Everything You Need To Know About Scar Camouflage Tattooing

No matter their origins, scars are often fraught with meaning. For some, they’re a sign of victory: the mark of survivorhood. For others, they’re a reminder of a chapter they’d prefer to close. Regardless, there remains the fact that, for a multitude of reasons, some scars heal better than others.

When it comes to mastectomy and breast reconstruction, for example, how well your scar blends into your surrounding skin over time depends on your surgeon’s skill and your unique physiology. Proper aftercare, along with topical scar therapies (think: silicone gel or strips) and cosmetic procedures (like microneedling and lasers) can make a noticable difference.

In recent years, a newer scar-minimizing treatment has been gaining popularity. It’s called scar camouflage, and it uses techniques similar to permanent makeup (a.k.a. cosmetic tattooing) to, well, camouflage the appearance of the mark. Here’s what you need to know about the trend.

What Is Scar Camouflage?

Also known as skin color tattooing or camouflage tattooing, scar camouflage is a needle and pigment technique that blends scars into the surrounding natural skin using permanent makeup pigments. Typically performed by a medical or paramedical tattoo technician/artist, skin repigmentation has become increasingly popular for its ability to improve the appearance of scars, stretch marks, and other areas affected by hypopigmentation (read: missing color).

Just like other forms of paramedical tattooing, scar camouflage isn’t the same as a typical decorative tattoo. Let’s review what makes cosmetic tattooing different from traditional tattoo techniques:

Traditional tattoos

• Considered a ‘cosmetic’ by the FDA (meaning they’re not regulated)
• Ink (black and bright colors) derived from a variety of chemicals, including metals
• Injected deeper into the dermis
• Cannot be broken down by the body (i.e. they’re permanent)
• May fade slightly and/or become fuzzy over time

Cosmetic tattoos

• Considered a ‘cosmetic’ by the FDA (meaning they’re not regulated)
• Micropigments (neutral skin tones adjusted with white) made primarily from titanium dioxide, as well as organic and inorganic substances
• Injected more superficially into the dermis
• Partially broken down and faded by the body (i.e. they’re semi-permanent)
• Likely to fade completely over time

What Type of Scars Can Be Camouflaged?

When evaluating a scar for corrective micropigmentation, the source of the scar is not as important as its look and feel. Once fully healed, any type of pigment loss is generally amenable to micropigment color correction, including:

• Scars (from surgery or injury)
• Stretch marks
• Areas lacking pigmentation (from skin conditions like vitiligo)

“Any type of surgery scar can be camouflaged, what matters most is how the scar healed,” says Nicole Johnston, a cosmetic and restorative tattoo artist at Studio Sashiko in British Columbia, Canada. Typically, technicians recommend waiting until the scar is, at a minimum, one year old before opting for scar camouflage. “Scars cannot be worked on shortly after surgery,” Johnston explains. “A scar will go through many stages of healing and will change in appearance over time,” she notes. As such, Johnston typically asks clients to allow their scar to heal for at least two years before visiting her.

Whether or not a particular scar can be repigmented depends on both the artist’s skill and the nature of the scar. The most ideal scars and stretch marks are those that are flat (or nearly flat) and paler than the surrounding tissue. “Most scars can be camouflaged,” Johnston shares. “But there are times when we won’t see ideal results.” She lists several characteristics that will likely impede a technician’s ability to successfully camouflage a scar:

• Keloid or highly textured
• Hyperpigmentation
• Thinned, translucent skin

How to Prepare for a Scar Camouflage Treatment

If you think skin color correction may be the solution for your scar, there are a few things you need to know beforehand:

1. Do Your Homework

When considering corrective pigment camouflage, finding a skilled and qualified medical or paramedical tattoo artist is extremely important. Although some states are stricter than others, the United States Food and Drug Administration (FDA) considers scar camouflage to be a subset of permanent cosmetics and does not impose much regulation.

Here’s what you need to look for when searching for a provider:

• Training & Certification: A one-day training session isn’t going to make a technician an expert. Look into your local municipality’s laws around credentials and be sure to research how long the provider has been practicing and what certifications they’ve acquired.
• Experience & Knowledge: As mentioned above, a certain level of expertise can only come from years on the job, and you'll also want to be treated by someone who has experience working with clients with similar features or concerns to your own.
• Facility: Check to make sure the salon or office the technician works at is clean and appears to be following local standards.
• Photos: Standardized before and after pictures will give you a good idea of the caliber of the work. Check out our guide to viewing B&As to learn more about what to look for.
• Happy Clients: A skilled and reputable artist will never shy away from allowing past clients to share their experience with you, so don’t be afraid to ask.

According to Johnston, “experience and honesty” are two of the most important qualities to look for in a skin camouflage professional. “Scars are complicated and every situation is different,” she explains. “If an artist gives you an immediate ‘yes’ without indications of what to expect with your results, you may want to keep researching.” As it relates to honesty: “I regularly turn away clients if I know I cannot make worthwhile improvements,” she adds.

2. Expect a Consultation

During your consultation, your tattoo artist will evaluate your particular scar and ask many questions — particularly about your medical history — in order to gain a better understanding of your body chemistry. This includes questions about:

• Medications (including vitamins and supplements)
• Any traditional, medical, or cosmetic tattoo history
• Skin type
• Allergies
• Autoimmune conditions
• Scar tendencies
• Ability to schedule follow-up treatments

3. Be Prepared to Prep

Based on the appearance of your scar, your medical tattoo artist may suggest any number of pre-treatments. “Often, I will recommend a client get laser or microneedling done on a scar prior to coming to me so that we can see the best results,” Johnston says. “Laser and microneedling will help flatten the scar and improve its texture.” Another benefit of lasers, she adds, is that they can also lighten hyperpigmentation. “By doing this first, the client can see a much better result than if I were to only work on the color of the scar,” Johnston shares.

4. Consider Cost

The price of a skin repigmentation varies by geographic location and the experience level of your tattoo professional. Expect to pay anywhere from several hundred dollars for work on a very small scar to several thousand for larger, more complex scar work performed by an in-demand artist. Typically, scar camouflage is not covered by insurance — unlike other types of medical tattooing, like reconstructive nipple and areola, for which some insurance companies do reimburse patients (at least partially).

What to Expect After a Scar Camouflage Treatment

“I always tell my clients that they shouldn’t expect to see immediate results,” Johnston says. The reason for this is because the tattoo needs to continue to be perfected. “In order for the results to look the most natural, I am conservative with the amount of color I add in one session to the scar,” she shares. “My focus is for the result to look like skin and not like I’ve applied makeup to the area.” As a result, “clients will see full results after their touch up session,” Johnston notes — and she offers additional touch ups as needed.

As with any healing process, it’s important to remember that the recovery from scar camouflage is an evolution. “A phrase I use with my clients is, ‘everything looks worse before it looks better,’” she says. “Scars and stretch marks are more fragile than the surrounding skin, therefore they tend to respond with a bit more redness or swelling when being worked over.” These side effects usually subside within a couple days, Johnston explains, but, for some individuals, the residual redness can last a few weeks.

What Are the Risks of Scar Camouflage Tattooing?

Just like a conventional tattoo, corrective cosmetic tattooing carries certain risks. Choosing a well-qualified provider will minimize your chances of complications, which include:

• Infection
• Allergic reaction
• Granulomas
• Poor color match
• Fading
• Discoloration

Sticking to the recommended after-care regimen is also extremely important, as your tattoo is essentially an open, healing wound for two to four weeks

Is Scar Camouflage Reversible?

Laser tattoo removal has come a long way in recent years. When it comes to skin repigmentation tattoos, however, trying to reverse the process isn’t as straightforward as it seems. Lasers target the color molecules and break them apart to be excreted by the body, but they can’t be used on titanium dioxide (a white pigment very often used to match lighter skin tones). Lasers turn this white metal gray, leaving an even more conspicuous mark.

Although there are alternative options for removing permanent makeup pigments, scar tissue doesn’t behave the same way healthy skin does. All of these factors make it much more difficult to alter a cosmetic tattoo than a decorative one or even microblading.

The Takeaway

A well-executed scar camouflage tattoo can be life-changing for clients — improving self-esteem and helping them move on. “This procedure can have incredible effects on a patient’s quality of life,” Johnston notes. As she explains, scars are often associated with difficult memories. “For our breast cancer survivors, it can help them feel like themselves again and recognize what they see in the mirror,” she shares. “We also help clients cover the scars from their abusers or from self-harm done in the past.” In many cases, scar camouflage represents a fresh start. “It’s a way for them to move on,” Johnston says, “and not see the reminder every day.”