Diminish downtime by helping your patients during their postprocedure recovery period with camouflage makeup techniques

Patients who have undergone cosmetic procedures often want to conceal the effects of the treatment while they heal. These patients can often benefit from the use of camouflage makeup. It is important, though, for you to understand the goals and needs of these patients and to learn the ways to make camouflage makeup most effective.

Appropriate candidates for camouflage makeup are patients of both genders, and of all ethnic origins and ages, who may be recovering from procedures ranging from laser resurfacing and chemical peels to rhinoplasty and blepharoplasty. Patients with more serious conditions, such as congenital or traumatic lesions—including surgical scarring—may also be suitable candidates. Once you learn how to correct the imperfections, you must also be prepared to teach the patients how to best apply the makeup themselves.

As with all your patients, it is important to learn about their prior medical history, current medical situation, emotional state, and attitude toward camouflage makeup. The patient’s ability and desire to perform the corrective makeup techniques himself or herself should be discussed, along with the cost of the treatments. Make sure to find out whether the patient has experienced allergic reactions to cosmetics in the past.

The main focus of camouflage therapy is not the makeup itself; it is to educate patients to enable them to apply the cosmetics themselves. Therefore, it is important to evaluate the patient’s dexterity and intellectual ability to determine whether he or she will be able to perform the procedures accurately. Camouflage makeup is only worthwhile if the patient can master the aesthetic procedure with the products provided and the skills learned.

Color Matching

Color matching is the basis of camouflage makeup. To make the disfigurement as inconspicuous as possible, you must create an optimal blend of makeup to conceal scars and discoloration. When corrective cover creams or mineral powders are applied, they must match the color of the surrounding healthy skin as closely as possible. This requires an eye for all of the nuances of color in the skin, including shade, tone, and intensity. In certain instances, you must re-create the appearance of natural skin imperfections, so that minor flaws promote the illusion of normality. For example, once the makeup has been applied, the patient may need to create elements such as veins, freckles, or beard stubble to avoid an unnatural demarcation surrounding the cover creams. For an adolescent boy who plays outdoors with peers, for example, such an oversight could result in psychological trauma.

To get started, assess the patient and discuss his or her lifestyle to understand which formulations will work best. In addition to age, skin type, and ethnicity, you’ll need to know the patient’s normal activities: For example, does the patient play sports or spend a lot of time outdoors? The kind of lighting they’re in most often and the type of activities patients enjoy will affect your product choices.

After compiling this information, you are ready to begin the color-matching phase. Camouflage makeup differs from conventional foundation products in that it is opaque, waterproof, and formulated to adhere to smooth scar tissue. It is available from several manufacturers in a wide spectrum of color shades, textures, and consistencies. It is important to experiment with many different camouflage cosmetic lines to find the ones that offer the best results for your particular patient demographic. The appropriate pigment base depends on the individual patient’s skin type. Be aware of the skin’s subtle nuances, including intensity of existing pigment, pink or rose undertones, or golden characteristics inherent to the patient’s own natural, ethnic coloring.

Using a palette of opaque, waterproof cover creams, mix two or three shades to achieve the desired color match. The use of more than three colors will make the camouflage solution too complicated and costly for most patients.

The Application Process

Step 1: Cleansing. Remove any makeup the patient is already wearing, and cleanse the skin. Pay attention to the patient’s skin color and the skin-tone variations. Take advantage of this opportunity to teach the patient the proper makeup-removal techniques that will be required later.

Step 2: Color selection. The correct pigments are chosen through a careful scanning of the various cosmetic shades contained in the camouflage makeup tester palette. The cover creams must match the gold, red, and bronze tones that are prominent in all skin types. The color shades that will eventually be selected and blended together will be determined by the percentages of these undertones present.

Step 3: Cover cream application. Apply the custom-blended cover-cream mixture onto the patient’s skin with the ball of the patient’s middle finger, and smooth it over the discolored area with a light, pressing motion. Use an artist’s flat brush to feather out the outer edges of the thick, opaque cover-cream solution until it is so well-blended that it is virtually undetectable.

Step 4: Powder application. Use a disposable, wedge-shaped cosmetic sponge or small cotton pad as a setting tool to apply a translucent, colorless powder to stabilize the foundation. Stabilizing will discourage the cover creams from sliding off.

Application and Skin Type

Skin can be classified into five types for applying camouflage makeup.

1) Normal and combination skin. The cover creams can be applied and set with powder. The powder can be brushed off immediately.

2) Oily skin. Once the cover creams are applied, powder is applied and allowed to remain on the cover cream site for up to 10 minutes. Using this method, the amount of oil absorbed by the skin from the camouflage is reduced, and slippage and excess shine are prevented.

3) Acne-prone skin. Greasy, waterproof cover creams should never be considered as a camouflage solution for acne-prone skin. In their place, mineral powders or pancake makeup can be used. Both of these products can be found in theatrical makeup supply stores. Either is capable of providing adequate coverage without exacerbating skin problems with oil-based formulations.

4) Mature skin. Lighter-textured cover creams with oilier bases are more appropriate than thicker, wax-based formulations. Mature skin tends to be heavily lined and thick, and as a result, opaque products are more likely to accumulate in facial crevices and emphasize deep wrinkles. Setting powder may or may not be necessary, because the skin will readily absorb the oil contained in the cover cream mixture if it is left undisturbed for up to 10 minutes.

5) Dry skin. The cover creams should be applied and left on the surface of the skin—unpowdered—for up to 10 minutes. Once they’re absorbed, the makeup should be lightly dusted with talc to set the creams and render them waterproof. Remove the powder immediately to prevent the talc from absorbing the cover cream’s oils and creating a dry, chalky appearance.

Solving Problems

Some patients require a bit more help than simple camouflage makeup application. Here are solutions to some common problems.

Eyebrows. The loss of part or all of their eyebrows can be devastating for many patients, whether it results from burns, alopecia, chemotherapy, or another condition. Ventilated, artificial eyebrows, available in theatrical makeup supply stores and hair-replacement centers, are more practical for some patients who will need them for many years. For the rest, eyebrow makeup can help.

Eyebrow makeup kits typically contain eyebrow stencils of different sizes, a brush, and a compact that contains compressed eyebrow powder. Select the appropriate stencil size based on the size of the lost eyebrows and the patient’s facial features. The arch of the template is placed where the original eyebrow had been. For uniform coverage, the patient should be instructed to press the stencil firmly against the brow bone and fill it in with eyebrow powder by gently brushing the powder in both directions until the pigment is equally distributed. A brow brush or mustache brush can be used afterward to remove extra traces of powder and to lighten the application so it appears more natural.

Skin graft discoloration and scar tissue. The more facial skin is grafted, the more mask-like the grafted area becomes. Certain grafted areas will appear sallow, especially if the new skin has been exposed to sunlight. Scar tissue is usually redder than the skin that surrounds it. Color correctors can be used to diminish this uneven pigment. They can be applied to the patient’s skin prior to applying camouflage makeup in a manner analogous to a primer coat of paint.

Yellow tones can be corrected with lavender, mauve, or rose color correctors. Ashy discoloration in darker-pigmented complexions is correctable with apricot tones. Redness and ruddiness are best addressed with green, aqua, or blue correctors.

Vitiligo or hypopigmentation of the lips. Transfer-resistant lip color can sustain up to 8 hours of wear. Matte formulas are available in shades that duplicate the natural colors of the lips for male patients. Browns look best on medium- to dark-skinned patients; rose and mauve tones are better for light-eyed, fair-haired patients. These lip cosmetics have grown so popular that they’re now available in many department stores and pharmacies.

Matching freckles. After the skin area with the irregularity has been concealed with cover cream and stabilized with setting powder, the color that matches the patient’s freckle shade is selected from the palette and applied with a fine brush. Freckles are recreated by placing small spots of color over the camouflage makeup. The artificially freckled area can be set with translucent powder with another fine cosmetic brush. Another alternative is a taupe or blonde soft grease-lead pencil, which can be obtained from a theatrical makeup supply store. The pencil must be sharpened to a point prior to stippling it onto the camouflaged site.

Matching beard stubble. A 5 o’clock shadow can be re-created by placing a mixture of cover creams that resemble the color of the patient’s natural beard stubble onto the back of the hand and by pressing a small, wedged cosmetic sponge into the creams to load the sponge with color. Test the color intensity by lightly patting the sponge onto the back of the hand. Once the color is right, gently roll the sponge over the area that has already been set with powder until it deposits the stippled color. Apply loose, colorless setting powder to the clean side of the sponge, and use it to set the additional color. Wait a few minutes for the talc to be absorbed before dusting it off.

In Conclusion

Patients with surgical scarring or other disfigurements are often troubled by their appearance. For some patients, accepting the physical modifications that cosmetic rehabilitation can bring about may be slow, and they can be resentful when undergoing cosmetic treatment related to their image transition. Understanding these issues and the psychological influence they have on patients is essential to provide the best care. Some patients may have a clear and realistic understanding of their new self, whereas others may have a vague, idealistic, or unrealistic idea of what their image should be. Encouraging patients to achieve a more positive self-concept is what cosmetic rehabilitation is all about.

Victoria L. Rayner is a certified edu­cational provider and founder of the Rayner Institute for Career Development in Washington and the Center for Appear­ance and Esteem in San Francisco. She wrote the book Clinical Cosmetology, a Medical Approach to Esthetic Procedures, and she most recently contributed a chapter on cosmetic rehabilitation therapy to the Textbook of Cosmetic Dermatology, from which this article was adapted. She can be reached at (202) 667-9596.