Testimonial for Scar Relaxation

What Maria Patterson, a burn victim, had to say about Scar Relaxation.



Scar Relaxation is the application of repetitive circular tattooing movements to create a softer skin texture and to soften the fibrous bands of collagen (scar tissue) to give the patient more flexibility in their movements. This procedure works well on all contracted tissue with exceptional results on hands.

Scar Relaxation was introduced by Susan Church at the first Society of Permanent Cosmetic Professionals (SPCP) conference in 1991 after she discovered it while working on several burn survivors in concert with Dr. Grossman.

Reasons to Consider Collagen Rejuvenation Therapy™

before_and_after-003-002-200x225 2before_and_after-003-001-200x225Collagen



Why Consider This Treatment?

  • No foreign substances are injected into your tissue.
  • Cost effective
  • Little to no down-time
  • Minimal discomfort during the procedure
  • Can be completed during your lunch hour!




Collagen Rejuvenation Therapy™ Plumps Up Wrinkles

Collagen Rejuvenation Therapy™ also known as Skin Needling, Neocollagenesis Plumps Up Wrinkles

BY: Susan Church CCPC, CPDA, CCRT

This simple process assists in restoring the integrity of the skin while it stimulates the collagen in the dermal layer of skin. This, in turn, plumps up the areas of concern.

Skin Needling/ Facial Needling treats light scaring, fine to deep wrinkles. Using a machine for the Skin Needling procedure, the needle cluster is gently inserted into the epidermis and top layer of the dermis.

Skin Needling promotes the natural reproduction of collagen and elastin, making the skin feel smoother and tighter. We treat only the area that needs attention. We do not work on any tissue outside the boundaries of the wrinkles and scar tissue as this will make the wrinkle appear even deeper.

Skin Needling stimulates the body’s natural wound healing reaction to produce natural collagen.

With microscopic punctures in the epidermis, Skin Needling is minimally invasive with little damage to the epidermis.

Anesthesia is generally not needed for Skin Needling as it is not so invasive as to cause pain.

Skin Needling procedures have minimal ‘Down Time’ and swelling, and most people return to work the following day.


With specific protocol, controlled microscopic punctures are made in the areas of concern.




Using a sterile needle grouping, pierce through the epidermal/dermal layer of tissue.





About Susan Church CCPC, CPDA, CCRT

Ms. Church has been performing Skin Needling since 1988. Her articles were published in 1991 in the ‘Society of Permanent Cosmetic Professionals’ (SPCP) Newsletters as well as in other publications on these remarkable findings. Ms. Church has also lectured to medical and beauty professionals on numerous occasions sharing photos of burn, scar, cancer, as well as ‘everyday’ clients that request her services.


Susan Church developed / invented

Skin Needling™

Scar Relaxation

Melanocyte Restoration while working on burn survivors in her clinic and physicians offices.


Susan has lectured almost on a yearly basis on these procedures. Others have taken her procedures, added other treatments to them and have had fantastic results!

Keep up with Susan Church and IIPC on Social Media:

on Facebook at https://www.facebook.com/SusanChurchIIPC

on Pinterest at http://pinterest.com/iipcsusanchurch/


Susan Church – An Angel Without Wings

Susan Church – An Angel Without Wings
By Britain Gregory

In this fast paced world of ‘me first’ attitudes it is refreshing to witness unselfish and compassionate acts of love for fellow human beings; especially for children.

Spend a day with Susan Church and you, too, will be amazed at the outpouring of love that she gives and receives from numerous children that suffer from cancer, alopecia, vitiligo, or are burn survivors. Susan Church has become their angel.

Since 1991 Ms. Church, of the International Institute of Permanent Cosmetics (IIPC), has developed techniques in “Inkless Applications” that restore melanocytes in damaged tissue, or skin disorders that were congenital. She introduced her technique of Skin Needling after discovering that the process aided in restoring collagen to damaged areas and promoting skin terger. With this discovery, Ms. Church has performed numerous procedures that have provided children with these conditions a better chance of normalcy and an ability to develop their self-esteem. Of all the pleasures in her life, the smile of a child affects her the most.

And in some cases, it is a smile that Susan was able to return to children whose faces were scarred by fire and deformed by the skin grafts that followed. This is where Ms. Church took Permanent Cosmetics to a level of medicinal value; a level far above that of aesthetics.

With this attitude, her application of knowledge and her compassion, Ms. Church has been awarded countless commendations and accolades in the Permanent Cosmetic and Medical fields. Moreover, it has provided her the vehicle to which she can continue to be of service to those who only ask for the opportunity to have a chance to be normal. For those, their smile is the best reward she could ever receive.

Keith Reid wrote: ‘The lesson lies in learning, and by teaching I’ll be taught’. This has become a mantra that Susan Church personifies. The success of her students exemplifies her success as an educator and epitomizes her devotion.

Some Angels don’t have wings. Susan Church earns hers daily.

Ms. Susan Church has been in the beauty industry since 1967 and has remained a leader in the Permanent Makeup Industry sine 1989. Her background in business, owning several full service salons and specializing in makeup artistry, has allowed her the opportunity to exercise her first love: working on burn survivors, cancer patients, and children with alopecia, and anyone who has a disfigurement where she can enhance their natural beauty.

Ms. Susan Church CPCP is the Co-founder of the Society of Permanent Cosmetic Professionals (SPCP), an organization that promotes high standards and ethics by its constituents.

Together, with Susan Preston of Professional Program Insurance Brokers (PPIB), both Susans saw a need in their industry for technicians to police themselves, which resulted in them forming the society. Neither could have envisioned the organization’s success 15 years later.

She has been featured on several television shows, radio talk shows, in magazines, trade journals, newspapers, and is an expert witness in court cases, and has lectured to over 10,000 professionals in the past 20 years.

County health departments in California look to her for advice in all aspects of the permanent makeup industry. She educates Health Department personnel on safety, cross contamination and teaches Exposure Control classes for tattoo artists, piercers and permanent cosmetic professionals. She has also lectured for the California Alliance for the Promotion of Safe Body Art (CAPSBA).

Colleges, including Medical and Professional Associations, also request her to lecture for them. She lectures on ‘Inkless Applications’©, Cancer Treatments, including Breast Repigmentation, Melanocyte Restoration, Corrective Pigment Camouflage and Permanent Cosmetic Makeup. She travels worldwide educating technicians, promoting and teaching proficiency in their techniques of permanent makeup.

Susan also developed the pigment colours, for both Tri-Lab Products and Absolute Perfection pigment colours line, as well as the anesthesia ‘Magic’, which is touted as one of the best topicals in the industry.

When asked about teaching students she states: “My success is measured by the success of my students.”

For more information on classes and Susan Church, please visit www.susanchurch.com

Who Started Skin Needling?

1-Before-and-After-Mouth-Scar-Relaxation-115x300Pre and Post Skin Needling from www.permanentmakeupschool.orgWho Started Skin Needling?Who Started Skin Needling?


Confused over who started Skin Needling™?

Some people are.

For those of you that are not aware of Susan Church’s work, let’s clear up the misconceptions.

She is the first person that is on record for discovering Skin Needling™ using a coil tattoo machine on burn patients starting in 1988. ( Incidentally, she still has several of her patient’s files that she worked on during this period).

Ms. Susan Church of California worked with burn patients at Dr. Grossman’s office in Sherman Oaks, CA in the late 1980’s performing Skin Needling™, Scar Relaxation and Melanocyte Restoration procedures.

Dr. G. was a world-renowned  burn specialist.  Burn patients worldwide sought out his expertise.  Patients would fly to Los Angeles from all over the world to have skin grafts and other procedures performed to return their burned tissue to a state of some normalcy. These patients ranged from celebrities, royalty, adults as well as children.512NCH0EA9L__SY300_

Ms. Church was very fortunate to work in concert with him in his office and administer procedures to his patients. This is also where she worked in concert with another burn specialist Dr. Elliott Rose.  Ms. Church accompanied Dr. Rose on rounds talking with patients that were just burned, giving them hope on impending results. She finally found her niche, her passion in life. Dr. Rose believed in Ms. Church’s work. He asked her to author a chapter in his book “Aesthetic Restoration of the Disfigured Face”. http://www.openisbn.com/isbn/9780316756464/

Ms. Church has been performing Skin Needling since 1988. She has written many articles and Educational Manuals on Skin Needling starting in 1989.  She lectured at the SCP conference in 1991 where she showed her colleagues, physicians, and other professionals her burn patient’s photographs that included  ‘Pre and Post’ Skin Needling, Scar Relaxation and Corrective Pigment Camouflage. Her articles were published in 1991 in the ‘Society of Permanent Cosmetic Professionals’ (SPCP) Newsletters as well as in other publications on these remarkable findings. Ms. Church has also lectured to medical and beauty professionals on numerous occasions sharing phenomenal photos of burn, scar and cancer patients, as well as ‘everyday’ clients that requested her services.logo_phoenix  Phoenix Society for burn suvivors

Ms. Church wrote a research paper on her work which included Skin Needling™, Melanocyte Restoration and Scar Relaxation with her own clients, Dr. Grossman’s and Dr. Elliott Rose’s burn patients. Unfortunately the research paper was never published. In order for her research work to be published, she would have needed to be a physician.

She disputed that she was the one that performed the procedures, wrote the AARBF_s2 Alisa Ann Ruch Burn Foundationprotocols for her work, established guidelines, wrote Consent and Release Forms which many insurance companies, technicians and educators still use to this day, documented all of the patient’s work and took all of the Pre, During and Post photographs. The physicians’ hands were tied. In order for the research paper to be published, she would have to allow the Dr.’s to put their names on the paper, her name would not be permitted on the articles.  

This was yet another blow dealt to her because she did not have M.D. behind her name. The school of hard knocks counts for very little in this world. thSNG9BU22 national alopecia areata foundationInstead she lectured, instructed and stayed in the forefront for more than 2 decades educating physicians, nurses, dentists and other medical professionals as well as cosmetologists, aestiticians, nail technicians, massage therapists and other beauty professionals. She has lectured and or written articles for Alisa Ann Rouch Burn Foundation, Phoenix Burn Society, Lupus Support Groups, Alopecia Support Group, Burn Survivors Throughout the World http://www.burnsurvivorsttw.org/cosmetics/camouflage1.html



One asks “Then why do the Dr.’s take credit for what she started”? It is self-explanatory, they have the initials of M.D. behind their name and she doesn’t. They also represent the dermal roller companies. Dermal Rolling and Skin Needling are two totally and distinct  different procedures. Ms. Church does not have a huge company behind her. She did this all on her own!

Did you know?  Most of the people teaching Skin Needling™ today were educated by Susan Church. Yes, even physicians were educated by her.

As you can all read, physicians say they developed these techniques in the middle of the 1990’s.

How? Why? are others are taking credit for starting Skin Needling, Scar Relaxation and  Corrective Pigment Camouflage when it is truthful to say that Ms. Church worked on her burn patients in 1988, 1989 and later, then lectured on these patients / clients  and,  she is passed over being listed as the founder  because she is not an M.D. or have a vested interest in a product company?

That is the only reasonable explanation for this error. We would love to know what do you think the possible reason / explanation could be?

Even though she does not hold the title of M.D., it is about time she received the appropriate accolades for her work!      Nothing More,  Nothing Less!








Permanent Makeup Safety Advice


The following information is beneficial to share with your clients.

Passing it along to your patrons will not only show you are a knowledgeable and credible technician, but it will establish that you care for the well-being of your patients; thus setting the foundation for a comfortable, trusting relationship between you and your clientele.

To Permanent Cosmetics clients:

  • Schedule a consultation with the technician prior to the actual appointment day. This consultation would most likely be the ideal time to go over all of these safety precautions with your technician.
  • Ask if the technician uses ‘disposable only’ machine parts. If they do not, make sure she/he has a functioning autoclave and uses a biological indicator test every month. (Autoclaving pressurizes steam heat to kill germ spores. At 121°C, the pressurized steam will kill all spores within 15 minutes; increased pressure and a temperature of 132°C can accomplish sterilization in 4 minutes.) Ask to see spore strip tests from an authorized lab to make sure the autoclave’s results are effective.
  • Most technicians use totally disposable machine parts. Make sure these ‘Single Use’ and ‘Sterile’ parts are safely disposed of immediately after your procedure.
  • Manual hand tools must be autoclaved prior to use for optimum sanitation. Used manual needles and/or the complete tool should be disposed of in a biohazard container. There are various hand tools that can be re-autoclaved using a new needle grouping. Technicians should check with their supply company regarding these tools.
  • Ask the technician if they follow all of OSHA and CDC guidelines. Ask to see their Sharps container and inquire what the proper protocol is concerning the disposal of used needles. All ‘Sharps’ or ‘Biohazard’ containers must be puncture-resistant, leak proof and color-coded or labeled “BIOHAZARD.
  • Make sure your technician washes their hands vigorously with soap and water and uses a clean pair of disposable gloves before setting up your sterile needle set.
  • IIPC is a latex-free clinic. If you have any allergies to latex or any other products, be sure to tell your technician at your consultation.
  • Insist on observing your technician as she or he removes a new needle and machine setup from a sealed pouch immediately before starting your procedure. You should also watch the technician set up a clean cap of pigment, poured directly from the bottle for each of your procedures. Be sure to ask the technician about their use of sterile procedures and isolation techniques. It is the responsibility of the client to observe the technician at work, inquiring about their experience and qualifications.
  • Be wary of the technician’s office during your consultation visit. If their areas are disorderly and cluttered, you may consider using another technician.
  • Question the technician on their use of barrier film. This is a clear or blue heavy-duty sheet of plastic that is sticky on one side and will adhere to light fixtures, the tattoo machine, telephone, door handles, or any other article the technician may come in contact with. If the technician does not practice using this product, there could be a transfer of contaminated blood-borne pathogens. All cords and machines should be covered as well.
  • The technician should never touch their hair, glasses, or other items with a gloved hand. If you observe this happening, you should ask the technician to replace their gloves to prevent any chance of contamination.
  • Used needles and pigment should NEVER be kept for a client’s future appointment. Pigment contains bodily fluids and bacteria, and it should be disposed of immediately after the procedure is completed.
  • Clients must sign all of the proper consent forms, as well as forms to confirm that any needles have been properly disposed of in a bio-hazard container immediately following each procedure.
  • Technicians working in open area beauty salons run the risk of airborne pathogens from acrylic nails, hair products and so on… Remember: permanent cosmetic makeup creates an open wound. Contaminants from the air should be kept to a minimum to ensure a healthy, clean procedure.
  • All surfaces should be wiped down with a hospital grade disinfectant (ex.Discide) prior to, and immediately following, any procedure application.
  • Ask the technician to see their current Health Department and Business License.
  • Ask to see a current certificate from a certified Blood Borne Pathogen and Exposure Control Class or from OHSA.
  • Ask your technician to see their current portfolio with photos of other clients who underwent the same procedure that you are requesting.
  • If you are having your permanent eyebrows applied, ask for an ‘Eyebrow Design’ appointment. This appointment should be separate from your consultation. The technician will go over various shapes and colors and what the best eyebrow design for your face will be. At this time, the technician may also wax your brows. If you are not in total agreement with how the permanent makeup procedure looks while drawn on, keep working with the technician until you are satisfied with the design.
  • On your procedure day, if you are not happy with the drawn on shape of your eyes, lips or brows, do not have the procedure completed. Your technician is there to work with you and give you a great looking procedure. If you do not like how something looks, tell them prior to starting, do not wait until they have started your application and change your mind.
  • If the technician is a qualified professional, they will have no problems complying with standards above and beyond these simple guidelines. If the technician, or their place of business, does not appear up to these standards, or if they become evasive when questioned, seek out a qualified professional technician.
  • Permanent Makeup is just that…….. PERMANENT!
  • Remember the old adage: “You get what you pay for.” If your procedure is less than desirable, you cannot cover your face. Choose your technician wisely, based on their training, professionalism and your judgment of their character.

Working with Skin of Color

Skin Differences

“Black skin is 60 to 70 percent higher in lipid content than white skin and has larger sebaceous glands. A layer of cells in black skin, although thinner, has a higher concentration of cells than in white skin. Because the stratum corneum is therefore denser in black skin, and the oil glands are larger, black skin is much more prone to lesion formation through follicular impaction.” This quote appears in Christine Heathman’s article, ‘Acne and Skin of Color’ that was published in Dermascope magazine.

Black skin appears thicker than other skin because of its compact nature with more cells per layer.

When black skin is injured or diseased, as it is healing, the melanocytes do one of two things:

  1. Hyper pigment—The skin will produce more melanin, creating darker pigmentation areas.
  2. Hypo pigment—The skin will produce less pigment, creating white areas.

Black skin is prone to hypertrophic scars and keloids and has a UVB protection factor of 13.4% in the epidermis while white skin has just 3.4% in the epidermis.

When deciphering a person’s skin type, we are most concerned with people that have a 4, 5 or 6 skin type on the Fitzpatrick Phototype Scale and a 4 or 5 on the Lancer Ethnicity Scale (LES).

Fitzpatrick Skin Scale:

Developed by Professor Thomas Fitzpatrick MD of Harvard Medical School, is a classification system based on skin pigment to calculate sunlight burning.


Skin Colour

Reaction to the Sun


Light, very white or freckled Always burns, never tans


Light, white Usually burns, tans with difficulty


Medium white to olive Sometimes burns, tans average


Moderate brown Rarely burns, tans very easily


Dark brown Very rarely burns, tans very easily


Black Never burns, tans very easily


The following chart is from Dr Harold Lancer, who is a world famous Cosmetic Dermatologist to the Stars. His practice is in Beverly Hills, California.


The Lancer Ethnicity Scale (LES)




LES Type

Asian Background

Chinese, Korean, Japanese, Thai, Vietnamese, Filipino, Polynesian

Skin Type IVSkin Type IV LES Type 4LES Type 4
African Background

Central, East, West African

Enritean and Ethiopian,

North African, Middle Eastern,

Sephardic Jewish

Skin Type VSkin Type V

Skin Type V

Skin Type III

LES Type 5LES Type 5

LES Type 5

LES Type 4

European Background

Ashkenazy Jewish


Central, Eastern European


Norhtern European (general)

Southern European, Mediterranean

Skin Type IISkin Type I

Skin Type III

Skin Type I-II

Skin Type I

Skin Type III

LES Type 3LES Type 1

LES Type 2

LES Type 1

LES Type 1-2

LES Type 3-4

North American Background

Native American (including Inuit)

Skin Type II LES Type 3
Latin/Central/South American Background

Central American

South American Indian

Skin Type IVSkin Type IV LES Type 4LES Type 4

LES Type Risk Factor

LES Type 1 = Very low risk
LES Type 2 = Low risk
LES Type 3 = Moderate risk
LES Type 4 = Significant risk
LES Type 5 = Considerable risk



Depending on ethnicity, clients that have a propensity to hyperpigment and/or have darker skin complexions may be subject to hyperpigmentation after their permanent cosmetic makeup or corrective pigment camouflage application. Technicians need to be cognizant of post-inflammatory hyperpigmentation in regards to all permanent cosmetic applications, and plan their procedures accordingly.

We prefer that our clients use a Hydroquinone, Kojic Acid or Licorice product for at least 4 weeks prior to their initial lip, eyebrow, or Corrective Pigment Camouflage (CPC) procedure application, and also prior to any touchup application. Some professionals also use Lactic Acid, vitamin C, Mulberry and Bearberry to lighten the skin prior to any permanent cosmetic application. We have found that by using these products, our procedure results are far superior than if we did not use them. Preexisting hyperpigmentation in procedural areas will only be exacerbated with the insertion of the needle into the skin, so be very aware of the area you are working on.

Many times after a lip color application, the client will acquire specks of hyperpigmentation in their lips. This seems to be fairly common, and normal skin color may return slowly over a period of months. Hyperpigmentation occurs in Caucasian skin occasionally, although it will most likely occur on clients with heavy concentrations of melanin in their skin. Educating the clients on the proper use of lightening products to be used on their lips is imperative, as many products will remove the pigment colour as well as lighten up the hyperpigmentation.

Increased risk of keloid scarring

As technicians, we need to be cognizant of two particular problems that may arise from the actual procedures which are hypertrophic and keloidal scaring.

Keloids are abnormal scars that are made up of a tissue masses of interwoven broad bundles consisting of dense fibrotic tissue. They may be shiny, are hard, dense and often the tissue is darker in the effected area.

Hypertrophic scars appear raised but stay within the perimeter of the scar.

Scarring may result after the skin has repaired itself. Prior to working on a client it is imperative to ask if they, or anyone in their family history, has a propensity to keloid or scar. If they do, use extreme caution when considering their permanent makeup or CPC application. All skin types can keloid, however, it is more prevalent in darker skin types, but not all darker skin types will keloid either. We have worked successfully on many darker skin toned clients with good results. You must always implement prudence and use good judgment when choosing your clients.

If a client tells us that in fact they do keloid, we will not work on them. Any application of eyebrows, eyeliner or lip colour, utilizing either straight pointillism, lines or hair strokes, may still cause and create a keloid.

If a client were to keloid, or already has a keloid that we need to flatten, we use a product called Kelo-Cote that is applied 2-3 times a day. Kelo-cote can be applied years after a scaring with good results. The client may also ask their physician for Kenalog which is a steroid that is injected into the scar to flatten it. Kenalog manufactured by Squibb is made up of sterile Triamcinolone acetonide that reduces or inhibits the actions of chemicals in the body that cause inflammation, redness, and swelling. Kenalog also dispensed in a topical lotion.

Choosing colors for ethnic skin can be challenging. We always use a cool and a warm color for our client’s eyebrow hair simulation. Applying hair strokes using several different colors will create a three-dimensional eyebrow and look excellent on any client. If you choose to create a ‘solid fill’ in the eyebrow, make sure the color choice is accurate for the client’s skin undertone. Your best results will be in choosing a warm based pigment.

For eyeliner application, we usually choose a very dark brown and add a few drops of a medium warm brown to our pigment color. This will usually ensure us that the pigment will not appear to look ‘bluish’ in the future.

For lip color applications, using a warm based pigment is the best choice. If, however you choose to use a cool color, be sure to warm it up with a Pumpkin, Coral or Burnt Orange shade. The amount of warm color you will need to add to the cool color depends on how heavy the concentration of melanin (blue tone) the client has in their lip vermilion.

If you are not sure how your pigment color will heal, give the client a patch test of color directly into the design line and wait 4-6 weeks to see accurate color results. The client may not want to wait this long, but remember that you are the one in control must learn that not following proper protocol can result in a finished product that is less than acceptable. After you have worked on many, many clients, you should begin to see a pattern of ‘healed results’ of pigment color in certain skin tones, and using these same colors will give you beautiful results.

We have used the same pigment color choices for years, and basically still use the same formulas because they work so well for us. When we find techniques, pigment colors, needle groupings, or anesthesias that give us great results, we tend to continue using them. Why reinvent the wheel? This makes our life and job much easier. (For information on specific color formulas used by IIPC, please email info@iipcusa.com or chekck out our DVD on pigment .)

Corrections on Ethnic Skin can be challenging as well. When a technician uses an ash color for brows on a cool under-toned client, the result will be a very ash or ‘battleship gray’ looking brow. If a client’s eyebrows have healed too ash, you can warm them up with a ‘warm’ brown pigment color. The best results are accomplished if we try to lighten the incorrect color by giving the client several quick light peels, Microdermabrasion and a peel or laser removal treatment. Lightening up the undesired color first will give you a much more pleasing final result.

Depending on the perceived color of the eyebrow, we lighten the brows first. Then, depending on the client’s skin undertones, we will use a Golden Bisque, Baby Blonde or Camel pigment and make hair strokes into the brow area to create the semblance of a skin tone color. Last we apply a ‘warm’ brown to the eyebrows alternating between the lightened hair strokes.

Following this protocol, we give our clients a color refresher annually or every few years. This generates a happy client that will spread the word about how we have helped them to correct their permanent makeup mistakes.

Extreme designs in all applications should be avoided. Some ethnicities are known for a more dramatic makeup application.



If a client requests an eyebrow design that you are not comfortable with, you should refuse to work on them.

If you keep the lateral portion of the eyebrow going ‘outward’ instead of ‘down’ in 5 years the client’s brows should still look great.

If you place the brows too close to the corner of the eye in a ‘downward’ position from the initial application, as the skin looses its elasticity the brow will droop and will make the client look tired and sad.

Positioning the lateral eyebrow portion correctly from the initial application is one of the most important measurements of an eyebrow procedure.



If a client requests an eyeliner design that has wings on the corners, remember: when the skin looses its elasticity, the wings will appear to go downwards and make the client look much older.




While ‘WINGS’ may look great when the client is younger…

Gravity is not our friend! As we age, and our skin looses its elasticity, the eyeliner is ‘pulled’ down, making the eye look droopy.





Bright/intense red realistically cannot be achieved on ethnic skin. Everyone has blue in their lips, even if the person has warm skin undertones. This fact should be taken into consideration when choosing a lip color, whether it is for a lipline or full lip color application. We have found that many Afro-Americans seem to have gray and/or brown in their lip vermilion. In order to achieve a good color result, we suggest patch testing the color directly in the lip vermilion, waiting 6-8 weeks to see your final result. This is the only accurate way of discerning what color the client will end up with. Using blue-based colors for lips may not be a wise choice; since the lips have an abundance of melanin, using warm lip colors is a much better and safer choice.



This client had a ‘cool’ red-based lip color applied without consideration to her Indian heritage. When her lips healed they looked almost black.

After several applications of Burnt Orange and ‘Warm it up for Lips,’ we have achieved a softer looking lip color. Upon close examination, you can still see specks of hyper pigmentation in her lip vermilion.


Lips Half Dark and Half Orange

We have used a Coral on darker Hispanic and Afro-American lipliner clients and they look great. This color is light, bright and makes their faces look stunning. With all lip procedures you need to make the client aware that the pigment color will change throughout the day. As the client’s body temperature warms up, the lip color will appear to be warmer and brighter. As their body temperature cools down, their lips will appear to be bluer.

Clients requesting a ‘Chocolate Brown’ color, while some say that it is in fashion, will have (in our opinion) lips that look like they have been eating a Hershey’s chocolate candy bar. We have not seen Chocolate lips look attractive on anyone. Softer colors that just give the lips a bit of pigmentation seem to work out the best. Suggest the client receive a more subtle color and then apply their favorite lipstick over their permanent makeup lip color.

Do not let your clients talk to you into anything that you are uncomfortable with, as the client did in the previous photo. Your name is on your clients face. You should be proud of your work.

You have heard this for years, but bears repeating again and again……..

Remember with all permanent cosmetic makeup procedures.

Pigment color + Skin undertones = Your final color result

Natural lighting or daylight full spectrum bulbs should be your light source of choice. we use full spectrum bulbs in our overhead and medical lights. This allows us to see the perceived color from the beginning of the process. Example: you think a color will look good in the skin and using the day light bulbs will allow you to see the color you are using immediately. If it appears too ash, you can immediately warm up your color. If your pigment is too warm, you can cool it down. Using the correct type of lighting will make your procedure look more pleasing to the eye right from the start.


When is Areola Repigmentation a Good Idea?

Areola Repigmentation is one of the easiest procedures to perform. Many technicians say that it is much more simple than performing a full lip color application. Lip procedures can pose challenges such as blue undertones, uneven pigmentation (whether hypo or hyper pigmentation), client’s pain threshold, herpetic outbreaks, lip tissue that may be spongy and excessive bleeding are some of the complications of a full lip colour application.

We feel that areola repigmentation, whether it is just inserting pigment around the white rings around the areola to conceal a light scar to rebuilding a complete areola and nipple coloration, is less problematic than performing a full lip color application.

Breast cancer patients need to be in the right frame of mind when going through the areola repigmentation process. They will look better and feel better about themselves when they can look in a mirror with confidence and see a breast that looks somewhat normal.

Here are some statistics:

  • 12% of women alive today will develop breast cancer.
  • Every 2-½ minutes a woman will be diagnosed with breast cancer.
  • Over 200,000 new cases of Breast Cancer will be diagnosed this year.
  • About 75% of women elect to begin reconstruction when their mastectomy is preformed.
  • 63.3% of cancer survivors lived 5 or more years following diagnoses and roughly 10% lived 25 years or more.
  • In 1992, roughly 11 million Americans, or 6.1% of the adult population were cancer survivors.
  • 41,000 new cases of ductal carcinoma in situ will be diagnosed in 2000, which is the most common type of non-invasive breast cancer in women.
  • Approximately 20%-30% of breast cancers that are detected by mammograms are carcinoma in situ
  • Less than 15% of cancer survivors received psychological support.


Types of breast surgery:

Lumpectomy: a simple procedure to remove a lump or tumor mass.

Partial mastectomy: 2.5 to 7.5cm of tumor mass and surrounding tissue removed.

Subcutaneous mastectomy: removal of all breast tissue except for the skin, areola and nipple that are left alone.

Simple mastectomy: the removal of the breast but leaving the lymph nodes.

Modified radical mastectomy: the total removal of the breast and partial lymph nodes.

Radical mastectomy: total removal of the breast, lymph nodes, pectoral muscles, adjoining fat and fascia.

Extended radical mastectomy: this is the same procedure as the radical mastectomy along with the removal of parasternal lymph nodes.

Staging Breast Cancer

Staging is the process where by physicians use to evaluate the location and size of the cancer area. One of the most important factors is selecting treatment options is identifying the cancer stage.

Staging Breast Cancer

Stage Tumor Size Lymph Node Involvement Metastasis (Spread)
IIIIIIIV Less than 2 cmBetween 2-5 cmMore than 5 cmNot applicable NoNo, or in same side of breastYes, on same side of breastNot applicable NoNoNoYes


Paget’s Disease of the Nipple

Paget’s is a disease of the nipple which appears as a rash on the nipple. Changes in the nipple will usually indicate an underlying cancer in the breast ducts. This is usually just under the nipple and may have extended onto the surface of the nipple.

Breast Cancer in Men

Breast cancer in men is less common than in women and in the year 2000, the American Cancer Society has estimated that there will be over 1,400 new male cases of invasive breast cancer diagnosed.

  • Out of these 1,400 cases of male breast cancer, 400 men will die
  • 1% of breast cancer is from males

Signs of Male Breast Cancer

  • Nipple Discharge
  • Skin dimpling or puckering
  • Abnormal lumps or swelling in either the chest muscle, nipple or breast
  • Retraction of the nipple
  • Scaling or redness of the breast skin or nipple

Breast Implants

We usually wait at least 6 months to create a permanent areola. You can however, (as long as the skin is healed around the areola) create a semi-permanent one while the breast tissue is healing and the relaxation process is taking place. Just make sure to ask if the implant is under or over the muscle.

If the implant is ‘OVER’ the muscle you can puncture the implant if you place the needle too deep into the dermis. Sometimes the skin is so thin it seems that if you just touch the skin with your fingers it will burst!

We like to let the patient draw on what size areola they would like, then we discuss exactly what they are looking for. Some women request really large areolas while others prefer very small. We tell them that this will probably be the only time in their life that they are able to have their “DREAM” areolas. This always puts a smile on their face!!


Tissue to rebuild the nipple can be grafted from the labia, the inside of the thigh, or the back of the ear. Nipple restoration takes place usually a few months after the breast reconstruction. The initial swelling from the surgery is now minimal and the breast tissue has now become more natural looking as the skin’s elasticity has lessened a bit.

Many women choose not to have a nipple reconstructed. They prefer to just have an areola tattooed on with different colouring for the nipple.

I personally think that this is an interesting alternative to having invasive surgery to create a nipple. Patients can purchase ‘semi-erect’ nipples made of rubber. They stick on the breast tissue like a suction cup. If you watched this episode of ‘Sex in the City’… Charlotte gives Miranda a pair of rubber stick on nipples. She puts on her fake nipples and walks through a bar. Heads turn to look at her erect nipples as she created quite a stir with her new look.

Insurance for Patients

Insurance companies are now required by law (as off October 21,1998) to pay for part or all of the costs incurred for a breast reconstruction. This law is the ‘1998 Federal Breast Reconstruction Law’.

To read information on this law look up SEC. 901. SHORT TITLE, the ”Women’s Health and Cancer Rights Act of 1998” (WHCRA). This law is designed to provide insurance coverage to breast cancer patients whose health care plans are not required by state law to cover the costs of breast reconstruction.

Check out these two site http://breastcenter.com/support/insurancestatelaw or http://www.plasticsurgery.org/advocacy/brstlaws to learn about Insurance Coverage for Breast Reconstruction laws in your state.

Every state has different laws pertaining to insurance. For example, in California:

California: enacted in 1978; covers prosthetic devices or reconstructive surgery incident to mastectomy, including restoring symmetry; law was amended in 1991 to include coverage for pre-1980 mastectomies.


To help protect us from cancer, the following 10 fruits and vegetables have superb cancer-fighting properties: Alfalfa Sprouts, Blueberries, Broccoli, Brussels sprouts, Kale, Oranges, Prunes, Raisins, Spinach and Strawberries.

Need for These Services

With all of the breast cancer patients now having the option for Areola Repigmentation, this advancing field is growing faster than any of the other tattooing fields. You can work in concert with physicians or in your own studio or clinic. One of the most rewarding feelings you can have is when you help a patient feel whole again. Remember that men as well as women have the need for these services.

If you would like more information on our Areola Repigmentation class, Areola Repigmentation DVD or our ‘Absolute Perfection’ Pigment Colors, please call IIPC at 800.282.0577 or visit PermanentMakeupSchool.org.


Corrective Pigment Camouflage: Part 3 of 3

This information is part 3 in this 3-part series.

In this article, we will concentrate on Scar Relaxation, procedure after care for C.P.C., and the final results.

Scar Relaxation is the application of repetitive circular tattooing movements to create a softer skin texture and to soften the fibrous bands of collagen (scar tissue) to give the patient more flexibility in their movements. This procedure works well on all contracted tissue with exceptional results on hands.

Scar Relaxation was introduced by Susan Church at the first Society of Permanent Cosmetic Professionals (SPCP) conference in 1991 after she discovered it while working on several burn survivors in concert with Dr. Grossman.

Scar Relaxation appointments are usually scheduled at 4-week intervals. However, dramatic results can be seen and felt after the first treatment.




Patients are excited with their results of the C.P.C. that has been performed on them, many times alleviating the need for potential surgeries on the contractured tissue.

In all post procedure phases of Corrective Pigment Camouflage (C.P.C.) there is an inflammatory response of the skins tissue. The skins typical symptoms may range from mild redness, heat, swelling and discomfort to lymph drainage. All patients will experience a typical wheal and flare reaction (redness, histamine release and swelling) to the procedure area that is much like a bee sting or mosquito bite. Applications of C.P.C. will also cause increased blood flow to the immediate area. The procedure area will be a bit sore, swell slightly to moderately within the first 24 hours, may possibly be very tender and be slightly pink to red.

Immediate after care instructions includes the use of either Petroleum Jelly, or some type of an antibiotic ointment. If possible, cover the area to keep it exempt from free radicals and pollution for 12-24 hours. If the procedure area is swollen, you may use ice for the first 24-72 hours to help alleviate the pain and swelling. Using heat after this period will promote circulation and removal of waste products. Injured tissue will heal much faster and scar less if the patient keeps the area moist. The patient should apply a thin coating of Petroleum Jelly over the procedure area while showering or bathing to protect it from moisture.

C.P.C. areas need to be protected and kept out of the sun and tanning beds.

Technicians need to be cautious of post-inflammatory hyper-pigmentation (darkening of the tissue) when applying C.P.C. Hyper-pigmentation occurs when the skin’s tissue is traumatized. Hyper-pigmentation occurs in Caucasian skin occasionally, although it will most likely occur on clients with heavy concentrations of melanin in their skin. Normal skin color should return in several months following the application of C.P.C. Bleaching agents such as Hydroquinone, Kojic Acid and/or Licorice may be used to lighten the skin if needed.

Final color results are not determined until several applications of pigment have been inserted into the procedural area and the skin has totally healed.

Final results cannot be guaranteed as the tones of the skin change throughout the day, and the temperature of the body changes from cold to warm.

We, as technicians, fine-tune and complete the finishing touches on the work the plastic surgeon has completed. Technicians should always work in concert with the patient’s physician. As the physician performs any ongoing surgeries, the patients C.P.C. color applications may need to be readjusted. Also, C.P.C. areas can be re-pigmented yearly for a ‘color refresher’.

Hopefully this series on C.P.C. will help you to understand the psychology of beauty that is created to present unique concepts of thinking about beauty that extends beyond traditional basic value.

Susan Church CCPC,CPDA
Director of Education
International Institute of Permanent Cosmetics
This article originally appeared in the SPCP July/August 1996 Newsletter

For product information, call 800.282.0577 or visit        www.PermanentMakeupProducts.com


Does Skin Needling™ Help Wrinkles?

Skin Needling Plumps up Wrinkles

before_and_after-003-001-200x225This client has deep wrinkles around the eyes and skin discoloration due to sun damage. She hoped that her Skin Needling™ treatment would even out her skin tone and smooth her facial lines, giving her an overall younger, fresher look.






before_and_after-003-002-200x225 2Our client, looks 10 years younger after a photofacial and 2 Skin Needling™ treatments. Her skin is brighter and there is an extreme reduction of the wrinkles around her eyes.

After the Skin Needling™ treatment, the Proper use of ‘At Home Products’ is essential for glowing and hydrated skin!

Skin Needling™ and Facial Needling treats light scarring and fine to deep wrinkles. Using a machine for the Skin Needling™ procedure, the needle cluster is gently inserted into the epidermis and top layer of the dermis.

Skin Needling™ promotes the natural reproduction of collagen and elastin, making the skin feel smoother and tighter. We treat only the area that needs attention. We do not work on any tissue outside the boundaries of the wrinkles or scar tissue, as this will make the wrinkle appear even deeper.

Skin Needling™ stimulates the body’s natural wound-healing reaction to produce natural collagen.

With microscopic punctures in the epidermis/dermis, Skin Needling™ is minimally invasive with little damage to the epidermis/dermis.

Clients who choose Skin Needling™ procedures have minimal ‘down time’ and swelling, and most people return to work the following day.

What Is The Needle Depth of Penetration For Skin Needling™?

The insertion depth of the needle is approximately .07mm, but this measurement depends on the severity of the wrinkles and the client’s desired results. For fine wrinkles, we barely insert the needle into the skin, for heavy wrinkles the needle penetration is deeper.

What Contributes To Wrinkles And The Loss Of Collagen?

  • Sun, and tanning beds
  • Anyone who works outdoors
  • Anyone who likes to ‘play’ outdoors: volleyball, golf, water sports, baseball etc.
  • Genetics
  • Smoking/ Excessive drinking
  • Unhealthy lifestyles
  • Dehydration
  • People that are Type I and II on the Fitzpatrick scale
  • Sleeping with your face buried in a pillow
  • Resting your chin in your hands
  • Pulling on your skin
  • Rubbing your eyes excessively
  • Diseases and / or Disorders
  • Improper diet
  • Weight gain and weight loss

Who Will Benefit from Skin Needling™?

  • In view of the fact that Skin Needling™ is a nominally invasive procedure, anyone with fine, medium or heavy wrinkling will experience positive results. Acne scars, chicken pox scars, stretch marks, surgical scars will show an improvement after each Skin Needling Application.
  • People with acne scars, chicken pox scars, and scars from surgery
  • People who have picked at pimples and scabs, creating scars and pits
  • People with naso-labial wrinkles, as well as smoker’s and laugh lines
  • People with chest, neck, knee, arm and hand wrinkles

Contraindications for Skin Needling™

  • Anyone who is darker skinned and hyper-pigmented will need to use a lightening skin treatment for 2 weeks prior to their treatment appointments
  • If you have the propensity to keloid you would not be a candidate for Skin Needling™
  • Anyone that has a raised moles or warts, or any other raised lesions

Who Is Not A Candidate For Skin Needling™?

  • Anyone that is under medical care that may be on a high blood pressure medication, heart medication, is diabetic, not in general good health, is a poor healer, takes a daily aspirin, has an active herpetic breakout, or has just had an invasive laser / deep peel / facial  treatment.
  • Anyone that has any type of facial skin disease or disorder that would be a contraindication
  • Anyone who is taking homeopathic substances, vitamins or herbs that thin the blood
  • Anyone with scars that are less than 6 months old
  • Anyone that has had facial fillers, or Botox, in the past 4 months in their lips or face
  • Anyone who has had facial surgery in the past 6 months
  • Anyone who has had ‘PERMANENT’ fillers, such as Dermagen or Shark Cartilage injected in the past 6 months would not be a candidate for Skin Needling
  • Anyone that has been using corto-steroids on the treatment area, as this thins the skin’s tissue
  • If you are under a health care providers care, we must have a physicians / health care providers release prior to any procedure application.
  • Pregnant or lactating women
  • Anyone that we consider a ‘High Risk’

What Tools Are Used for Skin Needling™?

Skin Needling™ can be accomplished by using a coil, digital, rotary machine or a manual tool. Although this procedure does not require the power of a heavy duty machine, if you are accustomed to using a coil or digital machine you can turn the power down and achieve successful results.

A permanent makeup machine is the ‘Primary’ modality that will target the individual wrinkle. The ‘Secondary’ tool can be the permanent makeup machine with a 6 flat needle spread. You can also use a roller at this point. Do not use a roller to start with as it plumps up the entire region of skin.

Sterile, single-use needle clusters will depend on the method of procedure, depth of area to be worked on, and condition of the tissue.

Skin Needling™ Pre-Treatment Care

The clients skin, general health, medications they may be on, homeopathics and supplements should be assessed prior to the client’s first treatment. The use of skin treatments and/or products both pre- and post-treatment will enhance the client’s results dramatically.

Sun worshippers and men / women that have not been on a regular skin care regimen would receive greater benefits if they have any of the treatments listed below prior to their Skin Needling™ procedure.

Several options are available to the clients Pre-Treatment:  Microdermabrasion, Peels – AHA’s, Glycolic, Salicylic, Malic, Enzyme Peels or Jesners, Laser, Retin A, Retinol, Renova or your favorite peel.

Anyone that is prone to herpetic outbreaks needs to be on an antiviral medication prior to their Skin Needling™ procedure. This applies to each additional procedure as well. Physicians suggest 3-5 days pre application and 3-5 days post treatment.

For clients that bruise easily, it is advised to consider taking Arnica Montana, Bromaline, or any other anti-inflammatory and anti-bruising product 1-2 days prior to each Skin Needling™ session and 2-3 days post procedure.

Always check for allergies to all products being used in your procedure.

Skin Needling™ Post Treatment Care

Cleanse the procedure area with warm water to remove all exudate.

Apply DMAE, MSM with antioxidants or other healing serum.

Mineral makeup can be used 12-24 hours post procedure.

If you use makeup on broken skin, the risk of bacteria entering the procedure area, as well as the makeup filtering its way into the open tissue, can be detrimental by causing darker pigmentation and infection.

After the skin has healed, the use of AHA’s will help to keep the top layer of skin softened and sloughed off, resulting in younger looking skin.

For the first few days our clients apply a very light coat of Petroleum directly on the treatment area. This will not only keep the area from scabbing, but will keep the skin soft and supple. The client may also us DMAE, MSM serum.

Using topical Vitamin C, A or E and Collagen producing products are also fantastic for the skin. Use these products when the skin is healed over and not broken.

I personally been using Pro Medical Skin Care Wrinkle Reducer, DMAE,MSM with antioxidants Serum.  The Wrinkle Reducer is great for sloughing off and regenerating tissue while the DMAE seals moisture into the skin making your skin moist and dewy all day long.

What Can A Client Expect From Skin Needling™?

Our clients report smoother, softer feeling and looking skin after each treatment; noticing creams and lotions penetrate their skin more easily, and their fine lines and wrinkles have softened considerably and they look years younger.

Clients with other concerns, such as acne scaring, scars from surgery or injury, do not notice the depressed area as readily post each treatment application. The body’s natural collagen is masking the imperfection of the scarring process after each treatment, while it regenerates the natural collagen.

We have clients that have seen immediate, long-lasting results, and other clients noticed an improvement gradually over an 8 week period. One of our acne clients said he noticed results 3 months post procedure and his skin kept looking better and better.

Each person’s results will vary as their body’s NATURAL collagen and elastin regenerate.

We Never Guarantee what percentage of improvement the client will have. The results will depend upon how they take care of their skin between procedures.

What Does Skin Needling™ Look Like Post Procedure ?

Day 1 and 2 – Depending on how deeply the technician inserts the needle into the epidermis / dermis, the tissue may be slightly to moderately swollen, tender, red and bruised, with a slight lymph discharge (exudate) from the treated areas. Minor itching may occur and the ‘needled’ tissue may exhibit the appearance of ‘cat scratches’.

Day 3 – The treated areas slightly crust and remain faint pink to red.

Day 4-–The redness and crusting have diminished.

Day 5 – There is barely any evidence of a procedure.

How Soon Do I Schedule a Follow Up Skin Needling™ Treatment?

Procedure applications are usually repeated at a 6-8 week intervals, depending on the condition of the tissue and desired results. The older the person is, the longer you wait between procedure applications.

How Much Does Skin Needling™ Cost Per Treatment?

The national average for technician fees range from $200.00 to $395.00 per 30 minute sessions.

We charge $250.00 per 30 minute treatment with a 30 minute minimum.

Comparison of Wrinkle Treatments

Procedure || Treatments Needed || Fees Per Treatment || Total

Skin Needling™ 1-4 every 6-8 weeks $250.00 per average session 4 treatments $1,000.00
Acupuncture 10-20 weekly sessions $140.00- $200.00 per session followed by monthly maintenance sessions First year $2,800.00+$4,400 for 2 years
Heavy Skin Peels 4-6 peels $300.00+ per average session 5 treatments $1,500.00
Microdermabrasion Monthly treatments – 12 treatments $150.00+ per average session 12 treatments $1,800.00
Laser 8-10 sessions $800.00+ per average session 9 treatments $7,200.00


Facial Fillers

After the Skin Needling™ procedure fills in wrinkles and lines with the body’s own natural collagen, the client may still want to have facial fillers in their lips, as well as Botox, to paralyze their glabella, upper forehead and crow’s feet.

The Skin Needling clients that have Botox will have longer lasting results, as the Botox paralyzes the muscles which in return allows very little movement of the treated area.

What The Client Needs to Know About Skin Needling™ Treatments?

To look their best, we still recommend that all clients should consider having Botox to paralyze their muscles to enhance their Skin Needling™ results.

Lip fillers are also highly recommended to plump the lips if the client is requesting fuller, luscious lips as Skin Needling will not accomplish this.

Skin Needling™ can be dangerous in untrained hands. Skin could be macerated by overworking of the procedural area and potentially creating scarring, infection, hyperpigmentation and uneven skin.

Always consult a trained professional for these treatments. People trying to do these treatments at home will not experience pleasing, lasting results often making their skin appear worse looking.

I have learned extensively about the body’s natural collagen; our intricacies, along with how vitally important collagen is for our entire body. I suggest that you go to these websites for detailed information on collagen.

* 1 http://en.wikipedia.org/wiki/Collagen

* 2 http://sanctumhealth.com/pure-col-collagen/technical-info/the-tie-that-binds.php