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Tip #1:  Breasts are seldom perfectly symmetrical.  In the above case, we made the Left areola slightly smaller than the Right areola to compensate for the differences in size of the breasts.  Colors used:  Kolorsource Baby Lips.  Highlights: Neutral Flesh; Shadow: Honey NuBrown.  The new Dixon DITTO™ needle was used in the Nouveau PRO handpiece which will be available November 2nd.  The Ditto™ is two-rows of 5 Slope® needles.  Twice as much of a good thing.

Tip #2: Nancy Rolfs RN, of Michigan, joined us in Las Vegas for Bootcamp Breasts on October 11th and shared an interesting "tip" on how she approaches areola tattooing.  She sends her patients home with Band-Aid Round "Spots" and has them place them on their breasts where they would like to see them.  When they come in for their procedure, they have the bandaids placed where they like them and Nancy uses their choice as a guide.  Search term online:  Band-aid Round Spots.  They're 7/8" round.  Keep a box of 100 spots handy.

Tip #3:  If you've ever wondered how breast cancer reconstruction surgeries are done, go to this website: Click here: http://www.breastreconstruction.org  You'll appreciate what your client has endured for her breast cancer treatment and understand her scar placement.  They also have a link for Insurance Coverage for Breast Reconstruction.

QUESTION:  What can be used instead of lidocaine if a person has an allergy to it?

ANSWER: Find out more information.  The questions to ask your client are: 

1)  Who told you that you are allergic to lidocaine?  The dentist? 

2)  What happened when you got the lidocaine?

3)  Have you ever had a reaction to a cream with lidocaine?

FACTS:

Anything is possible but allergic reactions to lidocaine are so rare as to be reported in the medical literature.  http://www.medscape.com/viewarticle/572120_4.  This study identified 1.4% of patients who reacted positively to lidocaine over the 5-year period of their study.

A rapid heart beat and sense of impending doom just after the dentist injects the local anesthetic is from epinephrine injected into the blood stream and not an allergic reaction to lidocaine.

If your client gets a rash or redness a day after they have applied a lidocaine product such as an anti-hemorrhoidal preparation, then they should be "patch-tested" by a doctor.  Histamine is released in an allergic reaction which results in redness and swelling of the area.

PERSONAL OBSERVATIONS OVER 43 Years:  I have yet to see a patient allergic to lidocaine.  I've heard of one case of latex allergy (gloves), several from Bacitracin, a few from A&D Ointment and so on.  However, a preservative in lidocaine, methylparaben, can and does cause dermatitis from the PABA metabolite.    What do I do?  I take a careful history to rule out any proven allergy to lidocaine.  Then I put a dab of the topical anesthetic with lidocaine only and cover it with a band-aid, check it after about 30 minutes and then send them home with instructions to remove it the next day and report to me if their skin is itchy or red.  If I determine that they were told by their dentist that they have an allergy, chances are I just proceed as normal (with caution) to apply the topical anesthetics and complete the procedure.  People can have sensitivity to local anesthetics but most often the skin gets red and swollen because the anesthetic numbs the nerves to BOTH pain and to the blood vessels.  Topical anesthetics are not absorbed rapidly as a rule and the small amount we use for permanent makeup is not going to cause problems.  The alternative to lidocaine is tetracaine (Numfast Green Cream).  There is no cross sensitivity between these anesthetics.

Question: Hi Linda, ...  I also do tattoo the nipples so they can look nicer, do you have the color specially for this purpose? My customers are mainly Asians.  Thank you very much for your time, TT
Answer: Dear TT,

Areola: This photo shows an areola where I have painted on the desired colors first. I always start an areola with NUDE LIP and AREOLA Mix (the darkest color).  Then I put a little half-moon shadow below the nipple area in HONEY NuBrown.  I use a little NEUTRAL FLESH to highlight the nipple in a little half-moon above the nipple. Sometimes you want a very soft areola color and that is called BABY LIPS and AREOLA. Baby Lips softens the outer border of the areola and is excellent for fair clients with pale, pink areolas.  I always paint on the color and then start working over that. The 5 Slope® Needle is the best needle by far for Areola work, including the scars. I've also learned to tilt the 5 Slope® Needle at about a 15º angle as I work. SAVE! when you buy the Areola Kit-1 #9982 with 7 colors.  I've shared several Areola videos on youtube.com. Just search for my name there: Linda H Dixon MD (or Dr. Linda Dixon)  Note: Do not put in color over scars that are outside of the areola itself.