Skin Removal Aftercare Instructions

While healing, it's very important you eat enough (even if you don't want to), stay hydrated, and rest. Try and eat more protein than normal, and if possible, eggs, fish, and poultry. If you're vegetarian or vegan and haven't had your zinc levels tested, consider taking oral zinc supplementation.

Note: If you're seeing this page and I, the author, did not direct you here, then please heed this important context! This is our provisional aftercare procedure, and it (or some version of it) has worked fine a few times, but there is a TON we don't know! We have so many open questions right now. Don't take it as gospel, and DO experiment and write back to us (if you include A/B test pictures I will be so grateful 🥺).

You Should be Given

If you end up needing more bandages, please ask!

You Need to Have

Tell me if you don’t have these! I will provide them.

First 24 Hours

Leave your bandage on.

Around 24 Hours

  1. Wash hands thoroughly. Don clean gloves if available.
  2. Put down puppy pad under wound area to catch fluids.
  3. Remove bandage. Use saline to loosen it.
  4. Assess wound for:
    1. Healing: pink tissue
    2. Signs of infection: redness, warmth to touch, fever, draining pus. If you think it might be infected, you will likely need a full course of systemic antibiotics. You need to go to urgent care. If drainage is lime green or yellow/green, this may be a sign of pseudomonas and you should get it checked out immediately.
  5. Wash wound with antibacterial soap - be gentle.
  6. Apply thin layer of hydrogel directly into wound.
  7. If there is little to no exudate, cover with tegaderm. Otherwise, continue:
  8. Apply xeroform dressing.
  9. Add ABD pad. Tape it directly to the skin.
  10. If you can wrap the area in a self-adhesive bandage, do that to help hold the dressing/pad in place.

As needed (about once daily, for the first few days), change bandage following above instructions. Your main goal is to remove any dead tissue, while not significantly irritating the wound.

Around 72 Hours

Continue changing bandage as needed, using same technique, but use antibiotic ointment instead of hydrogel.

Around One Week

A scab should have formed. Cease using antibiotic ointment. Switch to normal soap. Continue covering with tegaderm (other bandages OK).

Around 2-3 Weeks

You should have a firm, established scab. We’re gonna fuck it up so it takes longer to heal. You can either get your artist to do this (recommended) or do it yourself.

To do it yourself, at minimum, have:

Dig the scabs out. Clean it up. Apply hydrogel and cover with xeroform/ABD pads. Repeat steps starting from First 24 Hours. At this point, we don’t recommend a second peel, but you could do that anyways if you want.

Reasoning

If you're just here to read what to do, you can skip this part! Our goals for the healing process are to prevent infection, keep defined edges for the wound, and make the scar consistent and visible. We're generally not going for keloid scarring, as it's a bit harder to control, but I know people who have intentionally induced that to great success! Read this section critically!! It is here so that it can be argued with.

WHY HYDROGEL? We're using hydrogel for the inflammatory phase because it facilitates autolytic debridement, and we're using the kind with silver nanoparticles for their antimicrobial properties. We stop using this after the inflammatory phase, because silver nanoparticles are slightly cytotoxic to fibroblasts, and we want those operating at full capacity. We could do wet-to-dry dressings with manual debridement for the additional stress it puts on the wound, but I worry about the agitation being uneven and potentially blowing out the lines.

WHY COVERED? Keeping it covered while healing makes sense so that foreign particles don't lead to an infection.

WHY CLEANING? Our goal in cleaning the wound is to remove necrotic tissue that could be a food source for infectious bacteria. We shouldn't be cleaning more than necessary to achieve that goal.

WHY ABD/TEGADERM? We use ABD pads because they soak up the exudate well, and should have less of an issue drying on the wound than gauze does. When we used just gauze, it was painful to remove and re-irritated the wound in ways we didn't want. The xeroform keeps it moist. We use tegaderm because it's fun to look at your scar as it's healing. (Also, I think having an occlusive dressing keeps the wound moist, which we want?)

WHY BACITRACIN? This is a clean (ideally; maybe leaning clean-contaminated) wound healing by secondary intention. I haven't found a lot of research about whether or not topical antibiotics are indicated for this case. AFAICT, the main risk of overusing topical antibiotics is poor antibiotic stewardship. Given this and the small scale we're working on, I'm leaning towards antibiotic use being okay. We're mainly using antibiotic ointment as an adjunct to the xeroform, to keep the wound moist. (Is it necessary if the xeroform has its own antibiotic properties?) I don't know if it's still needed. The current aftercare procedure relies more on defined events to create the scar tissue, rather than continual stress. We use solely bacitracin rather than a triple antibiotic, because some folks are allergic to neomycin or polymyxin.

WHY NOT XYZ CREAM? We could add a numbing agent to the bandaging procedures. TBD. We could use silver sulfadiazine, but I forget what it does to scar formation. Need to research. We could clean with PVP-I, but AB soap should be less harsh.

WHY PEEL? We do a scab peel because this is what Enne started out doing, and it worked for it. We otherwise have no special attachment to this method of irritation, or speculation into why it works.

WHY ZINC? Studies (todo link) have shown oral zinc supplementation isn't useful for wound healing unless you're deficient in zinc. I think ~30% of vegetarians are, so we suggest supplementing in this case.

WHY PROTEIN? Your body needs proteins for the healing process. Albumin, specifically, is one that we want more of. This information came from someone with professional experience in wound treatment.

Areas for Future Research

Possible Interventions 
chemical irritation
    hperox
    salicilic acid
    capsaicin
medihoney
topical corticosteroids
silicone sheets/gels in pattern (e.g. strips)
retinoids
topical zinc oxide
silver nanoparticle hydrogel
petroleum jelly/AB ointment
scraping during process
    maybe also deepening during healing?
tattoo over healing scars
    ink rubbing
    stick-n-poke
    layering diff inks?
mechanical irritation
    sterilized sand
    AB+granulated sugar
    peeling scabs
        frequency and time
    needling (texture)
Questions I Have