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“Just like a printer, I work from the bottom and [go] up, and that’s largely because we don’t want to be smearing the design off [with our hands],” says Kyla Gutsche, a medical tattoo artist and owner of Cosmetic Transformations.
Her small business in Peterborough, Ont. provides permanent makeup services to disguise unwanted scars and disfiguration from injuries, and tattoo realistic physical features. Often, the staff tattoo over scars or visible signs of trauma to help clients deal with adversity they have faced.
Last year, I got the chance to visit Gutsche at Cosmetic Transformations and watch her work.
“We don’t want to change someone completely,” Gutsche says of her clients, while preparing for her next appointment.
Gutsche sits on a stool to the right of her client, Pam—who asked to be referred to by her first name—preparing 36 pigments and an assortment of plastic-covered needles. Her company’s logo, a blue butterfly, is embroidered onto the left breast of her black scrubs.
In a black chair, lined with white disposable paper, Pam sits patiently. She’s been waiting for this procedure for almost a year.
Gutsche tries to have a consultation with her patients between one to two months of them contacting her studio. However, once a client sees Gutsche, she still isn’t quick to begin the tattooing process.
“We generally suggest eight to 12 months waiting period, or ‘cooling off period,’ after the consultation, just to make sure that [the tattoo] is the right one,” Gutsche explains.
Pam was diagnosed with breast cancer when she was in her early 40s. Over the course of her treatment, she had a single mastectomy, chemotherapy, radiation and—a year ago—reconstructive surgery.
Before undergoing treatment, Pam reached out to Gutsche. She had a tattoo of a cherry blossom tree running from the base of her spine to the nape of her neck, and her reconstructive procedure needed a section of tissue from Pam’s back that would displace the tattoo. She was hoping Gutsche would know how to fix it.
A breast cancer diagnosis—and its subsequent treatment—threatens a woman’s body and her sense of self-control. Tattooing over the wound is one way to regain that power.
When I was growing up, my family didn’t talk about cancer. I thought this was because I was fortunate enough not to have anyone close to me with the disease—but I was wrong.
My maternal grandmother, Raylene Godel, had breast cancer when she was younger. A few years ago, I learned that she had a single mastectomy over 30 years prior and wears an artificial breast, known as a prosthesis.
According to the Canadian Cancer Society, every day an average of 72 women are diagnosed with breast cancer, and 14 will die from it. Breast cancer is the most common cancer among Canadian women.
My grandmother was 41 years old when she was diagnosed, in 1979—nine years before the Canadian Cancer Society recommended all women get regular mammograms.
After her daughter noticed a change in her nipple, my grandmother quickly went for the test, and was referred for a biopsy. Over the span of a few days, she was diagnosed with breast cancer and, on January 24, 1980, underwent a mastectomy.
She was not given chemotherapy as an option since it was not as widely available as it is today, nor was reconstructive surgery ever discussed.
Over the past 40 years, she has worked with countless organizations to bring control back into other patients’ lives, working with Cancer Care Ontario and Princess Margaret Hospital.
Like my grandmother, people find different ways to cope with illness, since there is no right or wrong way to deal with times of high stress. Some women choose to have reconstructive surgery, while others are not even given the opportunity.
Some women use their written words as a coping mechanism, like breast cancer survivor Ruth Rakoff, who wrote When My World Was Very Small: A Memoir of Family, Food, Cancer and My Couch.
“Cancer does not invite you to attend. It doesn’t even tell you when the party is,” Rakoff writes. “It just shows up and, if you’re lucky, after subjecting yourself to hellish treatments, it goes away.”
Gutsche guarantees that whatever her client chooses—a decorative motif, a 3D illusion areola, a scar or vitiligo coverup, or any other tattoo—she will create an environment that promotes healing through a sense of community.
Gutsche works hard to make sure other women have a better cancer experience than she did.
Becoming a medical tattoo artist wasn’t always her aspiration.
Gutsche originally studied chemistry, but she later switched fields to follow her passion for art. In 2000, she was finishing her doctorate in art and art history at Oxford University in England.
That year, at 26, she was diagnosed with ovarian cancer.
During her treatment, Gutsche experienced hair loss, including the loss of her eyebrows, which impacted her confidence. When someone who was part of her medical team offered to tattoo eyebrows on her—that wasn’t a tattoo artist—she agreed.
While her procedure was safe and sterile, the pigments soon changed colours on Gutsche’s skin.
She found a different tattoo artist who promised to fix the mistake. Since she also lost pigmentation in her lips from treatment, the artist offered to tattoo those, as well. Later, she found out that this artist had only a few days worth of course training.
Gutsche had an allergic reaction to the red tattoo pigment used and suffered from severe granulomas, a mass of tissue that grew due to the infection, known as a “red reaction.” Since her cancer treatments left her immunosuppressed, her oncologist advised that parts of Gutsche’s eyebrow and upper lip were surgically removed.
“I was left with quite severe scarring on my eyebrows and eyes,” Gutsche said. “Being quite a perfectionist and diagnosed with obsessive compulsive disorder [and] anxiety disorder, this, of course, was not ideal.”
“I used to pluck my eyebrows with a protractor, to now [having] pieces cut out of my skin. I felt like the world was over.”
After her facial surgery, Gutsche became depressed, and refused to leave her house for two years. A combination of the cancer and depression took its toll on her first marriage, which ended in divorce.
“I had a lot of anger issues. I had left [my ex-husband] to do all the chores, the cooking, [and] I didn’t want to socialize,” she recalled. “I didn’t want to do anything. I was very angry.”
Food was the only thing Gutsche could control. She became obsessed with what she ate and developed anorexia. At her lowest, she weighed only 71 pounds.
“I felt really alone until my ex-husband phoned my parents and said, ‘We’re going to be divorcing. I can’t handle this anymore.’ And I don’t blame him.”
After receiving the call, Gutsche’s father, Sig, flew from Calgary to visit her in England.
Gutsche remembers telling her father about her struggles to leave the house. When she went to the grocery store and smiled at little kids, they would cry because her surgery left her with part of her mouth twisting up.
“It’s hard to focus on that inner light when you’re just seeing darkness all around you,” she says.
Sig enrolled them both in a program at the local hospital to volunteer with young trauma survivors. He told her that if children could live through scarring, so could she. Gutsche also registered in an anorexia treatment program to address her other issues.
Slowly, she began to get better.
“I realized that I got out of the house not for me anymore, but because [one child] needed a stuffy before her surgery on Tuesday, or [someone] needed help writing for a grant application for the cosmetic procedure on his nose,” she says.
After her introduction to other cancer survivors, Gutsche’s doctor advised her to go to France for a surgeon’s second opinion to fix her appearance. The doctor told her she would need tattoos to cover up the intense scars on her face. She was shocked.
“I thought, ‘Did he not read my file? I am here because of the tattooing.’”
She also knew that her previous severe reaction to red ink meant that she possessed antibodies, increasing the chances of another negative reaction.
But the doctor introduced her to Biotic Phocea, a safe pigment company.
Eventually, Gutsche did have her eyebrows and lips properly tattooed by Dr. Belinda Lam, who performs medical tattoos in a medical facility in Vancouver, B.C.
“I had a lot of trepidation being tattooed again, given my first and second experiences,” Gutsche said.
To Gutsche’s relief, the tattoos were a success.
Eventually, she apprenticed with Lam. “She is one of my mentors, and I owe her a great deal,” she said.
Today, the marks on her face are nearly invisible.
Inspired by Lam, Gutsche decided to enter the tattoo industry to help clients rethink their scars.
“[It’s about] turning that shame into a shout about survivorship and […] reclaiming or reframing their body and their scars to be on their terms,” she said.
While most tattoo artists or technicians do one apprenticeship—the average lasting two years—Gutsche completed four apprenticeships over nearly a decade before feeling confident to tattoo on her own.
She still remembers the first person she tattooed during her apprenticeship in England.
To witness the beginning of her career, she invited her father to watch, despite his hesitation. “[My father] likened me becoming a tattooist to throwing away my Oxford education to run away and join the circus,” she said.
Her first client’s name was Sammy, who was eight years old. A year before his appointment, he had been playing with matches and started a house fire. His older brother died in the fire, and Sammy was badly burned on his face, arms, and chest.
Gutsche recalled Sammy telling her, “Even if I cry, you need to keep going because my parents can’t afford to come back.”
She had to use 25 hues to build up the pigments in Sammy’s skin to cover the burn scars, making them almost undetectable.
Due to the severity of the burns, Sammy needed four to six layers of pigments to properly cover them, compared to one or two layers of pigment for a traditional tattoo. Numbing cream can reduce the amount of pigmentation the skin absorbs, so Gutsche couldn’t use any.
It took Gutsche five and a half hours to cover Sammy’s burn scars. When she was done, Sammy asked everyone to leave the room before he looked at himself for the first time.
“I could hear crying, and we all started crying […] I made him look a lot better, but [I thought] maybe he was crying because he’s disappointed,” Gutsche said. “But Sammy came out, smiling as wide as a crocodile. He said, ‘You know what, I think my friends are going to want to play with me again.’”
“That moment is the only time I ever saw my father cry.”
Gutsche knew that even if she barely made any money and struggled to make ends meet, the joy in her heart showed this was what she was meant to do.
In May 2008, Gutsche opened her own business in Calgary, before moving to Peterbourgh the following year.
Cosmetic Transformations’ clientele is growing, and more people want medical tattoos.
Still, Gutsche continues to answer each correspondence her business receives personally, assessing each case to provide a quote.
She recognizes that this type of tattooing is emotional, requiring extra care. Because of this, people travel from around the world to see her, including across from Canada and the US, as well from as countries as far as Australia.
Although there is sometimes a language barrier between Gutsche and her clients, the trust between them remains consistent.
“I know firsthand how important […] regaining that sense of control over one’s life is,” Gutsche said.
She explained that most medical-related tattoo artists will see six to eight clients in a day to perform procedures, but she limits herself to two clients a day—about eight to ten procedures a week—to ensure they receive the proper care and attention.
In a week, Gutsche usually perform three to four procedures pro-bono—free of charge—for predominantly young trauma victims, under the age of 23.
Originally, she would donate her money out of pocket to acquire the pigments, material, and staff salaries needed for pro-bono work. However, her second husband convinced her to start the Young Trauma Survivors Foundation in 2009 to collect donations.
Fundraising has allowed Gutsche to continue doing pro-bono work and provide discounted procedures for trauma victims, cancer survivors, and injured people.
“I feel very strongly about supporting people who have been through hell and back and who often do not have many people in their life to help them recover from these battles,” Gutsche said.
However, like many small businesses, the COVID-19 pandemic has taken a toll on her.
“The closures have been very hard for my little company but so far we’re still managing to survive, so that’s good.”
Gutsche is now limited in the number of tattoos she can offer, only providing two pro-bono procedures a week. Unfortunately, her wait list is also suffering.
“Because we haven’t been able to do any of these procedures, they’re just stacking up,” Gutsche said.
Gutsche’s entire table is covered in a clear plastic sheet until the procedure begins, to ensure her tools remain sterile. Once the procedure is over, everything will be thrown out: all 36 pigments, the ten needles, and dozens of cloths—whether they were used or not.
While she has found tattooing to be an effective healing method, Gustche ensures it is the right choice for each person that steps through her office doors. When a client wants to cover a physical feature with a decorative tattoo, like Pam, she makes them wait several months to assure they are choosing the right design.
“When people have just had their mastectomy surgeries, they can be in grief […] they’re mourning the loss of a body part,” she says. “Sometimes our kickback reaction is we want to do something completely different to kind of snap us out of [the grief]. But that’s not always the best long-term decision to make.”
“I pride myself in making sure that the tattoos I do are there for life, with no regrets.”
Pam waited over a year before coming back, confident in her decision to tattoo over her scars.
They decided on a lotus blossom, a symbol of healing, to cover the cherry blossom branch from the tattoo on her back. A piece of paper of the design is taped to Pam’s collar bone and an outline of the flower has been drawn on her reconstructed breast.
Pam’s procedure won’t be easy, but she knows it’ll be worth it.
“I can’t wait for it to be finished,” says Pam excitedly, following her first of two appointments. “This is the last of my cancer. Everything [will be] finally over then.”
Megan Seligman is a recent graduate of the Master of Journalism program at Ryerson University. She’s previously written for The Ryerson Review, The Kit, and Betches.
If you require resources or assistance surrounding mental illnesses and disordered eating behaviours, please visit the Mental Health Commission of Canada’s website to learn more.