When David Rich sits down with a client to begin a tattoo, he always considers the concerns and safety of his clients. Rich has worked at Golden Tattoo & Piercing in downtown Iowa City for 14 years.

The cover-up process revolves around comfort, safety, and execution to ensure the comfort of the client, the safety of the scar tissue and the site, and the execution of a tattoo that will make the client happy.

“Since receiving [my] tattoo, it has given me so much confidence,” said Tia Scheitlin, a children’s assistant at Mount Pleasant Public Library.

Scheitlin sought tattoo coverage for keloid scars — raised scars that cover more skin than the original injury — she received from an infected vaccine site on her upper left arm. The raised bumps were noticeable, Scheitlin said, and became a point of insecurity for her.

“People would stare and that made me feel uncomfortable,” Scheitlin said.

One of the main complications when tattooing a scar is that the skin can often be different in depth throughout the site of the injury. The ink may also work its way out or the site can bleed much more in areas where the tissue is inconsistent.

Rich said the process entails more than just “running it through” like a typical tattoo.

“On parts where it’s deeper, you actually have to really saturate it to get it to stay,” Rich said.

Catherine Norwood, the director of clinic operations and therapist at Psychiatric Associates in Iowa City, cited the mental health benefits of this process.

“The scar itself is often not chosen by the individual but the tattoo is, which helps the individual have some control over the uncontrollable,” Norwood said.

Norwood believes cover-ups can offer a psychological sense of empowerment, confidence, purpose, and positivity that increases self-esteem and confidence, while also giving the individual an opportunity to control the narrative surrounding their scar.

In most cases, the process of scar coverage requires extreme delicacy from the artist. Establishing a partnership and trust between an artist and their client is paramount, according to Rich.

“You have to make them feel comfortable as much as possible,” Rich said, noting the experience of tattooing over a client’s self-harm scars.

Rich said he establishes honest, open communication with his clients by first explaining the tattoo process to them thoroughly, including showing them the needles he intends to use and their respective expiration dates to reassure the client.

“They need to feel like they’re safe,” Rich said. “I let them play their music on the speaker and really try to make them feel at home.”

Many times, clients experiencing insecurity are in a rush to conceal their wound, but Rich noted the client’s scar must be adequately healed before it can be tattooed to prevent further injury.

According to Rich, a telltale sign of a scar being ready is that it no longer has redness and matches the client’s skin color.

Steve Barjonah, owner of Crossroads Tattoo on 508 Second Ave. in Coralville, has similar tattoo processes to Rich. As a tattoo artist with over 36 years under his belt, he has applied a certain approach to the art of cover-ups.

“Usually, you try to do a design that’s bigger than the scar and will help mask where the scar tissue is,” Barjonah said.

Regarding the risk of the tattoo, there’s no guarantee that the ink will stand the test of time on damaged tissue.

“Sometimes the lines will spread, sometimes the color won’t hold,” Barjonah said.

However, Barjonah noted that this risk, though elevated when dealing with scars, is a point of consideration for any tattoo job.

While there are many reasons one might want a tattoo over a scar, Norwood has also seen clients who face some potential drawbacks from the process.

“Discoloration, aging, or the individual changing their mind at some point in their life,” Norwood said, are all possible at any point after getting a tattoo

The artists shared the sentiment of considering permanence for future clients interested in scar coverage. If the decision is made in haste or out of insecurity, it can quickly lead to regret, nullifying the purpose of this reformative process.

While this is only one of many potential solutions for healing, tattooing over scars can be a form of therapy in which an individual is able to reframe their view of oneself and their struggles, gaining a greater sense of resilience, encouragement, and purpose behind a dermal imperfection.

Now five months after receiving her tattoo, Scheitlin has a newfound confidence in her scars.

“I don’t even care if people stare at it, besides, I can now show off my guns,” she joked.