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The benefits of Medical Tattooing within the rehabilitation process
  • Jul 3, 2024
  • Latest Journal

By Rae Denman-Tanner
Rae Denman Medical Tattoo & Expert Witness Ltd

“Scarring may be skin deep but their psychological impact goes deeper still. The evidence is decisive; the presence of scars can result in clear markers of mental disturbance in patients with associated symptoms of depression, anger, anxiety, and post-traumatic stress. A scar creates physical, emotional and psychological marks. Identity is called into question and individuals must integrate the scar with their sense of self in order to achieve psychological acceptance. This process causes a change of behaviour and reduced functioning, socially and psychologically, driven by a fear of being singled out. This is supported by the theory that scar visibility acts as a mediator of psychological distress; thus, hiding the scars relieves maladaptive behaviour and often leads to a return to normal functioning. Leaving us with hope that these psychological scars can be managed and even reversed.”

As a Medical tattooist, I am often in the final stage of a patient’s recovery from trauma or surgery, and regularly presented with patients requiring my expertise to help reduce the visible impact of their scarring.

Medical tattooing is the process of implanting medical grade pigment into the dermal layer of skin to camouflage and colour it, in order to recreate the surrounding skin tone. Any part of the body can be treated, as well as any skin tone. There will be different recommendations depending on skin tone, age and texture of skin, and the type of scarring and how it has healed. Other features such as freckles, veins and blood vessels can also be tattooed to help add realism to the area.

A scar is a mark that is left on the skin after a wound has healed. They occur as a natural part of the healing process. Scars tend to fade over time although they never completely disappear.

Medical Tattooing does not remove scarring, but does make the scar look visibly reduced, sometimes invisible. It is gently invasive with no risk of any added scarring as the needle doesn’t penetrate deep enough. The pigment will retain it’s colour, but can be faded by UV rays, use of retinol products and the body’s lymph system. Colour boosts are required every one to five years, to keep the area looking optimised, realistic and camouflaged.

A typical route to rehabilitation
‘Following a critical incident, previously held beliefs about one’s self are called into question and reevaluated. One theory by Moss & Rosser 2012, describes the skin as a protective barrier separating self from the environment. A scar can be viewed as an intrusion - the barrier is no longer whole and one is left exposed. The change in appearance threatens sense of self and personhood. Patients must grieve for what has been lost and often there is a lack of continuity between the two self-images.’

The impact of the visible difference is not measured by whether the area of concern is big or small, can be covered by hair, makeup or clothing, is obvious or even barely visible. The impact is more often a deeper emotional response.

Scarring can impact a persons return to socialising, relationships and confidence. Rehabilitation aims to increase a persons independence and physical function after injury and to a return to as much of the previous ability as possible. A typical route to rehabilitation may involve scar revision surgery, laser treatment and physiotherapy to improve the quality and reduce visibility. However, a scar cannot be fully removed and will often remain visible due to its discolouration.

Physiological effects of scarring:
• Refraining from wearing certain items of clothing
• Deflecting intimate or personal relationships
• Avoiding public environments
• Inability to work

Medical Tattooing can visibly reduce the appearance of a scar by blending the colour of the scar into the surrounding skin tone. It will draw the attention away from the scar so that the client does not focus on it as much, and that strangers/friends at a conversation                 distance are not drawn to look at it and comment.

It negates the requirement for cosmetic camouflage cream which although is a very good solution, is time consuming on a daily basis. Moisturisers, sun protection, makeup can all be used over medical tattooing once it is healed. It is a low risk treatment with the main risk being infection which is minimised by an aseptic work environment and the client following the aftercare routine.

Scars that can be visibly reduced with Medical Tattooing;
• White or paler than the surrounding skin.

• Healed and sealed (Scarring needs to be fully healed which can range from 3-6 months for some minor surgical procedures to 6-12 months. Scarring can be older than this without any negative effect to the tattooing result)

• Smooth or within 0-0.5mm change in depth (raised or indented)

Scars that cannot be visibly reduced by Medical Tattooing;
• Hyper-pigmented scars (darker than the surrounding skin)
• Unhealed scarring

Each treatment is performed four to eight weeks apart for the best outcome, and approximately two to four treatments are required for smaller scars, and three to six treatments for larger areas.

Skin tone is a mix of colours taking into consideration the vein colour, undertone, shadows and highlights, wrinkles, hair, freckles, moles and other skin characteristics. Medically certified coloured pigments are mixed by eye and then implanted into the skin in a mosaic pattern, visually breaking up the line of the scar.

The results are immediate, although the final result is achieved once all the layers of the skin have fully healed, usually over the following four weeks.

Patient stories
Skin Graft Re-pigmentation with Medical Tattooing

Medical tattooing is safe, effective and low-risk for all types of skin grafts, on any area of the body, on any skin tone.

A client had a skin graft around the inner corner of her eye. Grafts often have defined edges and can look different from the surrounding skin, even though the skin has been taken from the same person. It’s not always a simple job of colouring in the graft to look like the rest of the skin as the treatment needs to be changed depending on the area concerned. The eye area needs a detailed type of tattooing incorporating wrinkles, skin texture, shadows and highlights whilst trying to camouflage the fact that the graft area is also more physically pronounced.

The cheek area responded well in the first session with a decent coverage and colour match. All that was required in the second treatment was to colour in any patches, add some fine-tuning such as freckles, and blend the edges. The whole treatment including the healing time took 2 months and had huge results on the visible impact of the graft, and the confidence of the client.

Anaesethic can be used on the area so the treatment is comfortable and each treatment can last from thirty minutes up to three hours depending on the size of the graft.
The patient below had hypopigmentation and hyperpigmentation in the same graft site area. Medical Tattooing will not cover the hyperpigmentation so we concentrated on the pale areas of hypopigmentation blending it to his natural skin tone, which meant the areas of hyperpigmentation did not stand out as much.

Dog attack injury
I was approached by a young client who had experienced a dog bite at a young age. She had received surgical treatment at the time and was left with asymmetry in her upper lip and a lack of a cupids bow. This impacted her in numerous ways affecting her confidence and how she engaged with her world. She booked to see me for a consultation and after making sure there were no contraindications for medical tattooing, we discussed what outcome she wanted and whether that was achievable.

Medical tattooing is always looking to achieve the natural, by adding symmetry, definition or indeed lack of definition and colour to make a visible difference look less visible. So, in essence, we are adding in order to subtract. Adding pigment to create an illusion is why medical tattooing needs to be done with precision, care, and safety in mind. Working slowly and precisely to recreate the natural lip line, the natural cupids bow, and the natural lip or skin tone.

Other scenarios where a visible difference is having an acute impact on lifestyle are illustrated in the following examples. Medical Tattooing provides an effective treatment whereby the loss of eyebrows and surgical scarring leave the client with scarring.

Medical Tattooing is a relatively new industry which is gaining an increasingly more established position within the route to rehabilitation process.

The knowledge and experience associated with skilled practitioners in this area of expertise requires a broad and particular understanding of the human body, its forms, functions and biology in order for it be executed effectively.

Mildred Ngaage & Mark Agius: THE PSYCHOLOGY OF SCARS: A MINI-REVIEW Psychiatria Danubina, 2018; Vol. 30, Suppl. 7, pp 633-638

Author; Rae Denman-Tanner
Rae Denman Medical Tattoo & Expert Witness Ltd
Rae specialises in Condition and Prognosis reports for personal injury claims.
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