Scars can be traumatic. They can also be annoying and itchy. They can draw unwanted attention, especially in areas usually plainly visible to the public, and they can push one to feel more isolated and reclusive, ashamed of their body. All of these are bad things, and many of them are a matter of perspective more than anything else. By all accounts, we can be proud of our scars. They mark us as survivors, or daredevils, or brave people. Regardless of how you got your scar, you had to likely endure severe pain to see it heal and form. It’s not something everyone has to go through, and it often makes you special – a detail of just one small chapter in a long and storied life.

But for many, trying to think that way just isn’t really feasible. There’s too much pain and history surrounding their scar, and it makes them angry whenever they’re confronted with it in a mirror. They don’t want it.

However, scars are difficult to remove or conceal, and it’s not always a good idea to attempt it. Some scars are recurring and will come back with a vengeance if you try to remove them. In comes another solution: the tattoo. By adorning your scar with something meaningful, you take what might have been a source of shame and turn it into a point of pride. Tattoos have been and continue to be a great way to own one’s scars, but there are things you should know about scars and tattoos before getting one.

How scars heal

When skin and tissue is damaged, the body does its best to heal the wound. But just like a broken teapot, you can’t really put things together and expect them to look completely the same. While minor abrasions with a little scabbing are unlikely to lead to any permanent changes in the skin – you likely won’t get a major scar from lightly scraping your knee – deeper cuts and larger abrasions can lead to scarring, wherein the body releases a protein called collagen to help build tissue to keep the wound closed.

Once the collagen buildup has reached its peak and the scar is formed, the body continues to supply the area with a larger than normal supply of blood, causing it to swell and become red. This swelling and red coloration eventually fades over time as the blood supply reduces, and the collagen breaks down. The skin that’s scarred becomes flatter, smaller, and paler. This can take up to two years. After two years, it’s unlikely for a scar to fade or grow flatter.

Scars come in different shapes and sizes, depending on the injury, but there are also different scar types. These types are based on the size and nature of the scar. Most scars are called fine-line scars, and they’re generally small. These are the scars you’ll see in most cases – fine, faded lines that aren’t raised nor pitted, but simply remain discolored and slightly paler than the skin around them. These scars are more obvious on darker or tanned skin, because scars don’t have as much pigmentation as the skin around them, and they do not tan.

Hypertrophic scars

Hypertrophic scars describe scars wherein the body produced more collagen than is necessary, resulting in a raised scar. These scars can also be provoked by retarding wound healing, as is the case in ritual scarring, where ash and other things are rubbed into wounds to slow and aggravate the healing process.

Keloid scars

Keloid scars are a more extreme variant of hypertrophic scarring. While they too are raised and far more pronounced than a fine-line scar, keloids grow beyond the scope of the original scar and can continue to grow if picked on or damaged. Keloids are usually hard and shiny, and difficult to treat, as any attempts to excise or cut into the keloid can result in the scar returning and growing even worse.

While keloids only occur on damaged skin, some people are genetically predisposed towards developing keloids. Most keloids develop on the upper body, and they can be a genuine concern for those who want a tattoo, as tattoos can aggravate the body into producing keloids.

Sunken scars

Sunken scars develop in cases where the tissue underneath the skin (fat and/or muscle) is severely damaged or destroyed. This causes the skin to heal differently, creating a sunken scar. They’re more common on facial injuries, including acne scars and ritual cuts on the cheek. Sunken or pitted acne scars come in different grades of severity, from mild (atrophic scars) to severe (boxcar and icepick scars).

Stretch marks

Stretch marks are a different type of scarring that occurs underneath the top layer of the skin. They when the skin is rapidly stretched, often during puberty, pregnancy, or when a person puts on too much weight too quickly (obesity or bodybuilding). The stretching causes gaps to occur where collagen production couldn’t keep up with the expansion of tissue underneath the skin, causing scarring.

Scar contractures

Finally, burns produce unique scars called contractive scars (or scar contractures). These occur when a swathe of tissue is damaged rather than a cut or incision, as is common in burns and major abrasions. The skin shrinks to grow over the damaged area, causing it to warp, grow very tightly, and become less flexible than normal skin.

Guy Aitchison – Anthony, third degree burn scar coverup

In modern society, scars and blemishes are often considered unsightly, save for very select exceptions (the ‘cool male scar’). While many cultures would purposefully use scars to celebrate certain personal milestones or mark tribe members, scars today usually indicate some traumatic experience, whether through injury or self-harm. As such, scars have been linked with lowered self-esteem and a poorer self-image. While a tattoo doesn’t heal the pain or change the scarred skin, it does do something about the mental aspect of carrying a scar – a tattoo has the power to be transformative, changing the context and meaning surrounding an injury, and allowing an individual to control how they see themselves and their pain, rather than letting it control them. This makes tattoos an excellent way to cover scars up. But does that mean you should go ahead and do so?

Should tattoos cover scars?

There are a few things to consider when wanting to tattoo a scar. For one, if your scar is hypertrophic or if you or anyone in your family is prone to keloid growths, any further aggravation on the skin might not necessarily be a great idea. That being said, some artists specialize in scar tattoos, including keloid tattoos. If you do want to adorn or cover a keloid scar, try to find a professional with experience in working with scar tissue.

It’s also helpful to visit a doctor and dermatologist to know what to expect, if you do decide to ink yourself. If you want to get a tattoo over a scar, it’s also important to note that scar tissue is very different from normal skin tissue and reacts differently to ink. Tattoo inks are usually less visible on scar tissue, which means that you’ll need more touch-ups and more work done on your scar to make it all blend in.

This leads us to our next issue, which is pain. Some scars come with major nerve damage underneath, which leaves them largely numb. If the nerves underneath the scar regenerate, however, they might do so with more nerve endings. The result is a scar that’s actually more sensitive than the skin surrounding it. While everyone has a different pain threshold, you’ll have to ask yourself if you’re mentally prepared to go through with the pain of tattooing over a sensitive scar. Note that there are anesthetic creams that can be applied to numb an area before a tattoo, but some pain will always remain (unless the nerve endings are permanently damaged).

It also goes without saying that you shouldn’t tattoo a healing scar. Scars heal at different rates, from person to person, based on their size and the level of damage on and underneath the skin. However, it’s a good rule of thumb to wait for a scar to begin fading and shrinking before you start contemplating a tattoo. As previously stated, two years is generally enough time for most scars to reach their permanent state.

What about a mastectomy tattoo?

Tattooing by Samantha Rae

Tattoos are generally safe after a mastectomy, as long as you’re done with your treatment. Don’t get a tattoo until after you’ve completed chemotherapy, radiation treatment, and the surgery. If you’ve opted for a prophylactic mastectomy, ensure that the scar has completely healed before tattooing over it. Mastectomy tattoos can be stunning works of art.

The only potential concerns some physicians cite is an inflammation of the lymph node. Sometimes misdiagnosed as lymphoma (cancer), this may be caused by an allergy to the pigments or other components of the ink used in the tattoo. The lymphatic system plays a vital role in the creation of the tattoo, as the ink we see isn’t just ink but inked white blood cells remaining underneath the skin, in response to the use of foreign materials. These blood cells engulf and hold the ink until they die, at which point new cells engulf said ink. Some ink types can aggravate nearby lymph nodes, so it’s important to use the right ink.