inconsistent results. The key is to employ a "hovering" and "floating" motion with the needle across the surface of the lip skin. The hand movements should be restrained, short, and gentle. Adopting a less-is-more strategy is especially beneficial when you're new to the procedure and gaining experience.
Benefits of Process Butter and Pigment Booster Balms
Many experienced PMU artists recommend using Process Butter and Pigment Booster Balms to improve the skin's texture and the pigment's retention. These products often contain nourishing ingredients like shea butter, beeswax, and various oils, which serve to condition and soften the skin. A well-conditioned and softer skin surface enhances the needle's ease of movement during the pigmentation process.
By conditioning the skin, these products enable it to hold pigment more effectively and act as a protective barrier, reducing the risk of skin irritation and potential damage. This is especially crucial when working on sensitive areas like the lips. Process butter and pigment booster balms also decrease friction between the needle and the skin, facilitating a smoother pigmentation process. This is highly beneficial for minimizing the uncomfortable "dragging" sensation that can occur during some PMU procedures.
Many of these balms also contain healing and anti-inflammatory ingredients such as Vitamin E or aloe. Some formulations even include elements that can control minor bleeding and swelling, further enhancing the procedure's success and comfort levels.
Psychological Comfort and Placebo Effects
While these butters and balms aren't substitutes for proper numbing agents, they do offer a mild soothing effect that improves the client's overall experience. Often, the mere application of these products triggers a placebo effect, leading clients to report reduced pain levels, even if there is no direct physiological reason for this. In essence, the comfort derived may be primarily psychological, but it contributes to a more pleasant procedure for the client.
Managing Bleeding Areas Effectively
Bleeding is sometimes an inevitable part of the procedure and can vary depending on individual factors, including a client's menstrual cycle. Novice artists often make the mistake of persisting on bleeding areas, which should be avoided. The area requires rest, and visibility is crucial for the artist. When blood, lymph, and other bodily fluids mix with the pigment, the work area becomes challenging to manage. Seasoned artists often refer to the strategy of moving between bleeding and dry areas as "dancing." They mentally divide the lip surface into sectors and immediately switch to a dry, less irritated section if they notice excessive bleeding. This allows time for the problem area to recover before resuming work.
Outlines and coloring
Being Patient with Color Changes
In lip pigmentation, the appearance of color is often delayed, unlike in other procedures such as Powder Brows. Artists, especially those new to the technique, should exercise patience and adjust their expectations. This is particularly important when using pigments that blend closely with natural skin and lip colors, like "nude" tones or pigments without titanium dioxide. Impatience can lead to unnecessarily intense work when, in reality, a wait-and-see approach is often best.
Approaching Outlines with Caution
Outlining is an interconnected part of the overall pigmentation process. Mistakes made during this stage can have a ripple effect throughout the procedure. It's crucial to remember that outlines, especially in Aquarelle Lips techniques, are not meant to be heavy or overly intense. Instead, they should serve as subtle borders that help correct minor asymmetries. As one veteran artist said, "The outline should be just a correction of the vermilion line where natural asymmetry exists." Creating heavy outlines often tempts the artist to over-pigmentate the inner lip area, causing unnecessary damage and losing the unique shading effect known as the "aquarelle effect," differentiating this technique from full lip pigmentation.
Conclusions
Artists who are new to lip pigmentation or transitioning from brow work often make the mistake of causing excessive damage to the delicate lip skin.
Overuse of numbing agents, or using them when not required, can contribute to this issue. These agents can change the skin structure, making it thicker and less sensitive. This may lead inexperienced artists to apply too much pressure, resulting in unnecessary trauma to the lips. In many cases, especially for clients without a history of lip procedures or herpes, numbing isn't even needed. If secondary numbing with epinephrine is used, it should be applied no more than 2-3 minutes before the procedure begins.
During the procedure, stretching the skin excessively should be avoided. Instead, pinching the skin lightly is recommended. This allows the artist to feel the needle's vibration, which is crucial for optimal pigment application. The needle itself should skim the surface of the lip skin, neither penetrating too deeply nor causing undue damage. Products like Process Butter and Pigment Booster Balms can make the skin more pliable and improve pigment retention.
Moreover, areas that are bleeding should be given time to recover. The artist must also be patient with color changes, especially when using pigments that closely match the client's natural lip color. Finally, caution is advised when creating outlines; heavy or intense lines should be avoided. For techniques like Aquarelle Lips, subtle corrections to the vermilion line are all that's required.