Association of Cosmetic Tattoo Inc. Newsletter January 2014 Issue

NEWSLETTER ISSUE

JANUARY 2014

ASSOCIATION OF COSMETIC TATTOO INC. Letter from the President Annual Conference announced on the Gold Coast Tuna –The Unlikely Suspect Colour of Confidence AFFINITY ALLIANCE Promote your BUSINESS for FREE ASSOCIATION OF COSMETIC TATTOO INC.

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Letter from the President Dear Members, Hopefully everyone had a wonderful Christmas and a much deserved break from work.

Paula Reali

As we are all aware now the year is in full swing again and I’m sure everyone is booking in their training Schedules for the New Year. Donna has been trying very hard to secure a Master Trainer for this year again and hopefully we will have news soon. It does look like we have to book two years in advance, so we are getting organised for 2015.

We do try and bring to our members up dated information in which helps us all grow in this industry and keep up with the best around. We cannot keep a closed eye in only what brands we know but also look at what the industry offers in other Brands, pigments, and techniques.

As soon as we have a Master Trainer all information will not only be sent out to you by email but I will try and ring you all as well.

Treasurer Report As you are all aware and as much as it is a pain to do every year, I do need with your payments, a new membership form signed by you with correct details so we can keep the web page updated. Also I am getting payments with only a partial business name as reference and even no name as a reference. Therefore I cannot send out receipts and you don’t receive your certificate.

PLEASE be active in getting all forms to me so we can both be happy. I would actually prefer your full name as reference or your invoice number only so you can be identified.

Also if Fees are not paid on time you will forfeit the Discount as I send out from beginning of December to allow 2 full months to be paid. If for some reason you cannot pay on time just ring me as soon as you receive your invoice.

Thank you

Paula Reali

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Colour of CONFIDENCE

Written by Jenny Marshall

BEFORE

When a lovely young client came to me after having endured a bilateral mastectomy, my goal was to continue the fabulous work of the surgeon, and help her ‘get back’ what she had lost. The surgeon had reconstructed her breasts and nipples and I felt extremely privileged when she chose me to assist her through this stage of her journey—the tattooing of her areolas. Utilising the various techniques I have gained from numerous international trainers, I decided to use a colour created by James Williams and Johnny McCarthy specifically designed for the breast. This amazing colour is called 'numee numee’ and as it is a pre mixed colour, there was no second guessing in creating the perfect the colour.

DURING

AFTER

I was able to accomplish my goal and give this beautiful young lady more than just a tattoo—I was able to give her the confidence she desired and more importantly, allow her to feel 'normal' again. Being such a wonderful and giving girl, she has allowed me to share her photographs in order to give hope to others in a similar situation. Thanks again to James and Johnny for developing a colour specially designed for the areola, one I like to call THE COLOUR OF CONFIDENCE. Cheers Jenny!

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TUNATHE UNLIKELY SUSPECT

Written by Jenny Marshall

As cosmetic tattooing professionals, we all understand the importance of pre-screening our clients to establish any contraindications that could impede the success of their cosmetic tattoo procedure. It is common practice to ask a series of questions relating to medication taken (notably warfarin, ibuprofen and aspirin) and complementary medication use e.g.- fish and krill oil. However, an easily overlooked factor that may lead to blood thinning and further tattoo complications is what we eat! Â

This issue of what we eat and its blood thinning properties was brought to my attention through a conversation with a regular client of mine. She told me of her recent adverse effects during routine plastic surgery, whereby excessive bleeding was the unfortunate outcome of the surgery. Questioning by medical staff prior to surgery had shown no apparent complications or contraindications, therefore the cause of this excessive bleeding was unknown.

Upon further investigation by medical staff, it was found that my client was eating a tin of tuna each day. This explained why the blood was thinned and delayed healing was occurring. The client was unaware that tuna would have the same effects on the blood as fish and krill oil supplements.

It is for this reason; I want to stress the importance of a thorough consultation prior to the cosmetic tattooing procedure. It may prove beneficial to be mindful of a client’s dietary habits as well as their medication history. Scenarios like this, although rare, can affect how well a patient heals, and how effectively the tattoo is implanted into the skin. Cheers, Jenny!

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Page 5 Invitation to All Association Members: TWO DAYS OF ADVANCED TRAINING WITH

DONNA MOODY-MARTIN

*Brisbane *Perth *Sydney *Melbourne

Day One: Digital Tattoo Certificate Seminar/Workshop $500 (Optional bring your own machine) v v v v v

Colour Corrections Colour Matching Advanced Digital needle usage Advanced Digital techniques Learn about Colour undertones and compensation on Lips,

v v v v v

Correction of Errors and old Tattoo Slope Needles for Hair Stroke European Brow Magnum and Power Needles Slope Needles for Wide Eyeliners

Eyes and Brows

Day Two: Skin Needling Certificate Seminar/Workshop $500 (Optional bring your own machine) ADD: The Micro Pen Machine Kit $1000 (Includes needles, Anaesthetic, Hyaluronic, Ampules, Mask, Aftercare & Mineral Makeup) v v v v

Theory of the Skin Skin Needling for Acne Skin Needling for Collagen Skin Needling for Lines & Wrinkles

BRISBANE: PERTH: SYDNEY: MELBOURNE:

17TH & 18TH, MARCH 2014 Monday & Tuesday 24TH & 26TH, MARCH 2014 Monday & Wednesday 7th & 8th, APRIL 2014 Monday & Tuesday 5TH & 6TH, MAY 2014 Monday & Tuesday LIMITED BOOKINGS! PHONE: 1800 024 050 or email info@actc.com.au For BOOKING FORM.

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Managing Complications, Side Effects and Consequences INTRODUCTION Every technician fears that he or she will make a mistake and cause complications for the client, and yet the odds of a mistake are rare. Moreover, the events that we see in the medical spa or other treatment facilities are not truly complications but consequences of treatment or side effects of treatment. What then constitutes a complication, and how is this different from a side effect or a treatment consequence? We hear these words used all of the time, but are they used in the correct context and for the right reason? In fact, significant differences exist between a complication and a treatment consequence. Technicians who are working the semi -permanent cosmetic industry have to know and understand the differences among these three labels.

Complications are unexpected events that occur following a normally applied procedure. For example, a client has a semi-permanent makeup treatment and an infection results .

Side effects are actions of effects of a treatment or drug other than that desired, such as nausea or vomiting (Thomas, 1997). In the case of semi-permanent makeup, bruising would be a side effect.

Treatment consequences are predictable outcomes of the procedure that occur in a reasonable percentage of people having the procedure. In other words, a client having semi-permanent makeup will have redness or swelling.

That said, let us move on and discuss in detail situations in each category and what to do, if anything, about them.

COMPLICATIONS The word complications can tie the technician’s stomach in knots. Nothing rings of fear the way a complication does. In fact, the word complications often- describes a mishap or problem.

However, some reality needs to be brought to the situation. What really constitutes a complication in the world of semi-permanent makeup? This procedure is generally safe and rarely has complications. However, they do occur. The only real complications are infection, scarring, dissatisfaction, corneal abrasion , eye injuries , cold sores, and migration . All other events are qualified as treatment consequences or side effects.

Complications, if they occur , can be minimised for the technician and client through a variety of steps. Among the import first steps is the technician’s response . Does he or she freak out and refuse to speak to the client, or does the technician response appropriately? Responding appropriately means the technician speaks with the client about the problem , sees the client in the office, validates the situation , and finds solutions . If necessary, the technician should be prepared to Other support systems for the technician will be provided by the clinic manager. Both the physician and the clinic manager can help the semi-permanent makeup technician gain authority and provide the necessary care if a complication occurs. However, given that most technicians are selfemployed , they must be properly trained and skilled in all aspects of client management , including first aid and having a physician list to which they can turn in case of emergency .

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Although communication is important in these situations , so is client education . Most of these situations can be avoided by thorough client consultations during which the client is educated as to what to expect. At every step of the procedure, the technician should explain to the client what is being done . We fear what we do not know or understand. Guide the client as to what to anticipate and how to help during the procedure. During eyeliner, for example , direct the client as to what will be done , where to think about looking, what the feeling should be, and any other expected results . Never discuss pain during the procedure . Only use positive terms such as, "Are you doing okay?" or "You are doing really great. " Mentioning the terms pain, hurt, or discomfort will focus the client's attention on this aspect of the treatment. Further avoid complications by educating the client as to the home-care responsibilities. The technician may work with the area for an hour, but the client

fearful because they do not know what is going to happen to them , which can make matters worse. Make sure the client understands the problem and the options available to solve the problem . The techn ician should be well schooled in understanding that the client will have predictable responses . Be prepared for the client and the responses . The client will go through not only a physical healing, but also an emotional healing. Allow the client the space and opportunity to go through this process with dignity . Being there for the client in a positive, supportive manner is the number one way to deal with any complication. Soon after dealing with the client's needs , the technician should contact their insurance firm and provide all the details of the incident, making sure that documentation is complete , thorough , and put in the client's records .

Dissatisfaction One of the most devastating and commonly occurring complications is dissatisfaction , which happens for many reasons . One reason might be the incomplete consultative process whereby the client was not clear (or the technician was not clear) about colours or placement. Another reason for dissatisfaction might be because the technician was not experienced enough to perform treatment on a specific region. Of course, dissatisfaction may also occur because the client just does not like that for which he or she asked . Dissatisfaction , unlike most other complicat ions , does not necessarily occur immediately following treatment, months and even years may pass for dissatisfaction to arise . One example might be a client who asked for a fad treatment. Suppose that she wanted very thick , almost gothic-styled makeup . Years later, some has faded , or she no longer cares to look that way .

The need for intensive client consultation and education, as well as the limitations as to the responsibility the technician can bear for work performed, cannot be stressed enough. This discussion includes thoroughly explaining the informed consent form. If the client insists on an extreme form of the procedure, this should be noted on his or her informed consent, and the client should initial that this procedure is what he or she wants. The other alternative is to decline to do a procedure that the technician knows is inappropriate. This difference between experienced technicians and those new to the field is key.

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The experienced technician knows that, most of the time, requests for extremes will require more stress and have more potential consequences than they are worth. We must keep in mind whether we want the form of advertising that doing this specific client will generate.

The most reliable guard against dissatisfaction is experience . The more experience you as a technician have, the more experience you will have in thwarting dissatisfaction through communication and steering client expectations . Avoid taking on a client if you feel uncomfortable in being able to make him or her happy. Many technicians consider the consultation an interview process , a time to make sure they feel comfortable with pleasing the client. Clinicians know that , at this point, that they can freely say , "I don't think I am the best person to perform the services you want." They can either stop there or refer the client to someone else . Why refer out and lost the revenue? Most experienced technicians agree that the times they did not refer to another technician , in spite of the fact that their stomach was in knots telling themselves not to do the procedure , was when they had the dissatisfaction issues.

Infections and Scarring Infections and potential subsequent scarring are rare occurrences and can be related to specific issues : unsterile instruments , allergic responses , granulomas , keloid scars , tattoo removal , and rarely magnetic resonance imaging (MRI) complications (Figure 7-1). Remember that the pigment is placed in the upper reticular dermal tissue . If placed too deeply into the dermis , the risk of fanning or blurring increases as the pigment molecules move around more easily. Therefore the technician must make sure that the treatment is meticulous and that the client follows the post care instructions.

Making the client a team member who is responsible for his or her home care is advisable . Let the client know that most healing issues result from inadvertent deviations from home-care protocols.

Working the garden and wiping the freshly treated brows with a dirty sleeve is a recipe for infection .

Cuddling pets near any freshly tattooed area risks infection. Small children , hands, money , and other normally innocuous parts of daily life need to be carefully monitored. Proper hand washing and application of topical healing agents with a clean cotton swab is the way to avoid issues. Give your client permission to pamper the skin for a day or two and to avoid heavily strenuous activities , sunlight exposure , and unclean environments such as gardening or cleaning out the garage, attic or basement.

The most common causes for infection during semi-permanent makeup treatments are ineffective home care, an allergic reaction that is not properly cared for , and granuloma formation . It stands to reason that the one-time disposal needles recommended for semi-permanent makeup are for the safely of the client. Sterile, single-use needles protect the client from infection and viral diseases such as hepatitis and human immunodeficiency virus. Therefore, to avoid this complication , use the disposables as they are intended, as single-use items.

Allergic reactions are rare and have been traced back to the pigment used in the treatment. Allergic reactions present as cracking, bleeding, swelling, pain, inflammation , burning, and a tattoo injury that will not heal. Some professionals recommend a patch test in the postauricular region before a full treatment. Although patch testing is a good indicator of allergic reactions , no scientific documentation exists for accurately predicting results.

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Staying apprised of any pigment companies that are having trouble with pigment reactions would be wise as well. Manufacturers are addressing these concerns by meeting and creating guidelines for pigment labelling, including ingredients and batch numbers, so that any problems can be tracked and dealt with in a timely manner.

Technicians can help protect themselves and their clients by looking for pigment labels with full disclosure of ingredients , as well as a batch or lot number . Some manufacturers are including an expiration date, but many traditionalists believe that this labeling is misleading as properly manufactured pigments are stable and can have a long shelf life.

Granulomas are small nodules that form in response to the implantation of the pigment. Many types of granulomas exist, but to those associated with semi-permanent makeup application , this is known as a foreign-body granuloma . These nodules may remain hard and encapsulate the area; other times , they may become infected . When infection occurs, a technician should always contact a physician for advice and treatment.

Keloid scars extend outside the area of healing and result in large bubbles of tissue . Keloid scars are not hypertrophic scars, which are simply raised scars . Individuals who are predisposed to keloid scars should not receive semi-permanent makeup because the injury sustained during the treatment can result in a keloid scar .

We know that the biggest reason for scarring is attempted tattoo removal. Once the tattoo has been placed, little can be done to return the skin to its original condition. Different attempts to remove the tattoo can include saline injection, peel application , dermabrasion , laser , and actual surgery to excise the tissue. Obviously , the tactic chosen depends on the size and location of the tattoo and the pigment. More recent methods of safe pigment lightening have rendered much better results, including use of saline pacts and specialty acid formulations that also use osmosis to pull or lift colour . Specialised hands-on training of either method is required before implementation A few people who have semi-permanent makeup have reported experiencing temporary swelling or discomfort while undergoing MRI. Some reports indicate the semi-permanent makeup will compromise the results of the MRI. The causes of the interference are unknown , but some people speculate that metals in some pigments cause the reaction because of the radiation to which they are exposed . Although the origination of the concerns is obscure , some evidence suggests that it was related to risks for the expensive equipment in use. The amount of metal by-product in a cosmetic tattoo is equal to that in a traditional dental filling. In the very first incident , excision was the technique used to eliminate the potential problem. Since that time , this approach has been demonstrated as extreme . Alternatives including changing patient alignment with a magnet. In one medical study, the risk or reaction factor was less than 1%. Many participating technicians had both multiple MRI and computed axial tomographic (CAT) scans of themselves done after having full- face cosmetic makeup with no side effects following the medical imaging. To avoid discomfort , advise your MRI technician that you performed semi-permanent makeup so that the necessary precautions can be taken .

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Corneal Abrasions and Eye Injuries Corneal abrasions and eye injuries can occur when working around the eyes . Corneal abrasions are the most common and require a trip to the emergency room or the ophthalmologist for treatment. The client will complain of severe eye pain, as if something is in the eye . In most instances , the symptoms are improved if the eye is closed . Corneal abrasions usually require that the eye be patched for several days as the abras ion heals. Once healed, the eye returns to its normal functioning without permanent damage . Other eye injuries are rare and require the attention of a physician immediately.

To reduce the risk of corneal damage , keep the eye lubricated during the procedure . Singleuse units of Celluvisc速 or other eye drops have proven to be of great value. Although these lubricants may make the v ision temporarily blurry, they act as a protective coating during the colour implantation process . Rinsing the eye with saline was following the procedure is also beneficial. Many technicians send Refresh速 or other eye drops home with the client for follow up use. The wise course of action is to use only lubricating drops to make the eye comfortable without masking potential problems .

Migration Migration occurs when the pigment travels beyond its intended placement (Figure 7-2) . This event is more likely to occur if your placement is near mucous membranes , for example , the corner of the mouth.

recommended .

Cold Sores (Herpes Simplex I) For individuals who get cold sores , nothing can be more frustrating or uglier. Therefore the idea of coming in for a beauty procedure and looking worse by getting a cold sore is not appealing (Figure 7-3). Clients who have had cold sores should be pre-treated by a physician with a product such as Zovarix 速 or Valtrex 速 before lip or mouth tattooing . This medication will ensure that the client does not have a breakout resulting from the stimulation of the lip.

Clients who report having had a cold .

,

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Complication

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Possible Contributory Factor

Herpes Simplex I virus

Technician Response to Complications of Treatment Any technician , nurse or physician can tell you, when a complication occurs , you can see your career flash before your eyes. What if the client becomes irreparably damaged? What if you get fired?

What will happen to your insurance rates? What if you get sued? Although the possibility of these things happening is real, taking proactive steps during the consultation and after you realise that a complication has occurred can minimise the likelihood . Communication is the key to successful damage control. First, make sure that the client is informed of the risks before treatment. The client should sign a treatment consent form that outlines the possible complications. This step is important in the communication process with the client. Second, you should know the processes that should be in place in the event of a complication. For example , you should know which person on your team can help. Attempting to correct a situation for which you are not trained or ignoring early symptoms of a complication can be considered gross negligence. If a complication occurs, of the utmost importance is being compassionate and sympathetic to the client's feelings. Effective management of complications will be heavily dependant on the steps you take both before and at the earliest stages after the complication occurs .

Client Education We have already discussed the value of client education. In the context of a complication , the subject is that much more important. During the consultative course of your interaction with a client , you should have discussed the treatment you have recommended to realise his or her particular goals. An important addendum to this discussion should include the risks associated with the treatment.

Your initial inclination might be to withhold this information for fear of scaring the client away .

Certainly , hearing that scarring or tissue damage may result will be frightening to many people, and it may, in fact scare some people away. However, communicating this information has a dual benefit. First, when a complication does not occur, which ideally should be the vast minority of the time , the client will have greater faith in your professional capacities for avoiding any aforementioned complications . Second, if a complication does occur, managing is psychologically easier for the client if he or she is prepared for this possibility .

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Printed literature is probably the most common approach used to improve client knowledge. The approach allows clients to take information with them , read it, and make a list of relevant questions for the technician. Literature that is specific to the procedure and your facility orients the client to the clinic's thinking and processes. This information eliminates misunderstandings such as, "My girlfriend said the procedure would be done this way" or "In the other clinic I went to they did it this way. " Additionally, the information burdens the client with some responsibility to read and evaluate the information before taking part in the procedure. During the consultation, this information can be reviewed section by section with the client to make sure he or she understands it and answers any questions that may arise.

Videos are common products used to educate clients , especially in the cosmetic plastic surgery office . Videos are available from manufacturers that show procedures and discuss procedure consequences and complications. The combination of a video and literature can be the best training tools available. However , these products do not eliminate the need for the technician to talk to the client!

Printed literature is probably the most common approach used to improve client knowledge. The approach allows clients to take information with them , read it, and make a list of relevant questions for the technician. Literature that is specific to the procedure and your facility orients the client to the clinic's thinking and processes. This information eliminates misunderstandings such as, "My girlfriend said the procedure would be done this way" or "In the other clinic I went to they did it this way. " Additionally, the information burdens the client with some responsibility to read and evaluate the information before taking part in the procedure. During the consultation, this information can be reviewed section by section with the client to make sure he or she understands it and answers any questions that may arise.

Videos are common products used to educate clients , especially in the cosmetic plastic surgery office . Videos are available from manufacturers that show procedures and discuss procedure consequences and complications. The combination of a video and literature can be the best training tools available.

However , these products do not eliminate the need for the technician to talk to the client! The Internet can be a good place for clients to do primary research on the procedure on which they are looking to embark. Aside from your own Web site, refer the client to additional Web addresses that provide good educational material. A third-party opinion can be valuable in the educationa l process. All of these tactics should be used in concert with a face-to-face consultation . Not enough can be said about the value of an organised and informational consultation . As you already know, the consultation is about educating the client, but it is also about creating a bond.

Communication and Complications Fair, hones , and compassionate communication is one of the most important skills you will use dur ing a complication and the subsequent associated healing. Becoming defensive during an event such as a complication is easy for the technician , and this behaviour is the last behaviour that we want to exhibit.

Therefore exactly what is fair , honest, and compass ionate communicat ion, and how do we learn this type of communication?

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The secret to fair, honest, and compass ionate communicat ion is the ability to manage one's self . In doing so, one becomes self-aware and able to assess the situation fairly , without the emotiona l attachment. These concepts are fairly esoteric , and in these situat ions , we need nuts and bolts to keep the situation in check . Therefore consider the follow ing concepts. Poor communicat ion may result when the sender of information has a poor working knowledge of the subject. In other words , you do not understand the complication , and you are frightened by the situation . Initially, you may find yourself in a sim ilar situation . Do not communicate your fear or lack of knowledge to the client.

Find your physician or the appropriate co-worker to help you speak with the client. If you are afraid , the client will be afraid; moreover , the client will lose confidence in you . Do not let this happen . Poor communication may also result in your lack of belief in the message . For example , you are telling the client that a wound will not scar , but you believe it might or will scar. Poor communication also happens when the receiver is not paying attention , which can happen if, for examp le, the client is looking in the mirror rather than listening to you. Finally, the concept of respect plays into the situation . If the client does not respect you and will not listen to yo u, then turn ing the care over to a co-worker will be in the client's best interest. You can continue to follow t he client, but bow out gracefully. In most situations , technicians are working solo . No one can take over the procedure.This problem should be discussed in the consultation . If the technic ian does not believe that the client's respect can be maintained , then the technician probably w ill be unable to make the client happy with the result. Referring the client to another technician in the area who specialises in the requested procedure or one whom the technician believes may be better equipped to deal with this particular client may be in the best interest of both parties. Physicians refer out without embarrassment ; so should semi-permanent cosmetic technicians .

Client Responses to the Complications of Treatment As you know, the complications of treatment are events that are not the expected results of a treatment. A common example might be the development of an infection and subsequent scar .

Clients will often have a wide variety of reactions to complications . These reactions run the gamut from anger and blame to fr ight and regret. Initially, the client will seem ingly accept the potential complication with ease and understanding . However , as the healing progresses and the number of office visits continue to rise, the client may become angry. This reaction is not uncommon . A female client will often use her boyfriend or husband as a weapon. "My husband is really angry at this situation ." Complications can often be made worse by personal relationships . A husband , boyfriend , or partner who did not support the treatment will certainly be angry if a complication occurs .

However , that relationsh ip is between the client and her companion . The fact that her husband is upset is not your responsib ility. It will make your care of the client more challenging , and you should be aware of the situation . As the wound heals , communication with all parties may be necessary as the complication is resolving. Remember , anger is sometimes motivated by fear . Bear this fact in mind as you manage the client's problem and healing process .

As you review this section , communicat ion is as important as is the management of the problem . In some instances, you will need a backup or simply someone to listen to you . You may also feel sad or guilty or helpless . Acknowledge these feel ings, and seek out someone to be a sounding board . This tactic will help you keep the situat ion in perspective . Then and only then will you be of help to your client.

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Affinity Alliance

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Dinning Directory

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