Why Is There Purple Writing on Me After Surgery?

Someone on TikTok woke up from surgery with initials written in purple marker on their shoulder and asked if anyone knew why. I do. I'm a surgeon, and that's how we mark our patients.

On the day of surgery, you come in and talk with your surgeon before you go back. (You might not remember this part. Some of the medications we give before surgery make you forget a lot.) During that visit, your surgeon marks the spot where the surgery is being done.

Different facilities have different rules about this, but most often the surgeon writes their initials on the operative site. My initials are KK, so I go mark KK on the area I'm operating on.

The alternative some places use is having you write "yes" on the side being operated on. So if you're having surgery on your right hand, you'd write "yes" on your right side.

Either way, it's a check that the right patient is getting the right operation in the right spot. Site marking is one of the steps in the Joint Commission's Universal Protocol, the safety process hospitals follow to prevent wrong-site, wrong-procedure, and wrong-person surgery.

The purple surgical marker is pretty universal. Every hospital I've worked at uses it, and initials are the most common mark I've seen across all of them. So if you have purple initials somewhere on your body after surgery, that's almost certainly what they are.

For plastic surgery, we usually don't need initials or a "yes." Instead, we draw the plan itself: where the incisions will go and how we're going to do the surgery. Those markings are the roadmap for the whole operation. (Here's how symmetric markings keep a breast reduction on course, and how we decide where the nipple goes in a lift or reduction.)

So if you wake up from a plastic surgery procedure covered in purple lines, that's normal too. It's the same idea: a plan you can see, confirmed with you before you go to sleep.

Years ago, I had a patient who was super funny. She was a cancer patient who'd had a bazillion different surgeries and reconstructions, and she thought the initials were hilarious. So she had a bunch of her surgeons' and residents' initials tattooed on her leg. I thought it was a pretty great way to keep a sense of humor through cancer treatment.

Purple initials on your skin after surgery are nothing nefarious or scary. They're your surgeon's mark confirming you were the right patient and that was the right site. Plastic surgeons draw out the incisions instead, but the purpose is the same.

The marking is one of several safety checks on surgery day. If you're vetting yours, it's also worth knowing who's actually giving your anesthesia. And if something unexpected shows up at your incision afterward, here's what that might be.