Misconceptions in training Materials

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1. Research and Expert Reviews

Numerous professional artists have highlighted inaccuracies in training materials, especially regarding the proportions and thicknesses of skin layers. This analysis is based on extensive research, including interviews with 49 professional pigmentation artists. These interviews were part of ongoing research projects that began in 2019. The majority of these artists, 38 in total, are from the European Union, with six from the United Kingdom and five from the United States.

The material was rigorously reviewed to ensure its accuracy and scientific validity. Two dermatologists and an expert in cellular biology provided insights and feedback. Notably, these professional artists' practical experiences support this analysis's conclusions, emphasizing our findings' real-world applicability and relevance.

2. The Structure of the Argument

We start by discussing the portrayal of skin layers by many pigmentation trainers, focusing on the relationship between the epidermis, dermis, and a typical pigmentation needle. This needle usually enters and often pierces through the epidermis. We then analyze proportional measurements that depict the relationship between the needle's diameter and the thickness of the epidermis in such cross-sections.

Next, we present scientifically accurate measurements of human skin layer thicknesses in the facial area, including a significant margin of error and focusing specifically on the skin in the brow or lip area. This provides a crucial range for the thickness of the epidermis. We compare this with the thickness of a standard 1 RL 0.3 needle with a medium taper, approximately 1.5mm, to ascertain the ratio of needle diameter to epidermis thickness.

When it comes to the lips specifically, the skin is even thinner. The epidermis of the lips, thinner than the general facial epidermis, ranges from about 50 to 100 micrometers (0.05 to 0.1 mm). Unlike other areas, the epidermis on the lips lacks the stratum corneum, contributing to their unique texture and color.

Dermis in the Lips

The dermis of the lips is divided into two layers: the papillary and reticular dermis.

Papillary Dermis. The upper layer of the dermis, containing thin collagen fibers, measures about 100 to 200 micrometers (0.1 to 0.2 mm).
Reticular Dermis. Beneath the papillary dermis, this layer consists of thicker collagen fibers and generally ranges from 500 to 1000 micrometers (0.5 to 1 mm).

These measurements can vary due to age, genetics, and environmental factors. For instance, sun exposure affects the thickness and health of lip skin. The lips' abundance of blood vessels also contributes to their color and sensitivity.

Finally, we aim to synthesize these insights to understand this phenomenon comprehensively. We aim to provide practical insights for semi-permanent pigmentation artists, enhancing their knowledge of skin and needle interactions. Based on available scientific data, we also propose a possible explanation for the origin of misleading graphics in training materials.

3. Mistakes in Training Materials

Examining Inaccuracies in PMU Training Materials

We analyzed cross-section drawings and graphics from five training materials used in courses for powder brows, lip pigmentation, microblading, and hairstroke techniques. Each training provider has been active for over five years, earning a reputation as a credible source in the field.

We looked into the backgrounds of academies using and distributing these materials. Our research shows that these academies and trainers are experienced and capable of offering quality training. While the overall quality of programs varies, they generally provide largely accurate information.

Analysis of Cross-Section Images in PMU Training Materials

We detailedly analyzed 12 cross-section images from the five academies' training materials, focusing on three key criteria in each image.

Needle Thickness vs. Epidermis Thickness. We assessed how the needle's thickness in the images compares to the epidermis thickness, which is vital for understanding the scale and impact of needle penetration.
Epidermis vs. Dermis Thickness. We examined the relative thickness of the epidermis compared to the dermis to assess the accuracy of skin structure representation.
Needle Length about Skin Layers. We analyzed the needle length relative to the thickness of the dermis and epidermis, which is important for understanding the depth of needle penetration as depicted in these resources.

Limitations in Depicting Dermis Thickness

Many drawings were overly simplified, making it challenging to determine the accurate thickness of the dermis. Therefore, we focused on graphics showing the dermis-hypodermis boundary. While any proportional inaccuracies in depicting the dermis thickness compared to the epidermis are noted, they don't significantly impact our primary focus on needle diameter versus epidermis thickness and are considered secondary.

Drawings vs. Microscope Photos

Medical and popular science graphics often emphasize internal skin elements rather than accurate proportions. When pigmentation trainers use these drawings to create images incorporating needles, it can lead to misunderstandings. In contrast, microscope photos provide a clearer understanding of the skin layers' proportional differences and thickness compared to needle diameters. However, interpreting these photos accurately requires specialized dermatology, biology, and anatomy knowledge.

4. Graphics in PMU Training Materials

Depiction of Needle and Skin Interaction

In most graphics we examined, the needle cartridge is shown above the skin, with the needle extending downwards into the epidermis. Typically, these images depict the needle emerging significantly from the cartridge and entering the epidermis. Our analysis of three materials revealed the needle piercing the epidermis and reaching the upper part of the dermis. One material illustrates the needle stopping at the bottom of the epidermis, while another shows it penetrating the basal membrane of the epidermis.

Measured Proportions in the Graphics

Our focus was on the illustrated needle diameter compared to the epidermis thickness. We observed that the epidermis is often portrayed as being 30-50 times thicker than the needle's diameter. This results in a visual depiction of a long, slender needle piercing a skin layer that is, on average, over 40 times thicker than the needle.

5. The Reality

How Are Skin Layer Thicknesses Measured?

Measuring the thickness of the epidermis, particularly in the facial area, requires precise techniques and specialized equipment. Common methods include the following.

Biopsy and Histological Analysis

Procedure. A small skin biopsy is taken from the facial area under local anesthesia.
Analysis. The skin sample is processed and stained for histological examination, enabling visualization of skin layers, including the epidermis, under a microscope.
Measurement. Epidermis thickness is measured using a micrometer from the top of the stratum corneum to the basal layer.

Ultrasound Imaging

Technique. A non-invasive method using high-frequency sound waves.
Procedure. An ultrasound probe creates images of the skin layers.
Analysis. The epidermis is identified and measured from the ultrasound images.
Optical Coherence Tomography (OCT)
Principle. A non-invasive test using light waves to produce cross-section pictures.
Procedure. A device emits and captures light waves, creating detailed skin layer images.
Measurement. Software measures epidermis thickness from these images.

Confocal Laser Scanning Microscopy

Technique. A non-invasive method using laser light for optical sections of the skin.
Procedure. Laser scans create detailed images of the skin's microstructure.
Analysis. Enables visualization and measurement of the epidermis layer.

Considerations in Measurement

Accuracy. Histological analysis is the most accurate but invasive.
Variability. Skin thickness varies based on location, age, gender, and health.
Ethical and Practical Aspects. Non-invasive methods are preferred outside research settings because they are safe and practical. The choice in clinical or research settings depends on accuracy needs.

6. Dermis Thickness in the Brow Area

The thickness of the dermis varies across different body parts and is influenced by factors like age, gender, ethnicity, and overall health. While specific measurements for the brow area are not universally standardized, we can estimate its thickness based on general knowledge about the facial dermis.

Variation in Brow Area

At Brow's Start. Near the beginning of the brow, the dermis can be relatively thick, possibly exceeding 1 mm (1000 micrometers or 1 million nanometers).
Range. Thickness may vary between 1000-2000 micrometers (1-2mm) depending on individual factors like skin type, health, and ethnic background.
Towards the Tail. The thickness decreases significantly towards the brow's tail.

Considerations in Dermatological Literature

It's important to note that specific measurements for the brow area are less common in dermatological literature. Most references concern broader facial regions rather than particular areas like the eyebrows.

Epidermis Thickness in the Eyebrow Area

The epidermis in the eyebrow area has less thickness variation than other skin areas. Typically, the epidermis thickness in this region ranges from 50 to 100 micrometers (0.05 to 0.1 mm).
Consistency with Dermatological Knowledge. This range aligns with established dermatological insights. The epidermis is significantly thinner than the dermis beneath it.
Variation Across the Body. There is some variation in epidermis thickness across different body areas, but it is generally less pronounced than in the dermis.
Comparison with Other Body Parts. The facial epidermis, including the brow area, is typically thinner than areas experiencing more mechanical stress, like the palms or soles.

Understanding the differences between "Thin skin" and "Thick skin" is crucial when addressing the source of incorrect graphics in training materials.

Needle Diameter vs. Epidermal Depth Analysis

For our analysis, we selected a 1 RL 0.3 needle with a medium taper as an example. The taper length of this needle typically ranges from 1.5-2mm, with slight variations among manufacturers.

Penetration Depth and Resulting Wound Diameter

Half Taper Penetration. When this needle penetrates to a depth of half its taper length, the resulting wound's diameter is approximately 150,000 nanometers (150 micrometers or 0.15 mm).
Full Taper Penetration. Conversely, replicating a cross-section image similar to the training materials, where the needle penetrates with its full diameter, the wound diameter would be 300,000 nanometers (300 micrometers or 0.3 mm).

7. The Real Proportions

Graphics Representation Training materials often depict the needle entering the skin at its full diameter of 300,000 nanometers (nm). This representation significantly differs from the wound created when a needle enters at half its taper length.

Actual Hole Made in the Epidermis by the Needle

The diameter of the hole made by the needle in semi-permanent makeup procedures is much larger than the depth of the epidermis in the brow area. Typically, the epidermis thickness in this region ranges from 50,000 to 100,000 nanometers (0.05 to 0.1 mm). This discrepancy indicates that graphics in semi-permanent makeup training frequently misrepresent the relative thickness of the epidermis, showing it as thicker than it is.

Epidermis Resistance to Needle Penetration

Despite its relative thinness, the epidermis, particularly the Stratum Corneum, plays a crucial role in resisting needle penetration. The Stratum Corneum, often called the "Horny Layer," has a tough structure similar to an animal's horn, significantly contributing to the skin's defense against mechanical intrusions like needle penetration in semi-permanent makeup.

8. Conclusions about Errors

Our analysis leads to an important conclusion about depicting skin layers in semi-permanent makeup training materials. Accurately represented, the epidermis should be shown as approximately 3-6 times thinner than the diameter of a typical pigmentation needle. This challenges the accuracy of images commonly used in training materials. Even accounting for the thickest epidermis and thinnest needles, the proportions in these materials are significantly off from reality.

This discrepancy underscores the need for more realistic portrayals of skin structure in training materials. Accurate representations are crucial for practitioners to understand their work's true scale and impact, ensuring the effectiveness and safety of semi-permanent makeup procedures.

The Extent of Misrepresentation in Graphics

A startling discrepancy is evident upon analyzing the training materials. The needle diameter to epidermis ratio is approximately 1:50. In contrast, the actual, accurate ratio is closer to 5:1. This indicates that the graphics are off by 250 times, significantly impacting beginners in the field.

Consequences for Starting Artists

The substantial misrepresentation in training materials leads new artists to falsely believe that the epidermis is much thicker than it is. This misconception may cause them to insert the needle deeper than necessary, assuming ample space within the epidermis. Unfortunately, this often results in the pigment being implanted too deep, sometimes reaching the hypodermis, which can cause pigment migration, known as a “blowout.”

Empirical Support from Professional Artists

The understanding that the epidermis is thinner than often depicted in training materials is supported by the experiences of professional artists in semi-permanent makeup. These experts confirm that the epidermis is much thinner in reality, making it easy to reach the dermis during procedures unintentionally.

Visualizing Epidermis Thickness

The actual thinness of the epidermis, particularly in the facial area, can be compared to the thickness of a sheet of paper. This analogy highlights the delicacy of the epidermis layer, contrasting with the exaggerated portrayals in some training graphics. It's crucial for practitioners, especially newcomers, to understand this to avoid overly deep pigment implantation and ensuing complications.

A Fascinating Sidenote (For Those Who Appreciate Humor)

If the training graphics were accurate, a typical pigmentation artist would be as small as a grain of rice or a pea, dwarfed by a standard paperclip. Human proportions would necessitate dramatic downscaling of organs and skeletal structures at this scale.

In such a tiny world, everyday objects would seem enormous. Pencils or coins would be massive and difficult to handle. Physical properties like surface tension and air resistance would present unique challenges. Insects could pose significant threats, potentially seeing such a small human as prey or danger.

Living in this altered reality would require a completely customized environment, from clothing to tools. Nutritional needs would also differ significantly.

While highly theoretical, this scenario explores scale and how size affects our environmental interaction. Of course, such a size is implausible for a human being due to human anatomy and physiology principles. Still, this thought experiment is valuable for understanding the importance of accurate scale representation.

9. Implantation into Basal Membrane

Additional Typical Errors in Training Materials

Many training materials feature three significant errors: “Pigment implantation into basal membrane,” “Sweet spot theory”, and “Epidermis thickness and resistance theory”.

This approach erroneously implies that pigmentation can be done "into the Basal" membrane between the epidermis and dermis. However, it's essential to recognize that the basal membrane is part of the epidermis, and implanting pigment particles precisely into this layer is dermatologically impractical.

Basal Membrane Thickness

The basal or basement membrane is a thin, fibrous structure separating the epidermis from the dermis. It plays a vital role in cellular processes like adhesion and signaling. This membrane is exceptionally thin, measuring only 10-50 nanometers (0.01-0.05 micrometers), equivalent to 0.00001 to 0.00005 mm.

Size of Pigment Particles in Pigmentation

Pigment particles used in tattoo inks typically range from 100 to 500 nanometers. This size ensures ease of insertion into the skin and retention within the dermis, preventing removal by the immune system. Van der Waals forces also affect these particles' behavior.

Conclusion on Implantatiothe behavior of n Deptparticlesof pigment particles and the basal membrane's thinness, implanting pigment solely into the basal membrane is anatomically unfeasible in microblading and semi-permanent pigmentation. In microblading, blade incisions penetrate the epidermis and basal membrane and into the upper dermis layers, especially the papillary dermis. Similarly, the needle in semi-permanent pigmentation reaches the same depth, ensuring pigment deposition within the dermis.

In semi-permanent pigmentation, the pigment often extends into all dermis layers and sometimes the hypodermis.

10. Hitting the “Sweet Spot”

The concept of targeting a “sweet spot” in the papillary dermis is a common misconception in pigmentation techniques, such as microblading, powder brows, and Hairstrokes. Understanding this concept involves considering the dermatological, physical, and biological aspects, especially the thinness of the skin layers.

Epidermis Thickness Revisited

As mentioned earlier, the epidermis in the brow area typically measures between 50 and 100 micrometers (0.05 and 0.1 mm), significantly thinner than the dermis. This is particularly true for the facial epidermis, including the brow area, which is thinner than areas subjected to more wear, like the palms or soles.

Conclusions about the “Sweet Spot”

Implanting pigment into the papillary dermis might be sound in theory, but achieving such precision is practically challenging. The practitioner must insert the needle or blade accurately to a depth of about 0.2-0.5 millimeters, which varies across brow or lip parts.

Analysis of Implantation Possibility into the “Sweet Spot”

The theory implies a precision in needle penetration that is difficult to attain. Human senses, like sight, cannot consistently discern such minor depth differences. While the human eye can detect differences as small as 0.1 mm, visually assessing needle depth during rapid penetration is not feasible. Other senses, such as hearing the needle prick or feeling its vibration, also lack precision. While one might feel the needle piercing the epidermis, differentiating between the depths of the papillary and reticular dermis is beyond our sensory capabilities, leading to pigment often being deposited in both layers.

Experienced and novice pigmentation artists frequently penetrate the hypodermis due to challenges in controlling the exact depth of pigment placement. The skin's varying thickness and human perception limits make this precision hard to achieve. Therefore, the main focus in practice should be on managing pigment distribution across the skin layers rather than fixating on the elusive “sweet spot.”

11. Hitting the “Sweet Spot” Theory

Epidermis Thickness Revisited

Conclusions about the “Sweet Spot”

Analysis of Implantation Possibility into the “Sweet Spot”

12. Potential Explanation for Misleading Graphics

Our analysis suggests that the inaccurate representation of skin layers of some pigmentation training materials may stem from confusion between "Thick" and "Thin" skin.

Thick Skin vs Thin Skin: A Comparison

Skin, the body's largest organ, consists of three main layers: the epidermis, dermis, and hypodermis. The critical difference between thick and thin skin is the epidermis and dermis thickness.

Characteristics of Thin Skin

Location. Covers most of the body, except soles and palms.
Epidermis Thickness. Ranges from 0.07–0.15 mm.
Structure. Includes hair follicles, sweat glands, and sebaceous glands.
Layers. Comprises four layers in the epidermis.
Function. Provides protection, sensation, and thermoregulation.
Characteristics of Thick Skin
Location. Found on soles and palms.
Epidermis Thickness. Up to 1.5 mm, including the stratum lucidum.
Structure. Lacks hair follicles, sebaceous glands, and arrector pili muscles.
Layers. Contains an additional layer, the stratum lucidum.
Function. Offers enhanced protection in high-friction areas.

Layer Analysis and Dermis Comparison. Each layer, from the stratum basale to the stratum corneum, has distinct characteristics in both skin types. The dermis in thin skin is thicker and contains sweat glands and sebaceous glands, unlike in thick skin.

Conclusion of the Thick-Thin Skin Mix-Up Hypothesis

Our analysis suggests that the misrepresentation of epidermis thickness in training materials might result from confusion between thick and thin skin images. The epidermis in thick skin (on palms and soles) is thicker due to the stratum lucidum, while the dermis is thinner. This can lead to misconceptions about the actual thickness of facial skin layers, which are essential for precision in semi-permanent pigmentation procedures.

To prevent such errors, pigmentation training materials must accurately depict thin skin, particularly in discussions of facial pigmentation techniques.

13. Conclusions

Significant Discrepancies in Graphics

The graphics in many pigmentation training materials significantly misrepresent the relationship between epidermis thickness and needle diameter. Typically, these materials depict the epidermis as 30-50 times thicker than the needle used for epidermal penetration. This portrayal results in a visual where the needle's penetration hole appears 50 times smaller than the shown thickness of the epidermis.

Reality vs. Representation

In reality, the diameter of a standard needle is about five times larger than the thickness of the epidermis. This discrepancy means the graphics are off by 250 times, misleading new artists into believing there is more space within the epidermis for needle insertion. Such misconceptions can result in the needle going too deep, potentially reaching the hypodermis and causing pigment migration or “blowout."

Three Common Misconceptions Debunked

Implantation into the Basal Membrane. Biologically and dermatologically, implanting pigment into the basal membrane is implausible due to its thinness compared to typical pigment particles.
Hitting the “Sweet Spot.” The idea of consistently targeting the uppermost part of the papillary dermis is beyond our sensory abilities. Pigment often spreads into all dermis layers and sometimes into the hypodermis.
Adjusting Needle Length for “Thicker Dermis.”The belief that a thicker dermis requires longer needles or offers more resistance is scientifically unfounded. The epidermis's resistance is primarily due to the Stratum Corneum's density, influenced by various factors rather than dermis thickness alone.

Potential Cause of Inaccurate Graphics

A likely explanation for these inaccuracies is the use of images depicting “Thick” skin, characterized by an epidermis over ten times thicker and a thinner dermis. Using such pictures for facial skin cross-sections leads to further inaccuracies, as "Thick" skin is not typical of facial areas, resulting in substantial errors in training materials.