Exploring tattoo artists’ understanding of decorative non-medical professional tattooing as a method of scar camouflage and decoration

ABSTRACT

Research surrounding the use of decorative tattooing by non-medical professional tattooists as a form of scar camouflage or decoration is limited. This study provides critical and deepening insights into tattoo artists’ experiences of tattooing scars, to help inform a more in-depth understanding of its uses from a health and wellbeing perspective. Specifically, it aimed to explore qualitatively, the different methods and techniques used by non-medical tattoo professionals to cover up or decorate scars, which can have a psychological impact on those affected. Six tattoo artists from legitimate UK based studios were identified through snowballing and purposive sampling methods. Data collection involved semi-structured telephone interviews. The data was then transcribed, and thematic analysis was then performed. Five themes were identified: Personal Opinion of Scar Camouflage Tattooing, Tattooing Methods, Scars and Tattooing Risks, Positive Impact, and Understanding of Customer Experience. These themes were then broken down into more specific sub-themes. The discussion considers these findings in relation to theory and existing literature, for example, around understanding of role, and makes recommendations for future study in this field.

KEYWORDS:

• Scars
• Camouflage
• Tattooing
• Qualitative Methods

Introduction

Scars on the human body can be present in a range of different and varying ways. Common scars include those resulting from burns, self-harm, surgery, and stretch marks (Reinholz et al., 2015). Within individuals who have scars, there is a growing number seeking to place decorative tattoos both over and around them. As such, tattoo artists in modern western society’s tattooing culture, are able to apply these tattoos in numerous and effective ways.

Scarring, from any cause, can have a profound effect on those affected, and how they perceive themselves and their interactions with others (Martin et al., 2018). Whilst some people with scars report positive outcomes and the scars have little impact on their lives, others report negative impacts in terms of low self-esteem, body dissatisfaction, and anxiety, which can impact social engagement (Williamson et al., 2018). Some individuals attempt to camouflage or disguise their scars, for example, by using camouflage make-up. Others use tattooing to cover (camouflage) or decorate their scars.

Garg and Thami (2005), summarises the emergence of tattooing as a method of covering scars. For example, using medical tattooing to match the pigmentation of scarred skin with the unaffected surrounding skin, emerged from a field coined ‘para-medical tattooing’, and is commonly used for the treatment of burn scars (Simonacci et al., 2018). This places emphasis on returning scarred skin to its ‘natural’ state, as opposed to covering the scars with decorative artwork (Vassileva & Hristakieva, 2018). This form of tattooing provides an altered ideological outlook on what it means to be tattooed and the different methods available to individuals (Sanders & Vail, 2009).

The emergence of decorative tattoos as a form of scar camouflage/decoration indicates a cultural shift surrounding the anthropological perspectives of tattooing. For example, moving away from an outcast deviant activity to an art form with the power to reclaim the body (Selim, 2020). This has created an acceptability within modern western culture (Rees, 2016). Despite this, little research literature examining decorative tattooing by non-medical professional tattooists (NPTs) currently exists. However, a case study by Spyropoulou and Fatah (2009) discusses the anxiety that can be associated with post-operative scars, and shows the use of decorative tattooing as a positive intervention, by showcasing how decorative tattooing can allow individuals to re-claim the affected area of their body without returning it to its ‘natural’ state.

It should be considered that not all individuals with scars wish to camouflage or decorate them. It is also important to consider that despite tattooing culture becoming less of a social taboo, it is not necessarily suitable for all individuals. For example, in some religions decorative tattooing may be considered a deviant and unacceptable activity regardless of age, race, or gender (Scheinfeld, 2020).

This study aims to expand upon existing research surrounding the use of decorative tattooing by NPTs as a form of scar camouflage or decoration. Specifically, the study explores the different methods and techniques that can be used by NPTs to cover up or decorate a range of scars. The focus and key areas of the study are as follows:

Primary research question

What is the NPTs understanding of their role in using decorative tattooing as a form of scar camouflage/decoration, and how can a deeper knowledge of this understanding be used to increase public knowledge?

Secondary research question

What methods and techniques are available to NPTs for covering different scar types and what are the potential risks and benefits to this?

Methods

This study was approved by the Faculty of Health and Applied Sciences Research Ethics Committee at the University of the West of England. Generated data was handled in accordance with the Data Protection Act 2018.

Recruitment and participants

The methodology for this study was based on a target population of NPTs based within the UK, who specialise in the decorative tattooing of scars. Recruitment was achieved through snowballing and purposive sampling, contacting artists from different geographical locations and advertising the study on social media. Those who accepted the request to participate and responded to the advertisement were recruited. All participants worked at legitimate tattoo studios. Six NPTS took part (4 females and 2 males) from different tattoo studios across the UK. Each participant gave informed consent prior to being interviewed.

Data collection and analysis

Data collection was performed via semi-structured telephone interviews lasting up to one hour. These interviews were recorded using the ‘Tape a Call’ smartphone application. The researcher used 17 open ended questions to engage in relevant discussion. The interview schedule covered: Length of time as a tattooist, experiences of working with scar tissue, risks, knowledge of their role, and understanding of customer experience. ‘Thematic Analysis’ (TA) was used to analyse the interview transcripts, theme identification, and coding. The type of TA used was reflexive thematic analysis. This method of TA was employed as is it theoretically flexible and therefore fits the predominantly inductive nature of this study (Braun & Clarke, 2019). A copy of the interview schedule is available from the author upon request.

Quality and rigour assurance was ensured through a reflexive understanding and consideration of the limitations of TA analysis. By taking these limitations into account during data collection, analysis, and the proposed recommendations to reducing these limitations within qualitative studies of this nature, measures were taken to reduce opposing biases.

Results

The framework, shown in Figure 1, comprises of initial themes identified within the data, which were then broken down into sub-themes. Table 1 presents illustrative quotes depicting the artists’ thoughts and beliefs surrounding these sub-themes. All names provided are pseudonyms.

Figure 1. Coding framework for TA analysis.

Table 1. Illustrative quotes depicting thoughts and belief.

Theme	Sub-Theme	Definition	Illustrative Quotes
Personal Opinion of Scar Camouflage Tattooing	Cost Effective	This refers to the tattooist’s view that tattooing can often be cheaper than other camouflage options.	Vinnie: Definitely, getting a tattoo over something is easier; it’s faster, most of the time it’s cheaper you know, to deal with that.
Tattooing Methods	Pre-Planning	The factors that must be considered prior to applying the tattoo to the scarred area.	Sandy: It needs to be 100% perfect and for me that uh- it puts that added pressure on me from hearing and seeing and helping her that it needs to be 100% right first time and that’s why it- it’s so important to spend that time with them and really map it out and draw on them and you know, get to know them.
Tattooing Methods	Application	This highlights the importance of this process of scar camouflage through decorative tattooing.	Lucy: So the dot work is like pointed and you just delicately put each dot in and you build it up and build it up and then you get your design- but then your restricted with what kind of design because not everything- like you can’t get a rose- well you can get a rose in dot work but it probably wouldn’t show up that well on the skin that’s damaged because its bumpy. Vinnie: If it’s an under-tissue scar or if it’s like an outer scar, if it’s raised on the skin uhm basically like tattooing over the scars not much different than tattooing over normal skin but the problem is that if the scar is raised from the skin, you can’t just choose a picture, it does make it a bit difficult.
Scars and Tattooing Risks	Blow-Out	Here, artists discuss the risks to tattooing scar tissue and how those risks can be reduced.	Lucy: You can do dots, it’s like pointed then, you can put each dot in and it’s a bit more of a gentle way to … (clears throat) tackle that area because it’s very unpredictable, cause one dot and it could just blow out and then you’ve got a massive load of ink under the skin, you can’t do anything about it. Sandy: So, we call that a blowout. So, you could be drawing a line, if the customer fidgets and pushes themselves into the needle uhm, and you basically hit into this fat layer this can then spread out, we call that a blowout.
Scars and Tattooing Risks	The Risks of Working with Damaged Tissue	This theme discusses potential risks related to tattooing scar tissue.	Hannah: It might well be a case, as well that it won’t take at all uhm if the skin- if the scars not physically built up in the right way to heal and keep the ink in the skin it just might not cover it.
Positive Impact	Reclaiming the Body	This theme opened up discussion regarding how tattooing can reclaim the body, with a focus on social engagement and positive impact.	Lucy: I just need to say how much that you’ve given me my life back. It’s like well I haven’t I- you asked me to do a job and we’ve done the job but, the job has given him his life back and it- yeah, I’ve seen pictures of him rock climbing now. What you see in the transition of the person that’s really withdrawn coming out and being confident.
Understanding of Customer Experience	Therapist	Being an artist often involved listening to individuals and getting an understanding of their experiences and reasons for covering their scars.	Lucy: I’m- like a therapist throughout the tattoo trying to like make the experience a nice one if it’s painful for example, if they’re struggling- go slowly, be calm, take your time, chat to them, distract them, maybe have a giggle you know, I always find a bit of humour somewhere to get through the session and then afterwards we get the finale looking in the mirror and then that smile hopefully you get every time and you know job done.
Understanding of Customer Experience	Acceptance	The artists discuss how they believe decorative tattooing as a form of scar camouflage can bring individuals to terms with not only the scar itself, but also the psychological underpinning of the scar.	Bob: So, to basically rub out that negative part of their life and the negativity that scar is showing them uhm yeah of course it makes a huge impact to them and changes their perspective of themselves. Tammy: It’s going to turn something that caused you pain into something that is okay. That makes you at peace with yourself.
Understanding of Customer Experience	End of a Journey	This theme refers to how artists perceive the impact of their work.	Sandy: Okay so, as I have said before, I do think it is important to remember that we are artists and not doctors. Uhm, searching hard- oh uh if- if they manage to search hard and find the right artist, we make people feel good and beautiful on a daily basis. Tammy: I mean really and do something around to almost honour the past.

Linked code findings

Figure 2 shows the final themes, the relationship between each theme, and how one can influence the other. For example, how the application of the tattoo can influence potential tattooing risks, such as a blow-out. These links have been formulated through the tattoo artists’ illustrative comments and presents a storyboard of how these perceptions link together to create a collective entity.

Figure 2. Interlinking connections between the outlined themes.

Discussion

Decorative tattooing as a form of scar camouflage/decoration is not a frequently discussed within academic literature. The diversity of the artist’s engagement with individuals and their scars has formed an interesting phenomenon surrounding tattooing.

The participants in this study discussed their perceptions of how their work can impact the lives of individuals with scars. For example, they explained how decorative tattooing can allow individuals to re-claim their body and engage with their environment in an altered way. Their interviews showed an understanding of individuals’ experiences of living with scars and a passion for their role as a tattooist. The transcript quotes highlight a well embedded understanding of the tattoo artists’ role in relation to working with scars. This presents the notion that the altered ideological outlook of what it means to be tattooed is not only a product of societal discourses but is also created through the artists’ understanding of the individual purposes behind tattoos, that presents itself in multiple facets of societal frameworks (Wuthnow, 2009). The data shown in this study presents decorative tattooing as a tool for altering the perception of the physical and mental (Reed, 2016).

This study shows that these NPTs take a complex and strategic approach to working with scars. The complexity highlights the artist’s position of power and understanding beyond just the application of the tattoo. Given the growing popularity of tattooing in recent years, there is a need for further research to gain a deeper understanding from the perspectives of people with scars who elect tattoos, and of the tattooists. Limitations did occur with this study. For example, the sample size was relatively small. However, this was due to recruitment issues occurring from COVID-19, such as being unable to contact tattoo artists directly at their places of work.

Conclusion

This study gives an insight into the intricate phenomena of tattooing scars by presenting a collective knowledge of how NPTs understand their role, and how this understanding is vital to the outcome that the artist can provide.

A focus on specific scar types and themes from the above findings would provide a more intricate knowledge of theoretical understanding. It is recommended that future studies in this area consider the experiences and motivations of individuals choosing to have their scars tattooed. Further research into the techniques and methods used by decorative tattoo artists to work with scar tissue would also add additional relevance to current literature.

Declaration

This study was completed for the MRes in Social Research Health and Wellbeing pathway at the University of the West of England, Bristol. This is my own work. Where the work of others is used or drawn on, it is attributed.

Acknowledgments

I would like to thank Dr Stuart McClean who supervised this project, and supported me through the process. I would also like to thank Professor Diana Harcourt from the Centre for Appearance Research team at the University of the West of England, Bristol for all her support and expertise. I am grateful to all the participants, and to the charitable organisations who helped to facilitate this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.