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The use of aesthetic tattoos for problems of hair loss is large and sometimes providential.
The following are the main cases where this treatment can give significant cosmetic improvements:

• Neck scars from autotransplantation FUT (linear). Fig.1
• Neck scars from autotransplantation FUE (punctiform). Fig.2
• Generic scars on the scalp. Fig.3
• Alopecia areata. Fig.4
• Androgenetic alopecia. Fig.5
• General thinning. Fig.6

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Duration of a Hair pigmentation®

First case: execution of the tattoo with bioabsorbable pigments

When dermopigmentation is done with bioabsorbable pigments, (improperly called "semipermanent"), is called "Bioabsorbable Hair pigmentation", and in this case it can last from 4 / 6 months to 14/16 months. The period within which the work may remain visible is very broad and it is not possible in any way to determine in advance when it will disappear completely. Although normally dermopigmentation is done with these pigments, with time it is destined to go away completely, it is important to remember that rarely, or in case of dermopigmentation done incorrectly, the treated area may retain a soft mark. Factors that could accelerate the disappearance of the pigment in the skin are many, the most important are:

• The power of phagocytosis in the individual
• The age of the individual (an additional factor to the above)
• The healing power of post-treatment of the individual
• Anatomical shape of the skin of the individual
• The type of pigment led in the dermis
• The manual technique used for dermopigmentation
• Time of exposure to sunlight or tanning lamps
• Taking drugs like anticoagulants and cortisone
  

By virtue of the foregoing therefore, we can say that the duration of a Hair pigmentation is highly subjective. Usually you get a good job of covering with at least two sessions, although in rare cases you may have a satisfactory effect with a single tattoing session. The first session may have an execution time varies depending on the work to be done: on average, ranging from 2 to 8 hours. Any second session of strenghtening must be made no earlier than 40/60 days from the first. If it should be necessary to perform additional sessions beyond the second, you should always wait about 50 days after the last treatment. Once you reach the consistency of the whole area which is being treated, the work will be preserved with dignity for about 8/10 months (statistical data). In fact, the pigment will take at least twice this time to disappear completely. Although the use of bioabsorbable colouring preparation, seems to be relatively short lived, and too difficult to maintain, it is certainly the most prudent and rational choice that can be taken.
The possibility to re-evaluate your own choices "each year", makes it the ideal solution for all those who do not want to risk second thoughts. Moreover, for individuals predisposed to graying (white hair) the temporary solution is certainly the most suitable. The approach to the aesthetic tattoo of the scalp should always be done through this type of option, especially to evaluate the real aesthetic result and the graphic impact that the micropigmentation of the skin provides.

Second case: execution of the tattoo with final pigments (very risky, to be carried out only in rare cases).

In some special and very rare cases, we can use final colouring preparations. This choice must be considered very carefully and together with the specialist of dermopigmentation. It attracts most of the people interested in Hair pigmentation, proposing a very popular solution of all the problems of hair, but in reality it is absolutely not like that. It must be said that nothing in nature remains unchanged over time, including iron oxides used for the creation of pigments. In other words, there is no assurance that a work done with final colouring preparations remains unchanged forever. It may happen that some brown tones, changing, may turn to other colours.
Although this problem can be relatively controlled with an appropriate balancing of the colour components of brown, it remains a significant bottleneck for dermopigmentation in general as well as a very risky choice. Among the factors that contribute to, or, in some way, interfere with the phenomenon of colour change of brown used in tattooing there are:

• Excessive exposure to ultraviolet rays; sun or tanning lamps
• Dramatic changes in temperature
• Alkalinity of the extracellular fluids in the dermis
• Purity of raw materials used in the colouring preparations used (iron oxide)
• Autoimmune diseases of the individual undergoing treatment
  

In the event that might arise over the years a significant colour change, which heavily affects the naturalness and credibility of the work, it is possible to intervene in the following ways:

• Removal with laser therapy
• Retreatment of the area previously treated with a new mixture of pigments. Indeed, by introducing artificially a component "antidote", it is possible to restore the original brown. (This method of colour restoration is certainly the most difficult and complex, and gives no guarantees about the actual success).
  

Also, it still remains the problem of graying, which in this kind of choice could create an important factor to consider, and eventually check in three ways:

1. Continuously dye white hair to avoid the contrast with tattoo
2. Shave white hair and extend the pigmentation, grading on surrounding areas or over the whole head
3. Remove the pigment in the dermis previously introduced by laser therapy
   

As for the covering strategy with final pigment, we will use the same technique used with bioabsorbable pigments, that is: first session of about 2 – 8 hours (depends on the type of work to be done: scars covering, alopecia areata or hair thickening), and finally a strengthening after 40/60 days. Once evenly covered the treated area, the pigment will remain forever in the dermis. Today it is not possible to say that this colouring preparation, will remain unchanged over time.
Given these risks it is fair to say that a good number of people have already switched to the final without having problems, but the lack of a proper "follow-up" in this sense, makes this data not sufficiently reliable.

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General considerations on the possibility of strengthening (valid in both cases)®

A strengthening carried out after 2 months may not be sufficient to achieve a homogeneity of the treated area. The probability of engraftment of the colour depends on many factors, not least the subjectivity of the individual. For example just think of the different conformation of the dermis in a healthy tissue and a sclerotic one (like that found in the scars from autotransplantation). It is obvious that for healthy skin healing will be better, resulting in an increase of probabilities of preservation of the colour used. Scar tissues, on the other hand, require an extra effort to be coloured! Finally, it should be considered in any case, the possibility of having to perform even more than a strengthening. These strengthenings should never be carried out before a month and a half from each other!

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Possibility to perform a pre-treatment colour test

Although the technical and qaulity level of the products used for Hair pigmentation can be considered very high and, even if today allergic reactions following a Hair pigmentation work are very rare, it must be said that ministerial guidelines impose to communicate the possibility of such allergic phenomena to those who submit to any tattoo session. Although many operators advise pre-treatment tests to minimize the risk of allergic reactions to pigment, it must be remembered that the only professional capable of expressing an opinion about the risk of allergy to a substance put into an organism, is the allergist. Only through in-depth analysis at a center for allergy, you can really minimize the risks which are already infinitesimal.

Read infinitesimal, that is tending to zero. A Hair pigmentation should be done safely, but mainly by a specialised and qualified professional. This will make these reactions much less likely. In essence, be or become allergic to the pigment is always possible but very unlikely. In reality, this test should be done only by the operator to assess a possible colour change of the pigment under the skin. The evaluation of allergic reactions should be obtained only by secondary intention, because due to another structure. In relation to colour change, the more experienced operators usually skip this procedure. If the customer wants to perform this procedure despite everything, it is good to know that:

• The test should be performed at least 40 days before the session of Hair pigmentation
• This test has a cost for the customer
• The intention to carry out the colour test must be notified in advance to the Hair pigmentation centre and then reserved.
  

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Post-treatment situation

Frequently asked questions on post-treatment are always relative to periods of recovery: "Can I go back to work the next day?" or "how long will the redness last?", or "after the treatment, can I drive the car?". In fact, the treatment is much less invasive and painful than you might think. 90 % of the works of Hair pigmentation takes place during a day, only cases of alopecia universalis need a megasession of two days. As soon as the treatment is done, the area immediately appears red, due to the inflammation of the treated tissue. This redness will take at least 48 hours to withdraw, but in most cases just 24 hours. Of course, to speed up this decongestion, specific soothing ointments should be applied, recommended by the operator. Once the redness is faded, the work will appear very clear, less opaque than the receiver expects and the single "dot" will be slightly darker than it will be in the future, as well as defined at the edges. This first situation is temporary. It identifies itself in the period of healing of skill. Before the skin heals completely, each "dot" will undergo a clearing (sometimes very visible) and finally a last faint darkening. Finished this healing period, primarily related to tissue repair, the second period of adjustment of the pigment in the dermis may start.

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Differences between the period of adjustment and healing

Although the treated area, it will seem completely healed after about a week, in fact, the tissue repair is ongoing. A complete repair of the tissue treated with Hair pigmentation can last up to a month, ending with the phase of re-epithelialization and subsequent graying of the colour used. After the healing phase, the micro-deposits of punctiform pigment will undergo an adjustment expanding its borders (the single bounce will blur losing definition), and thereby increasing their diameter, with an increase of the total coverage of the treated area. This second phase, called adjustment, may take up to two months. That is why we prefer to strengthen after about 40/60 days. If this time is not observed (advancing the date of strengthening), the risk is that we will over-darken an area that probably will darken individually, creating an unnatural dark spot. Essentially, the result of the first tattoo session, must be assessed after about 2 months and not before. You must care nothing for the initial changes of the total work, the rush to get immediate results, in this context, could be very, very dangerous!

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Interaction with implants or covering cosmetic products

As for prosthesis wearers, the advice is to take at least 2 days off work. By doing so you can evaluate the work without the initial redness and decide whether to shave the rest of the hair (the temporo nuchal crown) and exit the tunnel of the prosthesis immediately, or wait for the work to mature completely postponing the total shaving after about 2 months. In the latter case we advise to apply the prosthesis as little as possible during the months necessary to the adjustement of the work and limit the adhesives on the treated areas. The tattoo needs oxygen to successfully complete its healing. You should also pay close attention to the cleanliness of the prosthesis especially in the first 7/10 days. However, already from the third day you can reuse the prosthesis, possibly limiting the maximum times of skin covering removing it whenever possible. It is a good idea, however, shaving the crown after the second session, when you have a better chance of reaching an optimal result. If you are used to colour the skin with cosmetic substances, you should suspend for the first 3 or 4 days before using these products again. Limit the applications in the very first ten days.

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Advice valid in all cases

After the first healing, we recommend using colouring products for skin (Es.Toppik, Dermatch, etc..), in the case that the result of the hair pigmentation of the first session is not homogeneous.
Obviously this should be done only until it reaches the ideal result with the following sessions. When the tattoo is settled, the product will no longer have reason to be applied. To conclude this section, it is fair to point out that:

• Performing aesthetic tattoo on a healthy skin with lots of hair, has no negative effect on normal growth of the hair itself, in other words, the tattoo (if done correctly), does not damage the existing hair.
• Tattooing a bald area does not interfere in any way and do not affect the possibility of a future transplant surgery.
  
• It does not interfere with local drug treatment, such as MINOXIDIL. Nevertheless, it is recommended that you stop the applications in the days just after treatment.

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Preparation to Hair pigmentation

In the thickening of the scalp it is recommended to undergo the treatment possibly shaved (with a razor) or with a length of maximum 2 mm. (shaved with a trimmer). This will help the operator carrying out the work and make the final result more realistic. Moreover, if you use cosmetics for coloring the skin, you must come perfectly made up. This will give the operator precise information about the hairline and the tone of colour that you are used "to wear".

In the covering of scars the advice is to show up when there is a complete and total healing where there was a successful healing. So it is necessary that the scar is not yet vascularized, is relatively flat and has reached a pearly colour. It is still necessary to consult with your surgeon to determine the minimum post-transplant times, after which we can proceed with the coverage. Also in this case it is necessary to show up with hair already shaved, although you must prepare for the period after the first session, when the scar is, unfortunately, still quite visible. In the second session, the scar may begin to have a good coverage. Sometimes you have to do a third session. (the number of sessions in this case is closely tied to the quality of scarring dermis). Only prosthesis wearers should show up at the first session with the crown still unshaved. But even this choice is optional. In all other cases, you should come with the hair length you intend to keep after the treatment, or that you are accustomed to wearing every day. For all treatments is recommended to bring with you a hat just washed. Something like a cotton cap with visor or a bandana. You should not assume, for at least one week before the treatment, fluidizers or anticoagulants. In this regard, consult with your doctor. Do not sunbathe during the days before the tattoo (at least one week), in order to avoid sunburn that would make it impossible to carry out the work, and the rooting of the pigment in the dermis.

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