Corrective Pigment Camouflage

Part 1

By: Susan Church, CCPC

This is part 1 in a 3 part series. Part 1 will deal with the consultation of a burn patient. This will include: patient expectations, the ability to tolerate pain (pre-procedure sedation), consulting with the patient's physician, pre and post care and photos.

BSTTW Translations

Our primary concern is to correct tissue color defects and create the illusion of smoother looking skin. Dr. Francis Cook MacGregor, a research scientist and member of the rehabilitation team at New York University Medical Center states "In our culture the way one looks makes a difference in the response one gets. It is this fact that defines one's identity because it defines the reaction of others." The mouth is the second most noticed feature of the face, preceded only by the eyes. The disfigured face may be transformed by plastic/reconstructive surgery, corrective cosmetics or by Corrective Pigment Camouflage (CPC).

Patient assessment includes two phases: collection and analysis of information. This is achieved through the interview and examination. Most burn patients have lower self-esteem, social anxiety and fear of rejection. With this in mind, it is imperative to obtain information vital to your overall plan. The patient's past and present medical records contain data helpful to your overall assessment. These records should include a complete medical history including allergies to food, anesthesia, drugs, chemicals, metals, etc., and any diseases or disorders (psychological or physical).

Technicians must establish a rapport with the patient, identify their needs and agree on goals. We thoroughly discuss their perception of their present situation and what the CPC can do. Patients must be made aware this procedure is a multi-step process and final results cannot be determined until all applications are completed.

When a person initially phones for a consultation, the technician must ask whom the patient's physician is and if they are presently under their care. If they take medication or plan surgery in the next few months, the technician must work in concert with their physician.

The evaluation should include the use of glycolic or other Alpha Hydroxy Acid (AHA) prior to procedure day. This exfoliation/desquamation is the process of removing dead cells from the epidermis. This application will remove only dead, not living tissue. The technician should ask the treating physician if the patient should see a dermatologist to set up a skin treatment program. The cell renewal rate is generally every 21-28 days. For younger individuals, it is 3-4 weeks, for middle age adults it is 4-7 weeks and a mature adult's skin regenerates itself at a rate of 7-12 weeks or longer. This information is also vital when rescheduling the patient for their next appointment. The exfoliation process makes the skin more receptive to pigment retention.

The technician will discuss what is feasible for the patient to achieve with CPC, showing photos of other burn and scar work from onset to finish. Even though every case is different, this will enable the patient to see what is possible to achieve. The technician should write a detailed description of their treatment plan and go over it with the patient. Both of you must be in total agreement will all phases of CPC. Getting involved in their treatment should help give the patient control over their life, get them excited, and give them confidence.

Photos will be crucial in developing your overall plan of assessment for CPC. We photograph the patient's areas of concern and mark the areas. Patch color tests in marked areas of the skin will allow the technician to determine future colors to be used during application. An examination of facial morphology and symmetry is crucial.

We always have visible proof of our work as documentation for any and all interested parties, which may include physicians, worker's compensation cases, and insurance companies. attorneys, technicians and others.

Most patients have been through numerous surgeries and they are either oblivious to pain during procedures or the pain is very intense. We use a topical anesthesia to reduce the pain. We have found the best anesthesia to be ULTRAcaine White by Tri-Lab Products and/or Ela-Max 5, applied and wrapped in an occlusive dressing. Anesthesia is applied 1/2-1 1/2 hours prior to procedure application. We also use 1-2 drops of Numit liquid anesthesia in our pigment.

To the left are before and after pictures of corrective pigment camouflage on burn chest scars. These pictures show the changes this procedure makes.

Pre-care includes - Patients should drink 8-10 glasses of water daily, as this hydrates the skin. Other considerations include: limiting intake of caffeine, sodium, aspirin and alcohol 3-5 days prior to each procedure.

For product information on ULTRAcaine White, NUMIT LIQUID and Ela-Max 5, telephone number: Tri-Lab Products 714.839.6543 or email Susan Church at susanchurchccpc@yahoo.com