Permanent Cosmetics, Scar Camouflage, and Nipple Tattooing

Jamie DePolo: Hello, everyone. I’m Jamie DePolo, the senior editor here at Breastcancer.org. In this podcast we’re going to talk to Beth Fairchild. She was diagnosed with de novo metastatic breast cancer in 2014 at age 34. The diagnosis was a surprise to her because her mammogram results from the month before were negative, and she had never had a lump in her breast. Beth was familiar with breast cancer, though. Her mother was diagnosed with breast cancer at age 44, and her paternal grandmother died from breast cancer at age 33.

An artist and tattoo professional, Beth and her husband own five tattoo studios. Her focus is on permanent cosmetics, scar camouflage, and areola restoration for people diagnosed with breast cancer. Beth is the current president of METAvivor, a nonprofit organization dedicated to increasing awareness of metastatic breast cancer and funding research on metastatic disease.

During our first podcast with Beth we talked about the Serenity Project. In the second podcast, we’re going to talk about permanent cosmetics, tattoos to disguise scars, and nipple tattooing. Beth, welcome back to the second podcast. We’re so delighted to have you.

Beth Fairchild: Oh, thanks, Jamie. I’m happy to be here to talk about tattooing.

Jamie DePolo: To start, if you could describe what permanent cosmetics are and how that might work.

Beth Fairchild: So, permanent cosmetics are really anything that you get outside the standard tattoo, you know, like the cute dragonfly or the dolphin or the dragon, whatever you want to get. So eyebrow tattooing, eyeliner. We can do lip color, lip liner. Some people want to have freckles tattooed or a birthmark tattoo. We can also do scar camouflage, we can do areola tattooing, and even in some cases we can do simulated hair follicles. So if a woman has lost her hair or a man wears a really short haircut and has a scar, we can go in and just create the appearance of a hair follicle so that you don’t see that negative blank skin in their hairline.

I mean, there’s lots of different possibilities that you can do outside the normal scope of what people consider traditional tattooing.

Jamie DePolo: I know you told me, you had your eyebrows tattooed on before you had chemotherapy. So for anybody who may not know a lot about this, can you kind of talk about that process, how it works, how somebody might go about doing that if they so wanted to?

Beth Fairchild: Sure. Well, I had my eyebrows and my eyeliner tattooed on many years ago before cancer was on my radar. I was always very active. I was a swimmer, a beach goer, a camper, hiker, motorcycle enthusiast, and so it was nice for me to be able to have eyeliner on every day without the worry of it running off my face with sweat or water. And then someone talked me into having my eyebrows done because I didn’t realize that they were terrible and someone said, “The shape of your eyebrows are horrible. They’re just straight lines. We need to shape them and give your face a softer shape.” And so I allowed them to do that, and I was just taken away with the difference it made with the way I looked.

And so being able to offer that to people as a service for women who lose their brows or have thinning brows or for an older woman who maybe shakes and can’t draw her brows on, and then that just kind of evolved into helping out patients who lose their brows to chemotherapy, sometimes they never grow back.

But having that definition on your face when you’re bald and you lose your eyebrows and your eye lashes, it just makes a tremendous difference because you look in the mirror and you still look like yourself and not like this crazy space alien. We tend to kind of lose the shape of our face when we don’t have brows. It really frames our face and so I think it’s an important part, and I think that when you look good you feel better. And so being able to have that service is amazing, and a lot of people don’t know about it. So thanks for the podcast and letting me share this with everybody!

Jamie DePolo: For the eyeliner, does that help if someone loses their eye lashes during chemotherapy? I would assume it would give definition to the eyes. I’m sure it doesn’t replace the eye lashes but it probably makes it look like there’s something there?

Beth Fairchild: Exactly. So there’s different levels of doing eyeliner. You can do what’s called a lash enhancement, which is just a very thin line and it makes you look like your lashes are thicker, to having full-on eyeliner, like you would get up and draw on every morning. So having that line there, even if your lashes fall out, it does give kind of the illusion from a distance of a couple of feet that there are lashes there. Of course when you’re up close you can definitely tell that there’s lashes missing, but it kind of still gives you a normal appearance to anybody that you may meet or come across.

Jamie DePolo: Is this something that most tattoo artists do? I’m thinking if somebody did want to move forward and have this done, how do you go about finding someone who does this?

Beth Fairchild: So it’s a pretty specialized thing. I’ve been in the tattoo industry for a long time, and a lot of the artists are a little afraid to tattoo someone’s face or near their eye. It’s a very specialized procedure. I would research, I would ask for references, definitely ask for photographs. I’m of the opinion that anyone who’s tattooing, whether in a tattoo studio or in a medical setting, should have a working knowledge of the skin, should be a seasoned tattooist before they pick up a machine and start tattooing someone’s eyelids or their face. There are people who can go to a weekend school and then come out and buy the equipment and start tattooing people, and that’s perfectly legal. So it’s really important that clients and patients do their due diligence and research the artist that’s going to tattoo them so that they know that they’re going to get the service that they expect.

Jamie DePolo: Like much of anything, you’d want to find somebody who has a lot of experience doing this and see some previous work that they have done.

Beth Fairchild: Exactly.

Jamie DePolo: Okay. Now scar camouflage, how does that work, and what exactly does it do?

Beth Fairchild: So, we’re a little bit limited in what we can do with the skin as far as scar camouflage. But if you have a scar that over time heals lighter than your skin color, we can use pigments to camouflage that into your skin tone and make it go away. It would not match exactly, but typically people’s skin are not the same color throughout, right? Like there’s a little variation. And so we’re able to mix and blend colors and blend that light scar right back into your skin tone.

Now someone who, just for sake of explaining this, someone who is Asian or someone who has an Irish background, they have very soft skin tones, very even. Some people describe it as the porcelain doll skin that’s just so smooth. Those are very difficult to match, there’s not a ton of variation. But most people, the average person, if they have a light scar, it can be covered up with tattooing and it doesn’t even look like there’s anything there. It’s just gone.

If it’s darker than your skin color, you certainly can’t put a pigment in that and expect to lighten it, so you really can’t do anything with that unless you want to put a traditional colored design tattoo over top of it. But the scar camouflage is pretty amazing. I’ve done scars on women who had [tracheotomies], on women who had breast reconstruction, women who had hysterectomy scars or even port scars. So if you’re someone who has healed light, you can definitely have that as an option. And really any tattooist worth their salt can blend colors and put them in your skin and make that scar disappear.

Jamie DePolo: I’m curious if you ever have any men who’ve been diagnosed with breast cancer and had a mastectomy, because I know that can leave a scar, too. Have any men ever come to you for that, for scar camouflage?

Beth Fairchild: I’ve never had a man come to me for scar camouflage. I’ve only done the hair follicle simulation tattoos on men.

Jamie DePolo: Okay. Now you also do nipple tattooing/areola restoration for, I’m assuming, mostly women, but I suppose men could also opt for that, too, after mastectomy. So I’m curious, did you do that before you were diagnosed? Was that on your radar?

Beth Fairchild: I did. My mom, as you said, had breast cancer. She’s an 18-year stage II survivor. She had a lumpectomy that took half of her areola. And although she opted not to reconstruct or to replicate her areola, I saw that there was a need for that in the community, and I wanted to learn how to do that. So I did go and take a class to learn how to do that. They kind of billed it as medical tattooing, but it’s really no different than a regular tattoo. You’re recreating what was there, you’re using highlights and lowlights to create a 3D or a realism tattoo.

And so I came back home and put my own artistic spin on it, and now I’m able to provide that for patients — even before my own diagnosis. So it was kind of ironic that I was then leaving chemotherapy, going to work bald, tattooing areolas on cancer patients. And at the time I was a little more private about my experience, and I think they just thought I had an edgy look because here I am covered in tattoos and bald and they just thought that I had a cool haircut and didn’t even realize that I was going through chemotherapy. So, it was kind of funny, but it was so rewarding and it kind of gave me purpose while I was going through my own experience.

Jamie DePolo: How do you approach that, because I’m assuming every areola is different, and if somebody had a double mastectomy there’s nothing there to match per se. How do you start that process?

Beth Fairchild: So to be honest, when I first learned, at the time porn online was expensive, okay? So I went to the gas station and bought a bunch of dirty magazines, because every woman has different nipples! If you’re African-American or white or Asian or European or Middle Eastern, everyone, and even within those groups, everyone has different breast shapes and areola shapes. And so I bought a bunch of dirty magazines and cut them out, and I really studied them. And I would offer these little pictures to clients who came in. If they had a double mastectomy and reconstruction, that was so easy because I could say, “Do you have a photo of before,” or “Here’s what you could have now.” If you had large areolas and you wanted small ones, if you had small ones and wanted large ones, if you wanted heart-shaped ones, I mean, you could have anything you wanted. Someone who had a unilateral mastectomy, then I would match what they had before. I could go into the natural areola and give it more color if I wanted, if they wanted. But it was always easier if someone had bilateral mastectomy. Of course matching something natural is a little more difficult with the color, but the options are really endless. You can have what you want because you’re starting with a blank slate. But as I said, there was a lot of kind of research that went into it, learning the different shapes of women’s bodies and colors of women’s bodies and being able to replicate that and give them a natural appearance when they looked at their self in the mirror.

Jamie DePolo: If this is not too personal a question, did you have nipple tattooing done?

Beth Fairchild: I did not. I chose a bilateral mastectomy without reconstruction. It just wasn’t for me, and I’m very happy with my flat chest and my scars and I have no plans for areola tattoos. My chest was already tattooed before my mastectomy, and I will probably at some point add to that. But right now I’m just very comfortable with where I am.

Jamie DePolo: If somebody didn’t have nipple tattooing soon after surgery, could that be done at any time or is there kind of a window when it’s best to do it?

Beth Fairchild: Oh, it can be done any time, and actually, I won’t touch a patient any sooner than 6 months out from surgery. I prefer a year. Especially with implants, you never know what the body’s going to do. I mean, there’s risk of infection, there’s risk of rejection, and so I like to make sure that their bodies are healing nicely, that they’re adapting to their implants, that their surgical incisions are healed, they’re cleared from the doctor, and then we can talk about tattooing and what that’s going to look like. Sometimes I have patients come in and I draw the nipples on them and let them go home and look at them for a day, and then let them come back and discuss further. It’s a permanent thing, and you’re recreating a breast, and so you definitely want it to be something that they love, right? And so they have to be happy, I have to be happy. Breast implants also take some time to settle into the skin and into that muscle. And so I really think it’s wise to wait a significant amount of time, like I said 6 months to a year. And then certainly anytime after that, anyone is a candidate for the tattooing.

Jamie DePolo: What about discomfort? I know some people have said tattoos can be somewhat painful, but I’m also assuming that for someone who’s had a mastectomy there’s a lot of nerve cutting and there may be some numb areas, so it may not be as painful as, say, a tattoo on your inner thigh or something?

Beth Fairchild: Right. So just to kind of give some back story here, tattooing is creating a controlled abrasion on the skin. So you have a needle, you are creating that abrasion and delivering pigment under the skin, and that’s what the tattoo basically is. It’s not excruciatingly painful, but it doesn’t feel good, it’s annoying. It heals like a carpet burn with a really light scab and that scab flakes off and then you have the healed result.

What I have found is most people who have had a mastectomy have very little sensation in their breasts. Some people do have sensation in their breasts and have said, “Wow, I can feel that but it’s not so uncomfortable that I want you to stop.” I do have a numbing agent that I can use once the skin is broken. I can open the skin really quickly and use a liquid lidocaine. Sometimes that’s a little tricky because it causes blanching of the skin and when you’re trying to color match an already existing nipple, that can be a little tricky.

But the entire process, if I did two nipples on a woman, it’s probably going to take me a half hour to 45 minutes at the most, so it’s really short. It’s not excruciatingly painful, and people who have already undergone chemotherapy, radiation, surgery — this is like the easiest part of it. It’s almost like putting the bow on the package and it’s done. It’s kind of like they’re symbolically okay, this is the last step to my completion.

So most people usually come in very excited, a little anxious, but looking forward to this being the last step of the process. So I think the pain — obviously, that depends on who’s receiving the pain, everyone has a different perspective. But I think at the end of the day it’s pretty irrelevant to the women who come in for the service.

Jamie DePolo: What about the eyebrows or the eyeliner, just because that’s in a different spot, that’s on your face. Is there any more discomfort associated with those? I forgot to ask earlier.

Beth Fairchild: You know, the eyebrows are a little pinchy, they’re in a weird area. The skin is kind of tough but it’s sensitive, it’s near the eye. I do have a numbing agent, it’s sort of like all the people who have had ports or chemotherapy, they know the cream, the Emla cream that you put on before you go in. I have something very similar to that for the eyelid and the brow that I use. And that works to numb you pretty well, and then once the skin is open I use the liquid lidocaine.

And the same with the blanching on the breast, I can’t use that for scar camouflage: because it blanches the skin, I can’t match the color. So for a scar camouflage you just kind of have to suck it up and endure the pain like a regular tattoo. Most tattooists don’t offer lidocaine with a regular tattoo. But it’s such a short procedure, it’s pretty bearable and manageable for most people.

Jamie DePolo: To sort of finish up here, what have your clients said to you about this type of tattooing, whether it’s the permanent cosmetics or especially the nipple tattooing, the areola restoration. How has it helped them? What do they get out of it?

Beth Fairchild: I think probably the majority of my clients who get eyebrows or eyeliner are professional women who just don’t want to take the time to do this on a daily basis. Some of them are older women, again who… I had a patient who had Parkinson’s and she couldn’t draw her eyeliner and brows on, and it really gave her a sense of confidence to go out and face the world knowing that her makeup was always going to be perfect.

For my areola patients, most of them, they cry when they get up and look in the mirror and, again, see this final step. Everything that they’ve gone through, they see this as a final step and a road to completion. One of the first women that I tattooed areolas on had been 23 years without nipples. She had breast cancer and reconstruction and went 23 years. And she said, “Every time I got out of the shower, every time I looked in the mirror without a shirt on, I thought I looked like a Barbie doll. Because I had the shape of a breast, but I had no defining areolas or nipples.”

And when I tattooed her… I’m getting chill bumps just thinking about it. When I tattooed her and she got up and looked in the mirror, she just started to cry. And she said, “I feel like a whole woman again.” And I can’t imagine not feeling like a whole woman for 23 years, and all it took me was a half an hour of my time and talent to make her feel so complete.

And so I wanted to start offering that. I usually do it at no charge. To be honest, I’m not tattooing as much any more because I have neuropathy in my fingers. It comes and goes, but I never know when it’s going to be there and not be there. And I can’t feel the vibration of my machine, the kind of groove that I get in when I’m working in the skin. And that’s hard for me because this was really one of the ways that I could give back. I do a lot in advocacy work but this was a way I could give back personally and individually.

So I have since trained a couple of people who were working for my husband and I before, and they are now doing areola tattoos for cancer patients and they’re finding kind of the same thing. Although they don’t have the experience of having the diagnosis themselves, they’re just finding the work to be very rewarding. And I’m so happy that I could pass that along to other women who are then going out and helping even more women. And it’s pretty awesome.

Jamie DePolo: That is great, it’s like a ripple in a pond. You’re training the people, and they go out and help other people.

Beth, thank you so much for joining us, I really appreciate your time and your knowledge and sharing your stories with us.

Beth Fairchild: Oh my gosh, Jamie, I’m happy to do it. Thank you so much.