Anna Brodska
How a Surgical Scar Forms
Every surgical incision produces a scar. The surgeon aims to place and close it carefully; aftercare allows healing without unnecessary tension, infection or sun-related pigmentation. A scar cannot be erased, but most gradually become paler and softer.
I remind patients that the first few weeks are not the final result. Maturation takes months and sometimes two years or longer; products work only within an individual’s biology.
Never apply silicone, creams or makeup to an open, weeping or infected wound. It needs clinical assessment first.
Stages of healing
| Stage | What happens | Possible appearance |
|---|---|---|
| Early inflammation | The body controls bleeding and clears injury | Swelling, redness and tenderness near the incision |
| Tissue formation | New vessels and collagen develop; strength increases | Pink, firm or slightly raised line |
| Remodelling | Collagen reorganises and the scar softens | Colour, thickness and tightness gradually decrease |
| Mature scar | Active change slows | Usually a calmer, paler line—not an invisible one |
The phases overlap. Redness alone is not proof of abnormal scarring, but sudden deterioration after stability needs review.
What influences the final scar
- genetics and previous scarring;
- body site, tissue thickness and tension;
- incision direction, length and closure;
- infection, wound separation, seroma or haematoma;
- nicotine, uncontrolled diabetes and poor nutrition;
- mechanical load and ultraviolet exposure;
- individual reaction to suture material.
Even ideal care cannot make two people heal identically. I assess colour, height, firmness, itching, pain, tissue movement and whether growth extends beyond the original incision.
A safe sequence of care
- Initially follow only the dressing, shower and wound-care instructions.
- Do not pick crusts or stretch the area prematurely.
- Wait until the skin is fully closed, with no open or weeping points.
- After review, begin advised silicone or massage if appropriate.
- Cover the scar and use broad-spectrum SPF 30+ when exposed.
- Photograph change in consistent lighting and attend follow-up.
What treatments can realistically do
| Method | When it may be considered | Important limitation |
|---|---|---|
| Silicone gel or sheet | On fully closed dry skin when advised | Never on an open/weeping wound; stop if irritation develops |
| Massage | After clearance and sufficient healing | Early or aggressive pressure may injure the incision |
| Sun protection | Once closed and potentially exposed to UV | Silicone and clothing may not provide adequate protection alone |
| Paper tape | Only according to the surgeon’s protocol | Do not apply to irritated skin or create tension yourself |
| Injection, laser or revision | Selected problematic scars after diagnosis | Choice and timing depend on scar type |
An expensive cream cannot outperform infection control, reduced tension and time. “Natural” oils may still cause contact dermatitis.
Fine-line, hypertrophic or keloid scar
A fine-line scar may initially be pink and slightly raised before flattening. A hypertrophic scar is firm and raised but stays within the wound boundary. A keloid grows beyond it and may continue enlarging. One photograph is not always enough to distinguish them.
Seek review if:
- the scar rapidly thickens or extends beyond the incision;
- pain, itching or tightness increases;
- redness, heat, pus or odour develops;
- edges separate or bleed;
- movement becomes restricted;
- silicone, tape or cream causes a skin reaction.
Where scars are placed
When anatomically safe, I plan incisions in natural folds or concealable areas. Length alone does not define quality: an overly short incision can create tension. See abdominoplasty, breast lift and facelift for procedure context.
Frequently asked questions
When may silicone begin?
Only after complete wound closure and team approval. Timing depends on the procedure and healing.
Can I sunbathe with silicone covering the scar?
Silicone is not complete UV protection. Cover a new scar and use broad-spectrum SPF 30+ as advised.
Is itching normal?
Mild itching may occur during maturation; severe or increasing itch with rash, pain or discharge needs assessment.
When should laser or revision be discussed?
After defining scar type and phase. Some changes need time; others benefit from earlier treatment. There is no universal date.
Key point
A good scar is not created by one product. Surgical technique, uncomplicated healing, avoiding nicotine and infection, tension control, appropriate silicone and consistent sun protection all matter. Do not judge the final result in the first weeks.
Sources
- NHS: Scars
- Cambridge University Hospitals: Silicone for scars
- British Association of Dermatologists: Keloids
Medically reviewed by Anna Brodska, plastic surgeon. Updated 7 September 2026.
