A glance into the world of tattooing scar cover-ups

Though tattoos may only be skin-deep, their emotional impact can pierce much further than any needle. People seek out tattoos for many reasons, whether it’s out of love for someone’s art style, a means of self-expression or commemorating a momentous event in one’s life. 

If someone makes the choice to imprint a symbol in ink onto their body forever, it’s important that they find the right person for the job. For those trying to cover scars on their bodies, it’s all the more essential. 

Alexandra Winthrop, artist and founder of Emetic Ritual Tattoo, owns a trauma-informed practice, having undergone cover-ups for her own scars. Winthrop, with her new studio just over a year old, dedicates herself to approaching clients from a place of empathy and expertise. 

Winthrop said there are many unique challenges and factors to consider when tattooing scarred skin from a technical standpoint.

Posed Alexandra Winthrop. Photo by Morgan Kirsch.

“Certain scars don’t hold the pigment the way that unscarred skin does,” Winthrop said. 

Scars also take on a variety of patterns and, depending on the cause, can have different levels of thickness or extra coloration. Because of the difference in thickness and color to the rest of the skin, it may take more passes with the needle to “fully saturate the area,” Winthrop said.

Winthrop describes tattooing over scars like keloids, which are types of scars that grow and spread, and notes that this can trigger more scarring because tattoos are essentially abrasion-style wounds. 

A keloid integration tattoo featuring Floridian flora and a Polyphemus moth. The tattoo is designed to work with the shape and coloration of the keloid, using drippy and overripe fruit to make the visible scar a part of the art and not a focal point. Photo and caption provided by Alexandra Winthrop.

In these cases, Winthrop likes to incorporate the shape, color and pattern of the raised tissue into the artistic design. These efforts camouflage the scar tissue by diverting attention to the colorful inked design.

(Left) Designed for an x-ray technician, this tattoo features anatomical radius and ulna bones overgrown with various flowers. Floral is a great option for scar cover-ups, as petal texture, stems, and vines can be used to follow scars for a more organic look. Photo and caption provided by Alexandra Winthrop. (Right) A scorpion transforming into a phoenix, two symbols of strength and resilience. Both the repeating pattern of the scorpion’s plates and detailed texturing help the more raised scars blend into the overall design. Photo and caption by Alexandra Winthrop.

Winthrop sees a variety of clientele seeking cover-ups for marks like surgical scars, tummy tucks, c-sections, top surgery, accidental burns and more.

But “hands down, the majority of my clients coming to me are looking to cover self-harm scars,” she said. 

Alexandra Winthrop’s personal tattoo studio Emetic Ritual Tattoo. Photo by Morgan Kirsch.

Winthrop dedicated herself to creating a safe, nonjudgmental space while crafting art that helps people feel more comfortable in their skin. 

Walking into Winthrop’s studio, Emetic Ritual Tattoo, clients are immediately greeted with a lush, botanical garden accented by prints on the walls of beautifully unnerving, dark and surreal menagerie of floral and animalistic designs; her signature style. 

“I’m not going to be able to understand every single person’s experience with it, but I can definitely understand that it is impacting them and do my best to try and ease those fears as best I can,” she said.

That commitment to empathy is also reflected in Winthrop’s design process. She tries to meticulously share about every part of the tattoo process to alleviate clients’ discomfort or anxiety.

There is generally little tattoo training dedicated to scar cover-ups. Determined to tattoo scars as safely as possible, Winthrop is largely self-taught, meticulously studying medical textbooks with a singular focus on understanding various skin and scar types and their specific needs.

It’s “very much that mix of the technical side of what visually is going to help blend those scars away versus turning this into a symbol of healing for them and what kind of imagery in that aspect would make that impact,” she said. 

Winthrop described witnessing the joy and relief on clients’ faces after their cover-ups. Some clients felt emboldened to finally wear shorts in public in the summer while others walked into professional spaces with a newfound sense of ease.

“You can actively see that this is something that’s lifting that huge weight off of their shoulders, which is just incredible to watch. Absolutely fantastic. I am insanely humbled that it’s something I am able to help somebody with,” Winthrop said with a smile.

Dawn Grace, owner of Bella Rose Tattoo, is another trauma-informed tattoo artist who specializes in scar cover-ups and post-mastectomy art and design. Grace has been tattooing since 1996 and knew since she was five years old that the craft was her calling.

“I was drawing all over myself, my Barbies and my friends. I was drawing on everyone,” she chuckled.

During her tattooing apprenticeships, Grace noticed many tattooers “hated” doing cover-ups, and she consequently chose to take on those clients more often.

Provided by Dawn Grace.

“There wasn’t really anyone doing it and it needed to be done,” she said simply. 

As Grace entered the professional sphere and worked at different studios, she eventually became a go-to for scar cover-ups, inspiring her to open her own studio in 2012. She wanted to create a more private space where clients could feel more comfortable during a very vulnerable and intimate process. 

“I am doing what I was put on this planet to do,” Grace said.  

Grace’s shop radiates with her passions and love of the tattooing profession, from vibrant mixes of retro pop culture memorabilia to prints of work from artists she admires bedecking the walls. Alongside her memorabilia and art hang portraits of friends and mentors, some who passed away, as an ode to honor her loved ones. 

Clients enter Grace’s shop through an ornate, New Orleans-style iron gate and step into a world of vibrant color. The shop tells a tale of the artist herself. With pride, she adorns every open surface with decorative gifts from friends or clients who made gestures of love or appreciation, speaking to relationships that extend beyond the tattooing experience.

“People need to know that they’re going to be safe, whether they’re getting scar tattoos or they’re just going to a shop,” Grace said. 

Inside Bella Rose Tattoo. Photo by Morgan Kirsch.

Grace explained many of her clients come from referrals from friends, therapists and doctors who have seen her cover-up work and can attest to her reliability, bedside manner and respect for privacy. 

“Especially with the self-harm scars, people are super judgmental and nosy,” Grace said. “It’s very stigmatized.”

Clients often confide in Grace the stories behind their scars, though she is clear to draw the line that no one is obligated to share their experiences. 

“People know that I’m going to take care of them. And I’m not a therapist, so they don’t have to talk with me if they don’t want to,” Grace said.

From lending an open ear to stories of wounds from acts of gun violence to people’s darkest mental-health moments, Grace understands the importance of empathy while maintaining mental and emotional self-care.

“It’s heavy. It’s super heavy, and I have to remind myself to not take it home with me,” Grace said.

Grace encourages those considering scar cover-ups to seek out a specialist like herself first, since she has witnessed many failed attempts by other artists.

Provided by Dawn Grace.

“I’ve had to do a lot of cover-ups of cover-ups on self-harm scars, tattooers who don’t understand how scars work trying to tattoo over these scars and making it worse,” Grace said. “Scars are really tricky. They’re different from millimeter to millimeter.”

Many of Grace’s client referrals from doctors are those recovering from breast cancer operations. Grace is well-versed in designing 3-D nipple and areola tattoos as well as artistic designs over the breast or chest. 

Such was the case for self-proclaimed “breast cancer badass” and awareness advocate Karen Xaverius, who received her cancer diagnosis almost three years ago and underwent a bilateral mastectomy, or the removal of both breasts.

First tattoo sketch by Karen Xaverius and artist Grace Frantilla. Photo provided by Karen Xaverius

Xaverius knew from the get-go that she wanted an artist who specialized in mastectomy cover-ups. 

“I needed to check that box. I didn’t want just any tattoo artist doing this,” Xaverius said. 

Karen reached out to Grace after hearing her name thrown around in the breast cancer community and knew early on that Grace was the one. 

“It was like love at first sight,” Xaverius said. 

Karen Xaverius’s tattoo stencil. Provided by Karen Xaverius.

Taking an initial sketch made by Xaverius and her art therapist, Grace designed a large tattoo of peonies stretching across Xaverius’s chest, with words representing her values and written by her loved ones thoughtfully filling the empty spaces. The fine, delicate petals and leaves snake across her chest, growing with life of their own. 

Karen Xaverius’s full tattoo. Provided by Karen Xaverius.

“Going through all of those steps was what really got me to that finish line. Just a few more chemo treatments and one more surgery and then six months of healing…and THEN I can get my tattoo! I had that date circled on the calendar, and Dawn made it happen,” Xaverius said.  

The intimate process of sharing her story, crafting the design and undergoing the tattooing process began a long-lasting friendship.

“She welcomes in anyone, regardless of what has gone on in people’s lives, and she makes you feel like you’re part of her family and takes wonderful care of you, and you walk away with this beautiful design and a friendship,” Xaverius said with a smile. 

Xaverius displays her tattoo proudly, which she calls a key component of her recovery. 

Karen Xaverius posing with her full tattoo. Provided by Karen Xaverius.

Both Winthrop and Grace are profoundly moved when clients trust themselves in their hands. 

“It’s not a light decision for folks, and if someone is trusting of not only my artwork, but me as a person, to be able to do that for them, that’s the biggest compliment somebody can possibly offer,” Winthrop said. 

“It’s a big deal, and I know it’s a big deal, so I make sure to treat them like I know it’s a big deal,” Grace said.

Winthrop notes the stigmatization around scars, and their cover-ups, will take a societal shift in perspective

“The more that we push toward that as a society and not this ‘pull yourself up by the bootstraps bulls—t,’ the more people are going to be open about the fact that they’re looking for scar cover-ups,” Winthrop exclaimed.

Many of their clients walk away with lighter loads on their shoulders. 

Xaverius said. “It’s been a thing that’s changed my life. I’m forever grateful.”

If you or someone you know is struggling with self-harm, remember that support is available a call or text away. For the national Suicide & Crisis Lifeline, call or text 988 or reach out to 988lifeline.org. 

For free support groups, counseling, educational workshops and other community programs for those affected by cancer, you can reach Gilda’s Club Chicago at 312-464-9900 or visit gildasclubchicago.org.

Header photo by Alexandra Winthrop