There is only so much you can do with aftercare; a shallow, poorly done piece won't suddenly become amazing if you scrub it lots, nor is it likely that a very pale skinned person will develop huge keloid scarring, even from a deep well-cared-for wound.
When deciding on an aftercare routine, it is important to know the factors which will influence how your scar will heal, so you can choose methods that will exploit those factors and give the desired end result.
Factors which influence healing
There has been a large amount of research done in recent years to discover the optimal healing conditions for wounds. The faster a wound heals, the less scarring there will be. The focus of medical research has been the prevention of scarring, rather than the creation of scar tissue, but if we know what makes a wound heal quickly, we can do our best to alter the environment to delay the healing process, and create a larger scar.
- A wound will heal twice as quickly in a moist environment, especially during the proliferative phase. Keeping your new scarification dry is the easiest thing to do to encourage it to scar, which means leaving it open to the air. However, a dry wound will form large scabs, which, on areas of high movement, may begin to crack and form points of pressure, creating an uneven scar. In certain areas of the body, it may be preferable to keep the wound moist during the day when you will be moving the area, as the resulting smaller scar will still be preferable to uneven scarring. For larger scarification pieces, or skin removal, it may be advisable to keep them covered for 2-5 days, to minimize the risk of infection.
- a wound heals best in a slightly acidic environment. Aftercare products which create an alkaline environment will delay the wound healing process.
- a well oxygenated wound will heal faster than one that is deprived of oxygen. While our blood oxygenation level isn't something that we can safely control, it is mentioned here as if you smoke, your blood oxygen level is likely to be lower. It has been noted in medical research that smokers take longer to heal wounds than non-smokers. However, oxygenation, or more accurately, aeration of a wound is not determined by blood-oxygen levels and rather by exposure to the air. This is more related to the "drying" factor, mentioned above, which promotes scabbing through dessication.
- Foreign bodies
- Small foreign bodies (such as bacteria) are trapped by the cells of the immune system and are removed from the wound in the fluid that exudes from the wound in the early stages of healing. Larger foreign bodies surrounded by wounded tissue (such as implants) cannot be removed from the wound, so the body forms a pocket of scar tissue around the object to isolate it from the body tissue. Foreign bodies in open wounds can help increase the level of scar tissue formed. However, any foreign body introduced into a break in the skin barrier should be properly sterilized first to prevent the introduction of other pathogens into the open wound.
It should be noted that those with a history of immune deficiency or related diseases, such as a predisposition to influenza, colds or other infectious diseases are especially at risk of contracting further illnesses through the deliberate introduction of improperly sterilized foreign bodies.
- Repetitive trauma
- If additional trauma to the wound is suffered during the healing, the wound will be pushed back into the inflammatory phase, extending the overall healing time, and increasing scarring.
- Scars around joints and areas of high movement are generally the ones which form the largest scars. The continual pulling on the skin around the wound prolongs the inflammatory phase and more cells are released stimulating the production of collagen. Wounds in high tension areas can appear to heal normally, but often start to raise and form hypertrophic scar tissue when increased tension is put on the wound during the first couple of months of healing.
There are other factors which affect healing of wounds, but these are ones we are unable to (safely) control, including diet, and presence of infection.
When considering fresh wounds, it is important to keep the wound covered with a sterile bandage or dressing to minimize the risk of infection. This is especially important during the early phases of healing immediately after incision or damage to skin when the risk of infection is highest. Normally, the skin is a sufficient barrier to most pathogens but, in areas where the skin is ruptured, extra care should be taken to prevent disease.
Possible aftercare methods
- Manual irritation
- essentially, scrubbing at it. A (clean) toothbrush can be used, or an abrasive substance such as salt or sugar mixed with Vaseline. This repetitive trauma will prolong the healing process. If this method is to be used, its important that the area is irritated evenly, or uneven scarring will result. If the piece includes lines, it should be rubbed along the lines, not across them, and if the piece is very intricate, its probably best you don't scrub at it at all.
- Chemical irritation
- substances like lemon juice and vinegar are often used to lower the pH of the wound and take it away from optimal healing conditions. Hydrogen peroxide is one of the least painful chemical irritants used. Beware that hydrogen peroxide is highly toxic and should not be used if there is a risk of it entering the blood. 1
- keeping the piece open to the air will allow it to dry out and slow the healing process. This is not always a good idea as large pieces, especially skin removal, carry a risk of infection due to the breach of the body's first line of defense. If you will be spending time in an environment that will expose the piece to bacteria then it should be kept covered. Regular rinsing with strong salt solution will also help keep the area dry. Pieces on areas of high movement will probably be more comfortable if they are covered for at least the start of the healing process, otherwise scabs will form and crack as the body moves, possibly leading to patchy scarring.
- one of the most effective ways to promote raised scar formation is to pull the edges of the wound apart on a regular basis, for at least the first couple of months of having the piece. While it often looks like the scar is pretty much healed after a few weeks, in fact scar tissue is still being formed, and pulling the skin around the piece regularly will stimulate this formation. The continual tension caused by movement is one of the reasons why scarification on the upper arms and shoulders tends to form nice raised scars.