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Areola: n. The colored circle of flesh around the nipple.  The areola darkens after the second month of pregnancy and usually enlarges as pregnancy progresses, doing breast growth, weight gain or after breast augmentation. [pl. areolae, areolas]

What Is This Procedure For?
Dermagraphics, or cosmetic tattooing, is the color enhancement of the skin or re-pigmentation of hypo-pigmented areas of the dermis with non-reactive,  hypo-allergenic natural iron-oxide colored pigments which are implanted into the very first layers of the skin with a tattoo like  gun or pen.  These pigments can be very natural looking.

Scarring from breast surgery can cause pronounced hypo-pigmentation, however some patients may wish to have cosmetic enhancement of normal, non hypo-pigmented areolae.  With micropigmentation, the areolae can be made more rosy, or darker colored or can be used to blend the edges out a little.  Micropigmentation can also be used to "replace" an areola after surgical removal.

 Who Is This Procedure For?
Areola micropigmentation is for anyone who wishes to correct breast and areolae color irregularities, or enhance the areola and breast.  However, patients younger than 18 will need their parents permission.  

Patients with keloiding problems may not be good candidates for this procedures so be sure to disclose your prior scarring history.  Patients with active infections should wait until the infection has cleared before seeking treatment.

If you are choosing to undergo areola tattooing after a breast surgery, be sure to check with your surgeon before having the procedure performed.  Scar tissue accepts implanted pigment differently than normal tissue and can result in uneven coloring, pain, keloiding, and more.  It is usually best to wait until the scar tissue is mature and that can be anywhere from 7 to 12 months.

 What Are My Options?
Color options include a broad range of natural-looking colors.  Generally all colors of the rainbow are possible, however, most patients wish to have a normal darker flesh color which enhances the breast.  You may either wish to match the already existing color of your areolae, or darken it further with a deeper hue.  This is an important decision so please think this over thoroughly.  It is often wise to choose a color too light than too dark.

Regarding tattoo guns, there are many models of pens and guns, some cordless, some not, some very expensive and still others that are very basic.  Technicians can be very skilled, taking a course to train with professionals and some just buying videos and manikin kits to practice on before the receive real clients.  So please ascertain that your technician in both highly skilled and properly trained.

 What Are The Risks & Complications Of This Procedure?
Allergic reactions to the anesthetics, if offered, and pigments are possible.  You may request a skin patch test in an inconspicuous area prior to having a procedure performed.  Some technicians are very routine about patch testing and perform them on everyone.  Regardless, you should understand that an allergic reaction could occur at any time.

If you are prone to Keloids or hypertrophic scarring you may develop scar tissue at the treatment site.  Please think this over if you are prone to such.  Infection can also be an issue.

General dissatisfaction may be an issue whether or not you chose your technician carefully.  Either by differences in opinion, or a change of heart.  Pigments may fade or bleed overtime depending upon your body and sun exposure.

 Who Should Perform This Procedure?
As with a plastic surgeon, ask for the technician's background.  How long have they been performing micropigmentation?  How many procedures have they performed?  Ask to see their certificates of training and their tattoo license if required by your state.   Also ask to see any continued education certificates from say seminars and conferences or specialty courses.  As with Cosmetic Surgery, this field is continually changing.  Newer techniques are discovered.  A dermagraphics technician should always be on the look out for additional training in their field.  If the technician is new ask how many hours of training they have had.  Some attend only a one or two day (no more than 16 hours) course and I would certainly advise against that technician.  Unless of course they have been performing applications for at least a year, with a steady flow of clients.  The average course is five days (or 40 hours) but there are longer courses.  Unfortunately, since there is no industry standard, and there should be, a technician can learn from a video course after practicing on her manikin kit he or she can buy with the kit and possibly practice on herself or friends then go straight to your body.   So obviously, skill counts.

Look through the technician's portfolio (recent photos of their work).  Ask them point blank if it is indeed their own work/clients as there are circulated photos used all over.  Ask if you may speak to any of her clients personally, like a referral list.  Determine if this technician's work reflects your own cosmetic style.  

  • Is it natural?  

  • Does her work reflect a soft technique?  

  • Is he or she open to your wishes?  

  • Do you like the colors that the technician has to offer?  

  • Does she offer anesthetic?  

  • What types of anesthetics are available?  Topical?  Injectable?  A injection should be performed by a nurse not a technician with only a week long course in dermagraphics.  Some technicians advise to go to your dentist (or theirs) for a injection of lidocaine.  Be advised that Marcaine is available on the internet, with no license required.  Anyone can purchase the topicals and Marcaine injectable so take care when choosing your technician.

You should choose a technician that has been in the dermagraphics industry for many years to perform your application. 
The same approach should be used toward any re-pigmentation or scar camouflaging techniques.  Most scars are actually quite thicker that unblemished skin and the pigment may look entirely different than what is desired.  Thicker skin tattoos differently, as well.

The color chosen is very important as your color will be viewed through your skin tone.  For instance, a rosy color will look slightly different on a client with yellowish undertones than those who have peach undertones.  Discuss this with your technician or tattoo artist.

Where Should This Procedure Be Performed?
You should only have your procedure performed in a clean and professional environment and only by a licensed tattoo artist.  This does not include someone's home, a hotel or in an unclean work area in general.  Although laws vary from state to state and city to city, all tattoo artists of any kind must have a valid license displayed at all times.  You may check the validity of this license with the Department Of Health Regulation or Commissioner of Health for your state.  

 What Should I Expect At My Pre-operative Consultation?
Pre-treatment consultations are designed as meetings with the dermagraphics technician so that you are able to evaluate what they have to offer, their preferred technique, before and after photos, anesthetic preferences and other protocol.  This is a very important step in the treatment process as this is how you will ultimately choose who to choose to perform your procedure.

You will discuss fees, including the price of touch-up treatments, training, experience and other pertinent information.  Do not be afraid to ask anything which may concern you.

 What Are The Average Costs Of This Procedure?
The approximate costs of micropigmentation can vary significantly due to region and technician, and the amount of work necessary.  The average prices for areola repigmentation are between $200. and $800.  Although many regular tattoo artists are able to do the work at far less of an expense.  

 How Do I Prepare My Body For This Procedure?
At your consultation you may receive instructions on what not to take and how to prepare your body for your procedure as well as how to care for yourself after the procedure.

Typical instructions include cessation of all aspirin or vitamin E-containing products and supplements, alcohol consumption, and recreational drug use.  Bleeding may become an issue during your procedure should you continue to consume aspirin, large doses of vitamin E, alcohol, recreational and some prescription drugs and supplements.  Should excessive bleeding occur, your technician may have to stop your treatment.  

Although many vitamins and supplements can be harmful before and after a procedure, there are also helpful vitamins and supplements recommended to stimulate healing.  These may include Alpha Lipoic Acid, Arnica Montana, Vitamin A, Vitamin B Complex,  Bromelain, Copper, Vitamin C or Vitamin C Ester, Chromium polynicotinate, VItamin D3, Folic Acid, L-Carnitine, L-glutathione, MSM (Methyl Sulfonyl Methane), N-acetyl-L-cysteine, Niacin, Selenium, taurine, Thiamine and Zinc.  Please see our Helpful Vitamins & Supplements section.

You should discuss the desired areolae size right before your procedure.  The areolae size can be drawn on beforehand to determine an aesthetically pleasing size.  You may wish to start small and work your way larger, should you change your mind.  Tattoo removal is a long and painful process so be sure before you commit.

 How Is This Procedure Performed?
Prior to getting tattooed, the technician puts on a pair of latex gloves or other types if you or he/she has a latex allergy and inspects your skin to make sure you have no cuts, scrapes or other types of broken skin.  The area is either swabbed with alcohol or sprayed with an  antiseptic solution or both and the technician shaves the area of any and all hair with a disposable razor.  The razors and towels used for wiping your bodily fluids should also be disposed of in the same type of biohazardous waste.

Then, the  technician transfers a stencil of the tattoo or draws on the desired shape onto your skin.  You are then asked to verify the placement, position and so forth of the design.  If everything is satisfactory, a thin layer of petroleum jelly, or other ointment, is spread over the area to be tattooed.

Any modern tattoo is applied by using a small electric device (a traditional gun, rotary pen, machine coil, Softap™) with a needle bar that holds from 1 to 14 needles, each in its own little tube, to implant liquid, colored pigments.

The tattooing device basically works like a miniature sewing machine: the needle bar moves up and down really fast, forcing the needles into the superficial (epidermis) and middle layer (dermis) of the skin, implanting whatever colored pigment the technician dips the tip into.  The technician holds the machine with a steady hand while guiding it along the skin.  The speed and power is controlled by a foot switch or pedal, much like a sewing machine.

The needles penetrate the skin only a couple of millimeters as the tubes restrict the needles from penetrating any deeper. Each needle has its own separate tube.  This feature permits the  needle bar shaft to operate smoothly without damaging the needles.  A single needle (sometimes a micro-needle) is used to make a very fine, delicate line.  A row of needles (from 4 up to 36) is used for shading and more dense fill-ins, often used in areolae repigmentation.  From experience with traditional tattoos, I'd like to add that although it seems like the shading would hurt far worse (because of the multiple needles) is quite the opposite.  Outlining is by far the most uncomfortable.  However, if you will be receiving a topical anesthetic, you may not feel much discomfort.

The end of the needle tube is dipped in a small amount of ink.  The technician guides the machine over the skin and the needle(s) move up and down, penetrating the skin, implanting the pigment.  Excess pigment and blood, or other bodily fluids, ooze out from the puncture wounds and the technician wipes them off with an absorbent disposable towel, repeatedly. This enables the technician to better see what he or she is doing.

The level of pain really depends on the individual.  Some people's pain threshold (or tolerance) is high while others are quite low.  The level of pain also depends on the tattoo site.  Areola tattooing can be completed in about 45 minutes to an hour and a half.  If you are having more than one area/procedure it may take a few hours or maybe another sitting (this means you come back at another time).

When the technician has completed your tattoo is sprayed with water and antiseptic and wiped off.  A layer of Bacitracin is applied over the tattoo and you are instructed to wash it no more than twice a day with mild soap and water and apply a lotion like Lubriderm or Bacitracin as needed (no Vaseline!).  Your technician may then apply a  non-stick gauze pad over the site and instruct you to remove it that night (leaving it on no more than 12 hours).   

 What Should I Expect During My Recovery?
You will be asked to wash the treatment area gently with mild soap and apply Lubriderm, Bacitracin or whatever topical your technician has advised, as needed.  Do not apply more gauze to the area, leave it exposed to the air so that it can begin to heal but keep the area moist until the healing is complete.  It takes about a week (usually seven to ten days) for a tattoo to heal. Until then, you should not apply cosmetics over the area and NO PEROXIDE.  If you apply peroxide, you will bubble the healing skin and ink away.  No peeling the skin or itching of the area either.  If it flakes, let it flake.  If you peel the skin off, you will pull pigment right out of the tattoo resulting in splotchiness and the need for more touch-ups. 

Do not expose your new tattooed areolae to direct sunlight for at least two weeks.  If you do, you may get sunburn or changes in pigment (i.e. color fade). Use sunscreen like it's going out of style.  Do not go swimming, hot-tubbing or soak the treatment area in the bath.  That goes for fresh, salt or chlorinated water.  This could cause pigment fade as well cause infection.  You should always apply sun block if you expose your tattoo to sunlight (this means artificial sunlight, too).  Indoor tanning machines will fade your tattoo as well.

Day 1
Your areaolae will feel tender and you may be a little sore.  This can be relieved with Tylenol.  Please do not peel any flaking skin as this can cause an infection from bacteria being introduced by your hands.  This can also cause irregular pigmentation, scarring and fading.

After several hours you will remove your bandage and gently wash the area with mild soap and water.  You should keep the area moisturized with your instructed lotion or topical.

You may notice sensations such as sharp pains, tingling, tickling, intermittent throbbing and other sensations during the course of your recovery.  Know your body, although these are usually normal, anything intolerable could be a warning sign.

Day 2
The discomfort should be less and you may notice dryness and peeling.  Do not peel the skin off, let it flake naturally.  You should keep the area moisturized with your instructed lotion or topical.

Day 3 - 5
Flaking will get worse before it gets better.  You should feel very little to no discomfort.  Although this depends upon the patient.  Continue to keep the area moisturized with your instructed lotion or topical.

Day 7 - 10
Healing should be almost complete.  Continue to keep the area moisturized with your instructed lotion or topical until there is no more dryness and peeling.

Day 14
Healing should be complete.  Continue to keep the area moisturized with your instructed lotion or topical until there is no more dryness and peeling.

Day 21
If you need touch-ups, you may be instructed to return for another treatment.

Scarring Concerns
If you are prone to keloids and hypertrophic scarring, you may experience these problems.  If so, silicone sheeting and/or emu oil may be an option for you once broken skin is not apparent.

 Anything Else I Should Know?
Touch-ups are often included, inquire as to the price of each touch-up.  Be advised that more than 3 touchups are hardly ever needed.  If they are, inquire as to why this is.  Even in regular tattoos, touch ups are less than 3 for smalla reas.


photo credit: Janette Archer - Long Beach, CA  

 Where Can I Read More About This Procedure?
American Institute of Permanent Color Technology
The American Academy Of Micropigmentation 

Society of Permanent Cosmetics Professionals
Permanent Cosmetics Institute
Permanent Make-up by Janette Archer - Long Beach  

Permanent Makeup Services by Yolanda Moore  



(Updated on 02/25/10)
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