Anne Bouloc Saint‐Jacques Medical Center, Paris, France Camouflage techniques are very helpful in patients who do not achieve complete or immediately attractive results from dermatologic therapy. Because appearance is one of the pivotal factors influencing social interactions, facial blemishes, and disfigurements are a psychosocial burden in affected patients leading to low self‐esteem and poor body image. Camouflage makeup normalizes the appearance of skin and improves quality of life (QOL). Training in camouflage techniques is essential because the application is different from regular foundations. This chapter discusses the use of camouflage cosmetics. Camouflage cosmetics were introduced more than 70 years ago to improve the appearance of World War II pilots who had sustained burns. The products provided an opaque cover over the damaged skin areas. Modern high‐quality camouflage products provide an excellent coverage, but with a more natural appearance (Figure 25.1). There are several brands of camouflage makeup on the market. They aim to conceal skin discoloration and scars and to impart a natural, normal appearance. Camouflage products differ from makeup products purchased over the counter. They contain up to 25% more pigment, as well as fillers endowed with optical properties. Camouflage makeups are waterproof and designed to cover and mask a problem but must be mixed to match the patient’s skin tone. The goals of camouflage cosmetics are to provide [1]: There are several different types of camouflage cosmetics: Contouring is used to minimize areas of hypertrophy or atrophy present in facial scars, using highlighting or shading to create the illusion of smoothness. It is important to remember that camouflage makeup is most effective when applied over skin with color abnormalities or discoloration. The size of the defect is immaterial, because it is as easy to cover a large blemish as a smaller one. However, the camouflage of texture abnormalities is more challenging. Rough scars are more difficult to conceal than smooth scars because unevenness might be exaggerated after camouflaging [2]. This section of the chapter presents the steps necessary to complete a camouflage makeup application procedure for a given patient. First, patients should be asked about prior experience in attempting to camouflage their lesions with or without medical makeup. If they have no experience, the necessary steps should be discussed in detail. Second, the patient’s skin should be cleansed with a product selected according to patient’s skin type. For an optimal camouflage result, the skin should be well exfoliated and moisturized. If using a camouflage product without sun protection factor (SPF) protection, a sunscreen‐containing moisturizer should be selected otherwise a bland moisturizer can be used. Third, the camouflage product must be selected to match the patient’s skin. The camouflage therapist should identify the underlying tones that contribute to skin color: hemoglobin produces red, keratin produces yellow, and melanin produces brown [3]. Thinner skin possesses more red tones while thicker skin appears more yellow. For this reason, it is almost impossible to mimic natural skin color with only one shade. Fourth, the camouflage therapist must understand color. There are three color coordinates: hue, value, and intensity. Matching a color from one manufacturer to another one is a very difficult procedure because of the variety of shades that can be produced by combining various colors and the tints of the color that can be made by varying the amount of white. Judgment of color should always be made on the skin and never in the container because what seems to be the same shade may appear quite different on the skin. The use of neutralizers in camouflaging is somewhat controversial. Some experts think it is possible to neutralize undesirable skin discoloration [2]. For example, green undertoner neutralizes a red complexion and lavender undertoner negates a yellow complexion. Other authors think that makeup undertoners do nothing but create a third color [4]. They consider that when two colors are mixed, the result is a third color. Mixing opposite colors on the color wheel (e.g. green and red or yellow and purple) will result in an unattractive gray–brownish color that must be concealed with a color that matches the skin, which adds an extra step and thickness to the makeup. For contouring, several products have to be applied. Hypertrophic scars appear lighter than surrounding skin and have to be camouflaged applying a darker product than to surrounding skin. Atrophic scars, however, appear darker than surrounding skin and have to be corrected using lighter product. Once the shades have been selected, the camouflage therapist may apply them to the back of the hand as a painter uses a palette to warm and soften the product (Figure 25.2a). Camouflage products are either applied with a sponge or a brush in a patting motion or with the fingertips (Figure 25.2b). The patting motion applies the product to the surface of the skin and does not clog pores, which allows the skin to retain its natural characteristics. Distinct borders are eliminated by blending the edges (Figure 25.2c).
CHAPTER 25
Camouflage Techniques
Introduction
Definitions
Camouflage makeup application procedures