Scarification: notes on planning, procedure and aftercare
This is just some stuff that I hope to be helpful for a person considering something alike. I really hope that I would have found more precise data about this while in planning. There might be some spelling errors or mistranslations as my native language is Finnish so this might not be 100% accurate in medical terms.
Cauterization means "burning" the tissue with a tool designed to burn up blood vessels and alike during an operation. In my case this was with a pen that made a high voltage, high frequency electric discharge. Very neat compared to a soldering iron or branding, there is no spreading of damage via thermal conductivity.
This experience consist of a small diary that I've kept and so the generic style and feel of the text might fluctuate as some entries had been written while having a fever and some pieces are plain hurried notes that I've kept as reminders for myself.
The scarification was done in October 2004.
The scar is a simple tribal outline that begins from my mid shoulders and covers my back until to the first third of my right thigh. Width of the line varies around 1 cm to 2,5 cm.
Planning and scheduling.
For a long time I had an idea of a back piece made via scarification. The concept of this had been in my mind from somewhere around year 1999-2000. Main problem for me had been in finding the time to recover and a person to perform the scarification.
On somewhere around the spring of 2004 I discovered the beginnings of an inguinal hernia. A quick trip to the doctor confirmed my suspicions and yes, there was gonna be an operation. After a moment of going "Goddamnit, I'm going to be bedridden for weeks!", I remembered the back piece. I knew that the only place in my residential area that could perform this would be Mad Max tattoo.
I made a visit and, yes. They could do this. After a brief conversation on the methods we ended up on cauterization. The size of the picture was too large to made via scalpel on a one go and I wanted it to be done in a single session so I could go and recover at the same time that I was on sick leave anyways, because of the recuperation on the hernia operation. Also the look of the scar is a little different (and better in concern of my plans) if it is made with a cauterizing tool.
I agreed to call back later on at the end of the year where my operation was to be scheduled.
After this little less than six months passed.
I worked on the design of the piece on and off. Basically I would just scribble something up on the marginals of what ever notes I was working on and and if any of it would be good I would draw it on a larger scale at home.
On the beginning of October I got a call from the hospital telling me that the was a free slot to for them to cut me up and stuff my guts back in on the 11th. Well a quick call to mad max and I got an appointment to talk this over with the person who would do this.
I had made a couple of renderings with photographs and gimp to try out the piece. I took these with me and went to see Jussi, the guy I was going to be scarred by. We set the date to be on 10th as my operation would be on 11th. But...
In a meeting before the surgery I discussed this idea with a nurse and an anesthesiologist and got bad news. No way in hell were they going to allow me to have a fresh scarification while in surgery, there was even some talk on canceling the operation if I showed up with this. The reasons for this were good, (a little bit too accurate) basically the operation would be opening me up, stuffing my guts back in and placing a net to keep them dropping out again. If there was any infections my body would easily begin to reject the net and that would be big trouble. They would have to open me up again and cut the net loose where it had melded with the tissue and do it all over again. Not an easy task. In fact the minimum amount of time would be over 2 weeks to even consider anything being done on the scarification. So I called the parlor from the hospitals parking lot and told that we were going to have to move the date, people were very understanding and we settled on the 30th.
I healed well and with no complications.
So now were going to burn the picture, I took a shower before hand and switched in to loose cotton clothes. I drove to the parlor and we started to draw up the picture. We basically kept the before made pans as guideline, I never had this tried on my body so i didn't actually know what it would look like with all the muscle movement and distortions caused by stretching of the skin. The drawing up was easy and Jussi was a pleasant person to work with. We made up the sketch, tweaked around it a little bit and and after the upper back was basically done Jussi started to cauterize me.
I don't know am I less resilient to pain, but I do know that my basic methods of handling it are screaming, swearing and squirming around. Not the best ones for this.
Luckily Jussi handled it like a true pro, there was a little trouble with me kicking around, I twitched so much the progress was slow on the upper back. Now here is the part I paid for, lines would still be neat and even in width and depth even when I was being such a difficult customer.
The final result would have been less satisfactory with a more inexperienced artist. Jussi worked on the piece, we took breaks to redesign and to keep me from passing out from hyperventilating. :)
After the back was done we sketched the buttocks and started on them, this was a little bit faster because the fat tissue helps keeping the skin inert even while there is some muscle movement going on underneath. All in all the procedure took somewhere around 4 to 5 hours, I felt very secure and felt that my ideas and needs for the piece were being listened to.
After the deed was done the picture was more than satisfactory, I really didn't expect some of the lines to go along so well with the muscles beneath.
(On a later recollection it still surprises me that the pain right afterwards was a lot less than say a week from the scarring. I could easily drive home and on the next change my tires without larger wincing. Yes, I knew in theory that the nerves that I require to feel pain were dead at the moment, still it to experience it was strange)
Now here is is the main reason I'm posting this. On the planning I researched on aftercare on scarification and on basic care of burn trauma. I had presumed to have a mild raise in temperature and pain.
This was not going to be the case. We talked about the after care in mad max an discussed the previous cases on this kind of scar. All others had minor or no troubles and a basic small infection would be the worst.
I went ahead as instructed, kept the wound clean with showers, kept clean clothes, it and so on. But on Sunday evening the wound seemed to start to ooze something out. II presumed that this was normal lymph that I've been used to while having tattoos. It was pus instead and the scar was infected.
On Monday a friend took a look at the scar and told me that it seemed to be more infected that I presumed. I went "It's lymph, not pus." couple of hours from that I felt a little woozy and measured my temperature, it was over 37 so I had a fever. Now here I started to suspect that maybe this wasn't lymph after all. The previous night was lousy. I dozed on and off and secreted pus from my upper back so I had these yellow and bloody stains on my sheets. Even the antibacterial cream I scrubbed on made no help.
I called the parlor about the troubles and got advice, I was to scrub some more powerful cream on it and if there was any more issues like fever rising still I should call the "house doctor" Mika Hjerppe. Now I measured my fever a bit later and it was still rising, peaking somewhere upper 37:ies. I called Mika and we scheduled a meeting a couple of hours later.
Now if this would been run of the mill no-name parlor I wold have gotten a meeting with my normal referred physician. Instead I got looked up a person who has in a small way specialized in this. He made lecture covering tattoos and piercings on a doctor summit this year and has a very understanding viewpoint. So I got statement that this was a good sized infection that couldn't have been avoided in any means except prescription antibiotics. The small "zits" that I have on my back contain staphylococcus bacteria in such large amounts that even a tattoo would have been infected to this scale. Even had this scar been done piece by piece the result would have been the same. Now I just have a one larger infection in a one go instead of smaller ones. So it seems that acne and scars don't mix. All the material I've read didn't mention anything about this and no-one else seems to have had this kind of issues. And this kind of scarification isn't even that uncommon. Well, now I've got a prescription to antibiotics and an antibiotic cream. Now here's the good part, the cream is prescribed instead of normal cortisone because the scar would have healed too well on cortisone. Luckily Mika understood the idea to have a scar remaining after the treatment.
All in all the experience has been positive and all the people who have been poking around my body have known what they're doing. I'm very grateful to the people in Mad Max and to Jussi.
Some urls for you to click on: Mika Hjerppe Mad Max Tattoo Staph and Folliculitis.
Scar: day 6
Some development to better has been happening. The antibiotics kicked in on Tuesday and not a moment too soon. When I was writing the first entry on journal my fever was rising and though I didn't notice it I was starting to get semi-delirious, it probably shows on the text. The fever peaked around 39-40 C during the night and,but luckily it came down really quickly as has stayed gone.
Now that the wound isn't seeping pus so much some actual scar tissue has started to appear. Now it feels less painful and I actually can lie on my stomach and feel no pain.
One trouble I've been having is the tendency that the scar has to heal up on my clothes, i.e. I have to rip them off and that starts some bleeding again. I solved this by going to the shower with clothes on to soften the scar before undressing, sounds crazy, but it actually beats ripping my underwear of and opening the wound again.
I'm actually getting some work done and now I can even drive a car without slowing down to a 5 km/h crawl on every sharp turn.
I talked to a familiar nurse who has worked on the skin trauma unit in Tampere university hospital about the aftercare, one of the reasons for the frequent showers is to help remove the dead epidermis, the yellow straps of flesh that keep coming off. When this is removed the scar will heal more quickly and the chance of infection is diminished because of the removal of bacterial breeding ground.
One other thing that kept me wondering was the the idea of pre-medication. Usually when a person is about to receive an operation that is infection prone he'll/she'll get a heavy dose of antibiotics beforehand to lessen the possibility of new infections and stop any present ones. So I picked up the phone and made quick call to private clinic in Tampere and asked about the possibility of having a doctor prescribe a dose of antibiotics before a large scarification or a tattoo that could be infected easily.
The answer was that, yes, this was actually a possibility and they even encouraged the idea.
So now I'm a bit angry for myself for not having thought this beforehand, a quick trip to a private doc and 70 euros would have prevented me for having a lot of pain and fever.
Some urls for you to click on: Medication that kept me going, Dalacin and Fucidin.
scar: day 12
The antibiotics have worked and every sign of infection on the scar has gone. The scar is now covered fully with a healthy looking scab. This still leaves some issues, the scab has the tendency to harden up without any moisturizer so if I do not cream it up after a shower I can't move. I hope this doesn't leave the resulting scar diminished because just lying very still in a one position is not an option.
I usually apply some helosan to my middle back to allow some basic ambulation and leave the rest of the scar to dry up. For some reason even when the major infection has disappeared I still experience some mild fever around 37 C during the evenings.
Also some heavy itching is is starting to appear on the part of the scar that has healed more rapidly... I found some help for this with a basic method for burn trauma patients, I apply some pressure to the part that is itching/stinging the worst.
The combination of these minor annoyances, itching, disabled movement, nausea from the heavy antibiotics and sleeplessness has made it quite impossible for me to work or study.
During the weekend I had to drive a truck for 400 km, this was very difficult and I had much difficulty to keep myself alert and keep my concentration on the road and driving. Luckily there isn't any major work to be done and nothing critical to be learned from school this week so I have managed to call the rest of the week sick. I hope that some of the scab from my middle back has peeled of by then and I can start walking straight by Monday. The major infection that I had right after the cauterization has made me a bit vary of the idea of opening up the scar to promote a better result, I only have a couple of days of antibiotics left and to be honest an another round of 1 gram per day antibiotic induced diarrhea and vomiting would just be too much for me.
Called up Mad Max and asked about possible corrections if the infection will some how mangle up the scar, got an answer that 2 months would be the minimum to even consider any corrections and these would be included in the price I have already paid.
I'll probably wait till summer to see how this really ends up looking and hope that the offer is still valid.
Some urls for you to click on: Helosan, it's good for you even if you're not a horse.
Scar, day 27
Mostly all of the cauterization has now healed over and left a pink scar. Surprisingly there is hardly any elevation on the tissue itself. I don't know will some form as time goes by or is this the result of the antibiotic and antibacterial creams that I had to use to keep any infections at bay. One of the reasons for the "good" healing might be my tendency to heal well from scars.
I didn't pick any of the scab in fear of a relapse on the infection so this might probably be one of the reasons why it remains so flat.
Any ways, even though the scar is even the tissue differs largely from my normal skin so I presume that even when the scar starts to fade from the heavy pink coloration I think it will remain reasonably visible.
All in all the isn't any feeling of discomfort or restriction of movement left, all that remains is my odd sleep rhythm that developed during the heaviest infection. I sleep somewhere around two hours from 0200 to 0400 and after lurching around on coffee and nicotine, after that I drop off for a couple of hours worth of nap at 1500 to 1800.
But I guess I will get back to my normal schedule soon.
After all of the issues I have had I would have to say that I wouldn't go through this again. If I could choose I would take scar, but in smaller pieces over a longer period of time. Probably some pre-emptive use of antibiotics would be a good idea too. That would have kept me in a working condition and I wouldn't have had to take two week relatively expensive sick leave.
Four months later
Things are pretty much the same as on day 27, the scar is a little bit lighter with relatively no elevation except on my lower back where it crosses some stretch marks. I haven't experienced any long term issues on restriction of skin movement or on comfort otherwise, i.e. the scar isn't prone to getting chafed or getting sore.
On clarity of the lines there is some variation with my right upper thigh losing it's definition more quickly. It remains to be seen if the trend continues, I probably won't get it touched up, but over all it doesn't render any harm on the design which is pretty much looking as I presumed it would. That means that the width of the scar has increased while it's lost some of the sharpness on curves and tight edges. The divide between scar and skin is still clear so it couldn't be said that it's gotten blurry, just a bit more "rounded".
Only thing that that's been a bit of a surprise is that the scar has a tendency to pool up blood while I'm laying on my back or reclined and turning in to a purple almost bruise-like color. I don't know will the circulation change and will the effect diminish or will this remain. It doesn't look that bad, just makes it a bit more vivid.
Eight months later/now.
Well, the scar and the design remain clear and visible all around. Some differences in the texture and coloration are beginning to show.
My right thigh seems a bit lighter and smoother that the parts in middle back/upper shoulders. Coloration in the thigh varies only slightly from my normal unmarred skin.
Upper and middle back are considerably darker in coloration and texture is more rougher.
But my lower back is a prime example how scar tissue is not as elastic as normal skin. I'm a pretty lanky fellow and during my teen growth spurt I developed a bunch of strias in my lower back. Where these stretch marks and scarification overlap there has developed lumps of scar that are considerably darker and more elevated.
I wouldn't go as far to call these keloids yet, but I guess it remains to be seen will some develop as years go by.
I presume that the skin in my lower back receives a lot of irritation in extreme stretching as I work and static pressure and rubbing when I'm seated or lying down.
The bruising that was visible some time a go has disappeared.
Well, this is kind of it. I hope that some one finds this useful even if my English is pretty broken.
Right now I feel that this will remain my last visible "modification". Perhaps later on, when close range radio applications have developed a little more I'll start considering a small implant for practical purposes. Now the range and usability of rfid tags is pretty limited even in the hf models. But that remains till later and there really isn't enough information for me on how implants endure everyday stresses.
submitted by: Anonymous
on: 26 July 2005