BEFORE HAVING A TATTOO IML'S RECOMMENDATIONS:
If you are considering undergoing a micropigmentation treatment or having a tattoo, you should first be aware of the requirements that both the technician applying it and the centre should meet, as well as the pre and post treatment protocols, its risks, contraindications and possible complications. Instituto Medico Laser, together with Mr Mario Gisbert, President of the Spanish Micropigmentation Association, has drafted a series of basic recommendations to keep in mind before having a tattoo.
MINIMUM REQUIREMENTS
The centre should meet the following conditions:
Specialised Professional: The technician that performs the tattooing should have accredited qualifications from the relevant Autonomous Communities in reference to Health and Safety Regulations and Hazard Prevention, or hold a degree in Nursing, Medicine or Technician in Aesthetics. The technician should also be vaccinated against hepatitis B and tetanus.
Equipment: The accessories used for these techniques should comply with current legislation (Royal Decree 1599/1997. Additional order 2 of R.D. 209/2005 and R.D. 414/96. Additional order 5). Clients have the right to demand that all the material used be unsealed and disposed of in their presence.
Pigments: The colouring agents used in micropigmentation are subject to strict regulations both on a national and European level. The national authorities have published the requirements to grant authorisation for the pigments. The European Council resolution on tattoos and micropigmentation issued in 2003 warns of the health risks involved if certain substances are used. Said resolution specifies the information that the packaging should contain, although this is also amply covered in the national legislation (R.D. 1599/1997 of 17 October for Cosmetic Products; R.D. 209/2005, which modifies the previous one).
In particular, the colouring agents cannot contain substances that are hazardous to the health, such as aromatic amines or ingredients considered cancerous, mutagens or reprotoxic, as well as others susceptible of causing hypersensitivity. Furthermore, the pigments cannot contain preservatives. To avoid contamination of the pigments, they should be prepared following the norms of the European Council, in sterilised packages that keep them uncontaminated up to the moment of application. The list of ingredients according to the International Union of Pure and Applied Chemistry (IUPAC) standards, CAS (Chemical Abstracts Services of the American Chemical Society) number or the Colour Index (CI) code.
Pigment composition:
• In the case of micropigmentation, the pigments used are inorganic and organic of insoluble synthesis (such as the lacquers for shine); vegetable or animal pigments such as henna are not permitted. They are all carried in excipients included in the preparation formula and facilitate their preparation and stability. These pigments are mixed to obtain the required colours, the colours with which micropigmentation is performed can be tri or tetra generated.
• The inorganic pigments are insoluble and very stable to agents such as light or heat. They give greater or opaque coverage and matt colour. Those mainly used in micropigmentation are:
• Soluble synthetic organic pigments are those that give brilliant tones but less coverage and are also less stable as far as durability of the pigment and colour stability. They can be lacquered or true pigments, the most important ones are:
• Non-synthetic organic pigments are not permitted as ingredients and have been replaced by synthetic colouring agents that are more stable, reliable and with less risk of causing allergies, the most well-known are:
The compositions are often unknown in the case of tattoos due to the secrecy shown by a number of centres of doubtful quality. In these centres, the tattooists tend to use various brands that they then mix together, which makes it complicated for the patient to accurately know which type of ink has been used. This makes subsequent touch-ups difficult, since the possible reaction between the existing pigments and those added later cannot be gauged. This also makes its posterior elimination with laser complicated, since various colours have to be removed.
Most frequently used pigments in micropigmentation and tattoos:
Black:
Blue:
Green:
Red:
Yellow:
Brown:
Violet:
White:
Flesh:
PRE-TREATMENT APPOINTMENT
Before deciding on a micropigmentation treatment we should have a pre-treatment appointment in which the following should be explained:
1-. What micropigmentation involves.
2-. What the results are and, if possible, viewing photographs of other treatments.
3-. How many sessions are required?
4-. What the possible complications and contraindications of the treatment are.
5-. Pre and post treatment care, duration and future touch-ups.
6-. The legal requirement of signing an informed consent form.
7-. Performing a visagism test. The most appropriate lip, eyebrow or eyeliner design for your facial features will be sought.
8-. Estimate. Only when the patient’s needs are known can the cost be evaluated.
Tattoo contraindications
Possible complications of tattooing
In the event of deciding on treatment, the Centre should carry out an allergy test on the client.
PRE-TREATMENT ALLERGY TEST
The allergy test should consist of the following stages:
1-. Visagism file and face study.
2-. Questions about the client’s general health, in case the treatment may be contraindicated or if medical consent is needed.
3-. Reading of the pre and post treatment care.
4-. Reading of the informed consent form for the allergy test. Requesting the signing of the informed consent form.
5-. Performing the allergy test.
6-. Transfer to the micropigmentation booth, which should comply with current legislation.
7-. The practitioner should wear gloves, cap for the hair and a face mask.
8-. The client should be supplied with a cap and all jewellery and ornaments removed from the facial area.
9-. The rotary machine is prepared with a sterile, single-use applicator, that the practitioner will show the client.
10-. The pigment should be opened in front of the client and its contents poured into a container. Both items should be single-use and sterile and the client should witness their unpackaging.
11-. The rotary machine is put into operation and a small amount of pigment applied behind the earlobe or on the nape, at the hairline.
12-. After discarding all of the items in view of the client, an appointment for treatment is set. This should be at least a week later.
13-. For the allergy test, the micropigmentation practitioner will charge a non-refundable fee of 10% of the total price of treatment.
DAY OF THE TREATMENT
1-. The practitioner should receive the client and escort them to the adequately equipped micropigmentation booth
2-. The client is supplied with a cap, disposable gown or bib and any jewellery or ornament is removed from the facial area.
3-. The design is performed using the chosen pigment with a disposable tip or stick and the end result shown to the client.
4-. Once the design is approved by the client, he or she should sign the informed consent form to undergo the micropigmentation treatment.
5-. The practitioner should discard the latex gloves and put on a pair of sterile ones. Treatment continues, using the techniques agreed on with the client and closely following the design chosen by the client.
6-. Once treatment is complete, the client is advised to follow a care routine for at least seven days. This assures a good healing and scarring process and avoids unwanted alterations.
POST-TREATMENT
24 hours later: Changes will be noticed from the first to the second day. More scabbing, accentuated colour, tightness. All of these manifestations are normal and by following a correct hygiene routine, there should be no reason to worry.
Five to eight days later: Scabbing is over. An excessive drop in the colour will be noticed, as if the pigment had disappeared. This is also normal. The pigment will not stabilise until 30 to 40 days after treatment. Creams and makeup can be used at this point.
30 to 40 days later: This is the moment to assess the need for a touch-up. The colour, intensity, saturation and design is monitored.
POST-MICROPIGMENTATION CARE
1-. Protect the area from the sun with total block out
2-. Protect from contact with acids (glycolic, retinol, etc.) and from laser hair removal
3-. Have an annual check up the monitor development and thus avoid the feared changes in colour
4-. Perform a touch-up within two years
IML wishes to thank Mario Gisbert for his collaboration in editing this text
Mario Gisbert: President of the Spanish Micropigmentation Association
Co-author of the book: Micropigmentation: Technology, Methodology and Practice (Videocinco Editions).