Saline based removal

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1. Background

This article is based on insights from 23 interviews with pigmentation artists skilled in removal services using saline-based products. These artists also specialize in creating powder brows, hairstrokes, and lip blush. The interviews were carried out between 2020 and 2022. The group includes 14 artists from the EU, seven from the UK, and two from the US. Moreover, the findings from these interviews have been scrutinized and augmented by a dermatologist and a biologist.

This article aims to elucidate the saline-based removal process, particularly focusing on its application in pigment removal for semi-permanent makeup, including lip pigmentation. It also explores this method within the broader framework of the Holistic PMU approach, highlighting its relevance and application in modern cosmetic practices.

Saline-based pigment removal is particularly pertinent for lip blush treatments, where precision and care are essential due to the sensitive nature of the lip tissue. The insights provided by the pigmentation artists, combined with the expert review from a dermatological perspective, offer a comprehensive understanding of this technique, emphasizing its effectiveness, safety, and suitability for use on lips.

2. How Does Saline Removal Work?

The Principle of Osmosis

Saline-based removal of permanent makeup, including lip blush, utilizes the principle of osmosis, a crucial process in chemistry and biology. Osmosis involves the movement of a solvent, usually water, across a semi-permeable membrane from an area of lower solute concentration to one of higher concentration until equilibrium is reached.

In saline pigmentation removal, the human skin acts as this semi-permeable membrane. The epidermis, primarily made up of keratinocytes, is a barrier regulating substances' entry and exit. Introducing a saline solution, a high concentration of sodium chloride (NaCl) in water, into the skin via tattooing disrupts the local osmotic balance. This triggers the body's homeostatic mechanisms, causing water to flow into the area to dilute the salt concentration.

The Cellular Perspective

From a cellular standpoint, this influx of water into skin cells, such as keratinocytes and melanocytes, aims to balance osmotic pressure. This water influx exerts pressure on pigment particles in the dermal layer, typically held in place by fibroblasts and collagen networks. These particles, made of substances like iron oxide or titanium dioxide, are pushed toward the epidermis.

Removal Through Movement of Water

As water pushes the pigment particles upward, biological reactions occur. Macrophages, a type of white blood cell, may assist in moving some particles upward. Scab formation on the skin’s surface, consisting of dried fluids, dead cells, and pigment, is crucial in this process. The natural exfoliation of this scab carries away pigment particles, resulting in the lightening of the tattoo or pigmentation.

For lip blush removal specifically, the delicate nature of lip tissue requires careful application of the saline solution. The process is gentle but effective, making it suitable for lip pigmentation removal.

In conclusion, saline-based removal is an intricate combination of chemical, physical, and biological processes. It exemplifies the practical application of these scientific principles in aesthetic treatments, particularly lip pigmentation.

3. Saline vs Laser Removal

Comparing Saline-Based and Laser Removal Techniques

Understanding their fundamental differences is key when deciding between saline-based and laser removal for semi-permanent makeup applications like lip blush or powder brows.

Saline-Based Removal

Interestingly, the saline-based removal process almost reverses the initial Lip Blush procedure. Initially, a PMU (Permanent Makeup) machine injects pigment into the skin. The same machine injects a saline solution for removal, triggering the osmotic process to draw pigment molecules upward, ideally through the epidermis, resulting in a scab.

The high salt concentration in the saline solution disturbs the osmotic balance at the pigment site. Water molecules naturally migrate towards areas with a higher salt concentration, exerting physical pressure on the pigment particles. This process forces the particles upward through the skin layers, leading to scab formation and eventual expulsion of the pigment as the scab naturally exfoliates.

For lip blush removal, this method is especially beneficial. It's less invasive and focuses on drawing the pigment out rather than breaking it down, which is crucial given the sensitive nature of lip tissue.

Laser Removal

Laser removal utilizes concentrated light energy in ultra-short bursts, targeting the pigment particles and causing them to fragment into smaller pieces. Unlike saline removal, which moves entire pigment particles upward, the laser method shatters these particles.

The body's immune system plays a vital role post-laser. Macrophages, a crucial immune system component, consume and degrade these smaller pigment fragments. This process effectively clears the fragmented pigment from the skin, eventually eliminating the remnants via the lymphatic system.

Key Differences in Mechanisms

Direction of Particle Movement: Saline-based removal physically lifts entire pigment particles to the skin's surface. At the same time, laser treatment breaks down the particles within the skin layers for immune system removal.

Particle Handling: Saline removal lifts and removes intact pigment particles via scab formation. In contrast, laser treatment fragments the particles for macrophage ingestion and processing.
Body's Response: The saline method relies on osmotic balance for pigment expulsion, while laser removal uses the immune response to clear fragmented particles through the lymphatic system.

Both saline-based and laser removal methods have unique mechanisms. Saline-based removal expels pigment particles through osmosis and scab formation, suitable for delicate areas like lips, while laser removal employs light energy to fragment particles for immune clearance.

Next, we will delve into the specifics of the saline-based removal procedure.

4. Saline-Based Removal Process

Consultation and Agreement

The saline-based removal process always starts with a consultation. During this phase, the practitioner evaluates the brows or lips, clarifies the client's expectations, and explains the procedure, including possible risks and aftercare. This step is essential for setting realistic expectations, considering that skin types and the nature of the original pigment significantly impact results.

Impossibility to Predict Precise Results

Due to individual skin responses and the complexity of pigment chemistry, predicting specific results is challenging. Variables like skin pH, hydration level, and immune response can all affect the success of the removal process.

Signing a Contract

Typically, clients sign a contract acknowledging the potential risks. It's important to note that insurance may not cover procedures involving certain chemicals found in saline-based solutions in many regions.

Preparing the Treatment Area

Before the procedure, the targeted area is thoroughly sanitized to reduce infection risks. Applying a numbing cream or local anesthetic minimizes discomfort, especially for sensitive areas like the lips.

Applying the Saline Solution

The saline solution, high in sodium chloride, is applied using a PMU machine with a sterilized needle, similar to the tattooing process. The saline creates an osmotic imbalance, drawing water from surrounding tissues to dilute the salt. The technique often involves saturating the skin with circular movements using large needles (e.g., 3RL).

Osmosis Process

Osmotic pressure helps dislodge pigment particles from the dermal layer, moving them toward the epidermis. The process's efficiency depends on the concentration of the saline solution and the depth of the original pigment placement.

Scab Formation

After treatment, a scab forms, encapsulating the saline and dislodged pigment. Natural scab detachment is crucial; premature removal can hinder pigment extraction and healing.

Healing Process

Post-scab shedding requires time for healing. Following aftercare instructions, like keeping the area clean and avoiding sun exposure, is vital to prevent infection and ensure optimal healing.

Additional Sessions

Factors such as the original pigment's age, depth, and color may necessitate multiple sessions. Each session's healing response and pigment removal degree dictate the need for further treatments.

The saline-based removal process is a complex blend of chemical reactions, skin physiology, and cellular responses. It's important to note that some pigmentations may seem easy to remove but show no visible effect post-treatment. Conversely, some challenging cases might lighten significantly. This variability is especially true for lip pigmentation, where the tissue's delicate nature requires careful application and management of the saline-based removal process.

5. Limitations of Saline-Based Removal

Size of Pigmentation Area

The effectiveness of saline-based removal decreases as the size of the pigmented area increases. This is especially true for large areas with heavily saturated, dense, dark organic pigments. The osmotic process cannot draw out high pigment concentrations over extensive areas. In such cases, laser removal might be a more suitable option due to its ability to target and fragment pigment across larger skin sections.

Depth of Pigment Implantation

Pigments implanted too deeply, such as black colors that penetrate the hypodermis, encounter a significant limitation. These often involve small-sized (100-200 nm) carbon black (CI 77266) particles, especially those derived from Furnace-based carbon (Black 2). In these scenarios, saline-based removal is a labor-intensive process, requiring the mobilization of these particles through the reticular dermis, papillary dermis, and then through the epidermis.

While some practitioners have reported successful particle migration to the surface over multiple sessions, the outcome is often unpredictable. Deeply implanted and cold-toned organic carbon black particles respond better to laser treatments. Lasers can fragment these deep-seated pigments more effectively, allowing the body's immune system to remove them.

These limitations are particularly relevant when considering saline-based removal for lip pigmentation. The lips' delicate nature and the typical depth of pigment implantation in lip blush procedures necessitate careful assessment. Practitioners should evaluate whether saline-based removal is effective for the specific pigment type and depth or if alternative methods like laser removal are more appropriate.

6. Advantages of Saline-Based Removal

Versatility in Pigment Types

Saline-based removal is effective across various pigments, regardless of their chemical makeup. Unlike laser treatments, which may have difficulties with colors like camouflage, yellow, or green due to specific light absorption properties, saline methods are uniformly effective. This is because they rely on the physical displacement of pigment particles through water molecule movement, not color-specific light absorption.

Minimized Risk of Skin Damage

Saline-based removal generally poses a lower risk of burning or scarring than laser methods. With their high-energy light emissions, Lasers can cause thermal damage, potentially leading to scarring. Subdermal changes from such scarring can alter skin texture and complicate future pigment re-implantation. Saline methods, being gentler, are more suitable for sensitive skin and thinner areas like the lips.

Controlled Pigment Fading

This method allows for gradual, controlled pigment lightening, making it ideal for subtle adjustments or delicate areas where precision is crucial. This controlled fading is particularly beneficial for lip blush adjustments, ensuring a natural and precise reduction in pigmentation.

Safety Near Sensitive Areas

Saline-based removal is often preferred for areas typically more sensitive to the eyes and mouth. These areas' chemical and biological properties make them well-suited for effective osmosis, facilitating pigment mobilization.

Effectiveness with Titanium Dioxide (TiO2)

Practitioners find laser removal challenging when removing titanium dioxide pigments, especially unmicronized TiO2. Lasers can change the color of these particles to grayish shades without effective removal. Saline-based removal, not dependent on pigment color or light reflection, is more effective in mobilizing and extracting TiO2 particles.

In summary, saline-based pigment removal offers several benefits: versatility with different pigments, reduced skin damage risk, controlled pigment fading, suitability for sensitive areas, preservation of natural hair, and effectiveness in removing titanium dioxide-based pigments. These advantages make it a valuable method for semi-permanent makeup artists, especially when working with delicate lip pigmentation.

7. Typical Contents

Essential Components in Saline-Based Removal Solutions

While saline-based removal solutions vary among manufacturers, they generally contain several key ingredients, each serving a specific purpose in the removal process.

Sodium Chloride (Salts): The core ingredient is salt, typically sodium chloride. Salt creates a high-concentration solution crucial for initiating the osmotic process, which lifts pigment from the skin. The imbalance in solute concentration caused by salt draws water and pigment particles towards the skin's surface.
Orange Seed Extract: This natural extract aids in the exfoliation and fading of pigment. It contains citric acid, which gently peels the skin's upper layers, helping remove pigment particles during scabbing.
Lemon Seed Extract: Like orange seed extract, lemon extract facilitates exfoliation and fading, primarily due to its citric acid content. It assists in skin renewal and lightening the treated area.
Aloe Vera: Known for its soothing and healing properties, Aloe Vera in saline solutions helps calm the skin post-treatment. It reduces inflammation and promotes faster healing of the treated area, particularly beneficial for sensitive regions like the lips.
Sterile Water: The base of the solution is often sterile water to prevent contamination and infection during the removal process. Sterile water ensures the highest purity level, which is crucial for maintaining safety.
Glycerin: Included for its humectant properties, glycerin helps maintain moisture in the skin, aiding the healing process.
Potassium Sorbate: A common preservative used to inhibit mold and yeast growth. It ensures the solution's longevity and prevents microbial contamination.
Sodium Benzoate: This preservative has anti-bacterial and anti-fungal properties, extending the product's shelf life and ensuring its safety for skin application.
Witch Hazel: Sometimes added for its astringent properties, witch hazel can help tighten the skin and reduce inflammation after treatment.

Each ingredient in the saline-based removal solution has a distinct role, from kickstarting the osmotic process to ensuring skin safety and aiding healing. This composition makes it a versatile and effective option for semi-permanent makeup removal, including delicate applications like lip pigmentation.

8. Additional Observations

Insights from Experienced Artists

Importance of Quality Products. Using high-quality saline-based removal gels from reputable manufacturers is essential. The success of the removal process largely depends on the purity and concentration of the ingredients, which critically influence the osmotic process for effective pigment lifting.
Application Technique. The application technique for saline solutions differs significantly from pigmentation methods. It involves circular motions at a medium machine speed to ensure adequate saturation in the skin while minimizing tissue damage. This is particularly important for sensitive areas like the lips, where precise and gentle application is required.
Needle Selection. Experienced artists often use a 3RL needle for precise tracing and a 5RL needle for covering larger areas. The optimal needle diameter is typically around 0.4 mm, and the length is 1.5 - 2mm, allowing for effective solution saturation without causing excessive skin trauma.
Desired Bleeding. Some bleeding during the procedure is normal and even desired. It indicates that the needle has reached the appropriate skin depth, crucial for effective interaction between the solution and pigment particles.
Pricing Structure. The cost for saline-based removal varies, typically from USD 50-150 per session. Factors such as location and the case's specifics, such as correcting previously applied pigmentation, can affect pricing.
Emergency Removal. Saline-based removal is increasingly used as an emergency solution for brow corrections within 72 hours of the initial procedure. This timing is effective due to the pigment's location in the epidermis during this early stage.
Pain During the Procedure. The procedure can be painful, as implanting salts into the skin causes discomfort. While numbing agents are used, many artists recommend minimal usage to avoid interfering with removal.
Good Skill to Have. Mastering saline-based removal solutions is a valuable skill for semi-permanent makeup artists. It requires understanding the product’s chemistry, appropriate needle techniques, and knowledge of skin responses. This skill is especially important for artists performing delicate procedures like lip and eyelid pigmentation removal, where experience and expertise are crucial.

Seasoned artists emphasize the necessity of having experience in providing specific services, like eyelid pigmentation or lips, before attempting their removal. This ensures a deeper understanding of the intricacies involved in these sensitive areas, contributing to safer and more effective removal procedures.

9. Conclusions

Overview of Saline-Based Removal

Saline-based removal employs the principle of osmosis to draw pigments out of the skin. This method involves creating a high salt concentration area and applying a saline solution with a PMU machine, mirroring the tattooing process.

The Removal Procedure

Begins with a thorough consultation and skin evaluation.
The treatment area is cleaned and, in some cases, numbed to reduce discomfort.
Specific techniques and needle choices (like 3RL for tracing and 5RL for larger areas) are crucial.

Advantages of Saline-Based Removal

Effective across various pigment types, irrespective of chemical composition.
Lower risk of skin damage compared to laser methods, suitable for sensitive skin and areas like the lips.
Controlled, gradual fading of pigment, ideal for precise corrections.
Safe for use near sensitive areas, such as eyes and mouth.
Preserves natural brow hair, a distinct advantage over laser treatments.
Particularly effective in removing pigments like Titanium Dioxide, which might not respond to laser treatment.

Limitations and Challenges

Less effective on large pigmented areas or with deeply implanted pigments like carbon black.
May require multiple sessions for significant pigment lightening.
Results can be unpredictable, especially with deeply implanted pigments.
Typical Components of Saline-Based Solutions
Includes salts, sterile water, natural components like Aloe Vera, orange and lemon seed extracts for exfoliation, and preservatives to prevent microbial growth.

Professional Considerations

Emphasizes the use of high-quality saline-based removal products.
Different application techniques compared to pigment application, focusing on saturation.
Some visible bleeding during the procedure is normal and indicates effective saturation.
Recognized as an effective emergency solution for brow corrections within 72 hours of the initial procedure.

In conclusion, saline-based removal is a valuable technique in semi-permanent makeup, offering a safe and adaptable pigment correction and removal method. While it presents certain limitations, especially for large or deeply implanted pigments, its safety and versatility make it a preferred option for many professionals and clients, particularly in delicate procedures like lip pigmentation.

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