All scars will go through various natural phases of healing and maturation. Usually, surgical scars will become red and slightly lumpy over the first 6 weeks. This is due to a period of scar inflammation, which is the early phase of wound healing.
The scar should then gradually fade, losing its redness and turning pale, whilst also becoming softer and flatter. This period of scar maturation starts a couple of months after the surgery and continues for 1-2 years. Therefore, this period of time is usually necessary to assess the scar’s final appearance. Whilst most scars settle well, occasionally problematic or abnormal scars form. These can sometimes be unpredictable, and an understanding that these can occur is important in your decision-making about proceeding with surgery.
If scars are under tension, there is a chance they can widen as they mature. This means that whilst they remain flat, they can stretch in width. Occasionally it may be possible to revise these scars if there is a situation where the tension can be relieved, or there is less tension in the surrounding skin; however, it is often not possible to significantly improve stretched scars. Stretched scars are more common in children who are growing (whose skin is therefore continually under tension) and also on certain areas of the body, such as the upper inner thighs.
Hypertrophic means over-growth, and this refers to a red lumpy scar that can develop in some people. This most commonly occurs as a result of a prolonged early inflammatory phase of wound healing. This may occur in situations of delayed healing, such as due to a wound infection, or a wound coming apart slightly and requiring longer to heal than usual. They may also occur in scars under significant tension, such as the central part of an abdominoplasty (tummy tuck) scar. Often these can be revised (cut out and re-stitched) successfully.
Keloid scars are thickened and lumpy scars that are more common in people of Asian or Afro-Caribbean descent. They are a genetic trait, and therefore some people are “keloid formers”. It is important to mention if you have a history of keloid scarring as this may impact on the decision-making process.
Scar care after surgery
Immediately after surgery, you will often have brown surgical tapes as part of your dressing. These act as a dressing and as support for the scar. They should be left in place until you are instructed to removed them. Often you are allowed to shower while these tapes are in place. Do not saturate the tapes with water during the shower. Afterwards, please pad the tapes dry and either leave them air dry or dry them using a hairdryer on the coolest setting before dressing again.
If you have no dressings or different dressings, please follow the instructions given to you regarding showering or keeping the area clean and dry.
Scar moisturisation & massage
When scars are healed sufficiently (usually 2 to 3 weeks after surgery), you will usually be asked to start moisturising and massaging your scars. This is done with a plain moisturiser or a vitamin E cream and should consist of gentle but firm circular massage with your fingers along the scars at least twice daily. This helps soften and desensitise scars and also helps resolve dry skin and itchy scars.
Silicone scar gels or scar sheets or tapes can be placed along scars after the moisturiser has fully absorbed. They help soften, flatten and reduce redness of scars. While optional for scars that are healing normally, they are very useful in treating firm or raised scars.
New and healing scars should be protected from the sun. They are often more sensitive to sun exposure than unscarred skin. Sun exposure can also affect the appearance as scars do not react in the same way to sun exposure as unscarred skin.
Steroid injections can be helpful in treating hypertrophic and keloid scars (see earlier section). They are performed in the clinic and the steroid is injected directly into the scar. Sometimes a series of injections is needed and not all hypertrophic or keloid scars will respond to this treatment.
If a scar remains problematic e.g. persistent puckering or stretched, sometimes it benefits from a surgical scar revision. The old scar will be revised, and the new scar refashioned in a manner designed to reduce the previous problem recurring. This new scar will then go through the process of healing and will need scar care again.