Tattoos are a form of art. Plastic surgery is also a form of art. Tattoo artists and plastic surgeons share one big thing in common: our canvas is the human body. The tattoo artist, like the plastic surgeon, takes pride in his or her craft. They are accountable for permanent changes to the healthy human which imposes a lot of stress and excitement. As with plastic surgery, the sophistication and technology of tattooing is evolving. Some of the masterpieces that come across my exam tables are impressive, to say the least.
Because we share the same canvas, struggles can sometimes arise wherein the path of the scalpel and the stroke of the tattoo may sometimes intersect. In certain cases, like medical emergency and trauma, nothing trumps the importance of life and limb. In such cases, tattoos are an afterthought. However, for elective surgery, a challenge arises when there is an option for where to place the scar. If the optimal scar position lies along the path of a tattoo, it is better to change the scar position, or to sacrifice the tattoo? This becomes a very personal question.
Even more challenging are liposuction cases. As the abdomen and arms are very common locations for tattoos and liposculpture, liposuction in these areas allow a surgeon to place a scar within a tattoo or outside the tattoo. The benefits of placing a scar within the pigment of a tattoo are 1.) scar inconspicuousness and 2.) the ability to tattoo over the scar. However, this is, by definition, defacing somebody else’s artwork. In most cases, patients will quickly consent to placing a scar within the tattoo. This is because a plastic surgeon will appropriately posit that this makes the scar relatively invisible, or at the very least, hard to see.
But I learned recently that this is disrespectful. In fact, many rules exist amongst tattoo artists regarding etiquette and mutual respect. For example, except for an artist’s sickness or incarceration, it is inappropriate to have another artist complete the tattoo that was initiated elsewhere. Even more so, it is unimaginable to tattoo over another artist’s work. And of course, it is very inappropriate for a plastic surgeon to place an incision through a stroke created by his fellow artist. So what’s the right answer? Obtaining patient consent alone, or respecting the tattoo artist?
Ideally, both. In most cases, the plastic surgeon will discuss optimal scar placement with the patient. In many cases, he or she will opt to take advantage of pre-existing tattoos. After watching this video, hopefully plastic surgeons and other surgeons may think twice about doing this. Rather than putting a scar within a tattoo, it may be better to put a scar just outside the tattoo. In both cases, and inconspicuous scar is achieved, and the tattoo artist’s work will have been respected. Avoid the pigment. That is the take-home message of the story.
The science of camouflage is relevant to scar appearance. Disruption of object edge contours make it harder to detect. Object boundaries are harder to detect when they are the same color and intensity as their background. Pigmentation making strong edges near to or perpendicular to an object outline might suppress information about the true outline by providing disruptive information about non-coherent edges at erroneous locations. Objects are better camouflaged in the context of a heterogeneous background. This is particularly true for gradients and shadows characterized by diffuse boundaries. Finally, strong line stimuli can make a weaker stimulus invisible; we expect the contrast of tattoo, surgical scar, and skin to be a distractor from the scar itself. These principles may explain why placing scars on the boundary of- but not within- tattoos generates satisfactory, and often imperceptible, scars. And it respects the artist.