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Scars represent narratives we didn’t necessarily want to write—surgical wounds, accidents, teenage pranks, and a self-destructive impulse. Nevertheless, the tattoo parlours and studios of the world, from Tokyo to Tottenham, have experienced a slow but steady transformation for decades. Tattoo artists practicing scar coverage have elevated the state of their artwork to something approximating restorative art: raised keloids, indented surgical lines, and burn tissue are transformed into phoenixes, mandalas, and at least impressive koi fish.
Tattooing on scars requires much more technical skill than tattooing on “normal” skin. Scar tissue is a lot like that impossible-to-manage dinner guest—it doesn’t hold ink in a predictable manner, it’s often raised or recessed in relation to surrounding skin, and it has the texture of something that’s a cross between rubber and leather, depending on the age and type of tissue.
The Science of Scarred Skin: Why it is Important
Scar tissue is fundamentally different from “normal” skin in ways that would send any tattoo artist rushing for a stronger cup of tea before starting their work. For example, collagen fibers lay down differently—consider a jar of spaghetti noodles compared with a non-organized ball of string. Blood flow through the scarred site is reduced, and as a result, ink absorption becomes less predictable. In places, scar tissue drinks ink like a sailor on shore leave, in other places the tissue entirely rejects the ink.
Hypertrophic scars and keloids present unique challenges. These raised, over-happy healing tissues require the artist to vary depths when using a tattoo machine. When the needle goes too shallow, it is then obvious that the ink lies on top of the scar like oil on top of water, and if it’s too deep it’s not unusual to do further damage to the tissue. There is a sweet-spot, or “Goldilocks spot” if you will. We must hit it right, not too deep, not too shallow.
Burn scars or other scars can complicate this as well, and because even skin can vary in texture from tissue-paper thin, to thick and a little adherent, there can be variations within millimeters. This is where highly accomplished practitioners treat scarred skin like artisan restorers treating a Rembrandt or other renowned masterpiece. They will test small areas before embarking on larger designs.
Historical Precedent: Transformation Through Tattoos
The Japanese yakuza, body art transforming scar coverage existed prior to following Instagram pages. Hueman was often of great dialogue and overlap, folding in scars from the broader narrative being depicted (e.g. where a sword was slashed to demonstrate a war becomes the cloud or a scar). Tattooists in the Edo period (1603-1868) working in tebori and hand-poked tattooing had the incredible control over pressure and depth inadvertently making them incredible artists working with damaged skin to begin with.
Tatau and Polynesian tattoo and scarification also viewed tattoos and scars as not mutually exclusive. Tatau ceremonies in Samoa would work around scars incurred from sacred warfare or accidents incorporating into the geometric patterns also marking someone’s social status.
Modern Techniques: Tattooing Scarred Skin
Modern tattooists that are experienced in working with scarred skin have some common specialized approaches:
The use of patterns or stencils on textures is like wrapping a hedgehog for a gift—a visualization to keep in mind. These artists would potentially approach the outline free-hand and following topography rather than against it. Practitioners may even take a photograph of the area under varying light conditions good or bad for a quasi tactical map prior to any ink to skin procedure.
Overall the configuration of the needles will be altered depending on type of scar. Smaller dots are better for raised scars, while larger dots are better for skin that is depressed. Reducing the speed of the machine down is expected; we advise you to wait and see. What may take two hours on regular skin can take four or five hours of time and attention on scarred tissue.
Consideration will need to be given to color selection. White ink and lighter pigment colors can show more dramatically on scar tissue, which often tends to be lighter than the surrounding skin. Darker pigments can show lighter than is always intended, and colors red or orange can be funnier in how they behave.
Most people will end up needing more than one session as opposed to one session. The first session shows, to what degree, the skin can accept or not accept ink with the process. The second can involve color and some detail; after that, the artist will do what is appropriate according to how the skin reacted.
Realistic Expectations: The Real World
Not every kind of scarring will be tattooed, and it’s important you know this before you book someone for three hours to have an electric needle run over you. The scarring that happened in the last year is still too volatile of a tissue. The skin has not finished remodeling, and tattooing can be too problematic to the scarring process; tattooing can also worsen scarring and, in addition, blur every layer of tissue after the art is finished.
If they are still a thick keloid, it is most often not practical to try to tattoo over the keloid itself. The nature and major thickness of the keloid, and sensitivity that goes with that type of tissue, that tattooing in any fluctuating way can stimulate the keloid to grow. You really need to consult a tattoo artist and a dermatologist before moving forward to view what is possible as there can be disappointed feelings if you have stronger expectations of possible outcome.
Finally, stretch marks, as the type of scarring, can yield ambiguous results. So, any fresh and still fresh red stretch marks will show poorly; the older, silver stretch marks may yield better results than the fresh, again, but still no where close to what once was, prior to injuring. Numerous artists recommend implementing them in designs instead of trying to cover the area completely – tiger stripes turn into tiger stripes, for what it’s worth.
Pain Issues: Let’s Not Sugar Coat It
Tattooing over scars usually hurts more than a regular tattoo. Scar tissue has different nerve arrangements – sometimes more nerves crammed together and sometimes bizarrely absent of many nerve endings. You could be feeling nothing in one area and then run into a swath of skin where every nerve ending in that area has decided it is the time to throw a party.
The feeling is different as well. It is not the usual hot-scratch feeling; on scars like this, it is often a deeper, more uncomfortable pain. Analgesics can assist somewhat, but their effectiveness is wildly variable depending on how thick the scar is.
Finding the Right Artist: Credentials Speak
Finding a tattoo artist who has experience with scar coverage is what will have the difference between a successful tattoo and very expensive regret. An examination of the artist’s portfolio is going to be critical – take note of healed tattoos, as opposed to pictures with fresh ink on it. When getting a tattoo, fresh ink always looks fantastic; healed work is where you’ll learn about the artists skill level.
Questions to ask a potential artist would be, Have you ever tattooed scars like I have?, Are you willing to do a small test patch, and how long do you think this will take to heal? An artist that is willing to refuse a challenging scar will show better judgement than someone who will take on every project that comes their way.
Professionals worth the salt will maintain and not burn bridges with dermatologists or plastic surgeons in their local area, because they know the biological aspects of skin damage and healing.
Aftercare: More Than Normal Aftercare is Required
Once survivor skin has been tattooed, you’re going to need to obsess about aftercare more than usual. Healing a tattoo on already-less-than-optimal skin is going to require more of a fight than healthy skin. There is a higher risk of contamination, especially when the scar is raised and has less blood flow.
Wound care is to keep it clean but not washed to pieces, moisturized without drowning and bandaged but not stuck on, akin to a melancolly orchid! Typically, the artists will elaborate on this; this instruction is the difference between the art being pretty or failing completely.
Sun exposure is the traitor of all scabs; anything UV protected is a must with scarred skin; it loses its melanocytes and will burn easily. You definitely don’t want to put sunscreen on your scab while it is healing, it will accelerate the loss of the tattoo.
The Psychological Piece: More Than Skin
Tattooing over a scar has a psychological impact that goes beyond the aesthetic. Many clients come to have ownership of a body is marked by trauma. Whether it is a scar from self-harm, a surgical entry/exit scar or marks from an accident; the scar indicates evidence of life and lives that survivors are trying to reclaim, re-imagine and/or represent with them however they see fit.
Research published in medical journals recognized that it did improve body image and decrease overall anxiety, of people who chose to tattoo over their traumatic scars. Choosing art for the person to embed communicates a permanent change from passive nature of scarring to an individually expressive choice.
Mental health professionals are starting to recognize tattooing as part of the recovery process after trauma, especially new self-harm survivors. Engaging the body’s pain in a selected way, as compared to the pain that develops the injured skin, is a powerful shift.
Designing: Work With What You Have
Tattoo designs that reflect the shapes instead of directly fighting the shapes are most often successful. Flat solid colors design rarely work as well or not at all over textured tissue. Designs that include organic elements—flowers, feathers, water, smoke—usually allow for more irregularity.
Geometric patterns can work beautifully or terribly depending on where the scar is and what the shape is. Straight lines on bumpy tissue will provide wobbly results while flowing curves will “give” more freely.
Black and grey work generally succeeds when colour fails. The shading techniques of a black and grey tattoo are more forgiving than a mass of colour than on a scarred area.
Generally, larger designs are superior to smaller detailed pieces. Fine lines tend to blur in scar tissue, while bold imagery maintains the ability to read through that texture.
Medical Clearances Are Non-Negotiable
Medical clearance is a matter of fact before any trustworthy artist can begin tattooing surgical scars and/or scars from significant trauma. Some issues, active skin infections, immune disorders, cancer, will suggest that the tattoo is simply not appropriate.
Individuals with keloids must be particularly careful. If you’ve developed keloids from your wounds, you must understand your tattoo could elicit a cropping up of keloids. A dermatological consult is not just an item to check off, but rather a matter of acceptance of risk.
Some scars are an indicator of internal medical devices such as a pacemaker or implanted port. If so, it’s likely that your physician will require notification as the proximity of the tattoo machine puts you at risk of the electromagnetic field. The tattoo machine likely doesn’t cause harm but does merits further investigation.
The Cost of Doing Business: Scars Add Value
Tattooing a scar sometimes costs considerably more than a regular tattoo. And rightly so; covering your scar will require some extra time, skill level, and multiple session so it generally does costs 25-50% more than comparable work should be expected and is justified.
Many artists charge hourly as opposed to by the piece when tattooing on scars, simply because of the unpredictability, variability, and periods of skin tension. The artist discusses a design that influences a time of 6 hours on normal skin which is going to take 10 hours on scarred tissue.
Clients that care about money, please try to avoid inexpensive solutions to the original tattoo or the scar. The lesser quality tattoos will look much worse compared to an original scar and creates more problems altogether.
Success Stories: It’s All Good
Mastectomy scar tattoos have garnered a lot of attention with artists creating beautiful florals, decorative things and/more realistic, 3D nipple tattoos. Organizations that connect breast cancer survivors to tattooists have launched on a mission whereby providing service to do pro bono or a lower charge.
Scarring coverage through tattooing is another avenue where talented artists have impacted lives. Arms that once needed covered due to scarring (and therefore had to wear long sleeve shirts all the time to protect them) now have beautiful works of art to be showcased, instead of hidden in shame.
Veterans with scars from combat are increasingly looking for tattoo work to modify their scars that may have been due to some kind of trauma due to the service. Specifically, each tattoo has been developed into military-themed designs that contain, symbolically, what was left behind from the military experience. Vet participants often display their scars with pride, rather than trying to hide them.
Burn survivors have received some of the highest quality work from tattoo artists, where the artist can spend dozens of hours developing layer upon layer of color and detail over extensive scarring and burnings.
When Not to Tattoo: Wisdom Over Want
Sometimes, the answer to not tattooing over scars is the best answer. Very thin scars may be more appropriate to leave alone or treat with dermal fillers instead. Extreme sensitivities to parts of the body where the pain would be unbearable probably doesn’t make it worth the suffering for merely aesthetics.
If you are judging getting a tattoo merely to please someone else, or feel pressure to hide scars, the motivation is surely off. There is no shame with scars. A coverage process should come from you and not external pressure.
Scars remade through tattooing represent one of those beautiful intersections of where art meets healing. Skills meet compassion, permanence meets peace. Whether you are considering coverage for surgical scars, wounds from an accident, or even marks from a darker time, please approach the process with grace, research it, and choose an artist as if you are looking for a surgeon.
Tattooing over scars will not erase what happened – nothing does such a wonderful trick. However, it can change what you see in the mirror, change what those markings mean to you, and rewrite the narrative you carry on your skin. That is a wonderful type of magic – a needle and ink, at its finest.
