Is Lip Tattooing Safe After Shoulder Replacement

past Whitney D. Tope, MPhil, MD

Oftentimes asked questions by cosmetic tattoo artists business concern the advisability of performing corrective tattooing in association with other common surgical procedures. Does 1 negatively touch on the results of the other? Tin can multiple procedures be performed at the same time or at different times? Which should be performed showtime? How long should one wait earlier performing the second procedure? The answers to these questions lie in understanding the individual procedures, the changes they create in the skin, and the timing of wound healing.

First, we should understand the process of tattooing. This is well taught in cosmetic tattooing instructional courses and is witnessed starting time hand during the daily practice of tattooing. Briefly, tattoo needles create multiple puncture wounds extending into the dermis. The tattoo pigment on the needles is carried into the epidermis and dermis past repetitive motions, either manual or automatic. This procedure creates multiple puncture injuries and deposits strange bodies; these events incite an initial clotting and inflammatory response to heal the wound and an influx of circulating macrophages to remove foreign particles. Fortunately for tattoo artists, the pigments used are quite inert and the bulk go unrecognized by immune cells. Of those pigment particles which are consumed by macrophages, some are carried to the draining lymph nodes, but virtually remain stationary within the tissue. More often than not, the tattooed peel requires a calendar week or then of topical intendance. Within two to 3 weeks, the well-baked advent of a fresh tattoo subsides afterward the process of epidermal maturation sloughs the tattoo paint which was deposited within the epidermis. Tattooing does carry a very low chance of infection and tattoo pigment reaction. The latter may occur from days to decades afterward tattooing. Importantly for this give-and-take, the tattoo's shape depends upon the position of the skin within which the tattoo is placed. Also, the most common anatomic locations for cosmetic tattoos are the lips, eyebrows, eyelids, and areolae. Finally, once a tattoo has healed, any process which causes significant local inflammation tin cause additional removal of tattoo pigment.

Given these anatomic sites and the prevalence of photoaging, one can predict the most commonly encountered procedures a customer may wish to pursue to enhance their appearance. For treating wrinkles or excessive folds, one might pursue soft tissue augmentation to elevator the skin dorsum into identify, botulinum toxin injections to eliminate dynamic wrinkles, ablative resurfacing to smooth wrinkles and improve skin texture, tissue tightening with radiofrequency or infrared light to create subtle lifting or tightening effects, or surgical lifting of the brow, upper, mid or lower face. Molded solid implants can alter facial shape. Laser for hair removal is normally used on the face, as are Q-switched lasers to care for facial hyperpigmentation.

A now dizzying array of injectable filler substances are available for soft tissue augmentation (STA) of the lips, the melolabial folds, and atrophic scars. These range from collagen derivatives to hyaluronic acid to hydroxyapetite to silicone to autologous fat. In the absence of an allergic reaction, these substances are injected with balmy degrees of inflammation, which settles chop-chop and should not crusade enhanced removal of tattoo pigment. While occasionally STA leads to pregnant changes in skin position, soft tissue augmentation typically should not impact tattoo position and could be performed before or afterward tattooing. Another permanent "filler" employs use of Gore-Tex or molded silicone implants which are placed near the bone, commonly at the mentum or malar eminences, to reconfigure facial shape. These besides should have picayune effect on tattoo intensity or position.

Botulinum toxin injections paralyze selected muscles of facial movement to lessen the advent of dynamic wrinkles. While most no inflammation accompanies botulinum toxin injections to affect paint intensity, overuse or imprecise injection tin can lead to brow ptosis (droop) and lid ptosis (hat lag). These changes may alter forehead and hat position, but appropriately placed tattoos volition maintain their position with respect to the forehead and lid lashes. These furnishings are also temporary, typically lasting no more than six months. Since few individuals volition remain affected by botulinum toxin all of their lives, it makes sense to identify corrective tattoos when no botulinum toxin is present and the face has its natural animation.

Lifting effects may also occur through "tissue tightening", a method of creating deep dermal collagen contraction by heat application. Originally performed with radiofrequency free energy by the Thermage device, other devices combining light amplification by stimulated emission of radiation or intense pulsed light with radiofrequency energy (Syneron devices) or infrared light energy lone (Cutera device) may soon claim to attain similar results. While the dermal collagen is injured, associated inflammation is typically minimal, and there is no current show that any of these devices, accordingly used, would interfere with a tattoo. The tightening effects are also subtle enough and then as not to create dramatic changes in the position of the eyelids, brows, or lips. Since these are rather new devices, the treating doctor should be informed of the presence and location of cosmetic tattoos, so that these may be avoided. The most ambitious lifting techniques, surgical lifts, are employed specifically to create more dramatic lifting effects than other techniques can deliver. A customer strongly considering these therefore should probably undergo surgical lifting before tattooing. In add-on to positional changes, more meaning inflammation would be expected to accompany surgical incisions, tissue undermining, and their bellboy mail service-operative wound healing.

Use of Q-switched laser (alexandrite, ruby-red, or Nd:YAG) are well known to cause permanent paint concealment reactions in titanium and atomic number 26 oxides ordinarily used in tattooing. Therefore it is exceedingly important that a doctor who may use a Q-switched laser in an area of corrective tattooing must know of the tattoo'south existence; otherwise a beautifully performed cosmetic tattoo may apace become an unsightly black tattoo. Ablative resurfacing (removal of the epidermis and portions of the dermis by dermabrasion, carbon dioxide or Er:YAG laser, or chemical peeling agents) should as well exist strictly avoided. This technique allows pigment to eliminate through the "open" surface and causes significant inflammation to remove tattoo paint and decrease tattoo color intensity. While non-ablative laser resurfacing (creating a dermal injury while leaving the epidermis intact) has not been reported to cause problems with cosmetic tattoos, vigorous treatment can result in inflammation lasting hours or days and might theoretically lead to some pigment removal. Laser hair removal, which employs alexandrite, diode, and Nd:YAG lasers, deposits light over a longer pulse duration than their Q-switched counterparts and is not known to cause tattoo pigment concealment. Still, significant inflammation can occur and the multiple treatments required for successful laser pilus removal might lighten cosmetic tattoos. Finally, topical photodynamic therapy using aminolevulinic acrid (ALA) and intense pulsed light or pulsed dye laser is condign very pop for improvement of photoaging. This technique alone tin cause significant facial inflammation (2-3 days), and fifty-fifty more so if boosted sunlight causes an unintended phototoxic reaction (2-3 weeks).