Normal healing: how does a scar evolve?

1. Every scar is permanent

Whether the skin is stitched, heals on its own or is grafted, healing always results in a scar, which never disappears. The plastic surgeon does everything possible to make it as fine and as discreet as possible: placing it in a skin crease or a hidden area, closing without tension, appropriate aftercare. An imperfection can be improved, but a scar cannot be erased.

2. How does a scar evolve?

• When the stitches are removed: the scar is generally fine and discreet.
• From 1 to 3 months: it becomes red, firm, sometimes raised, and itchy; this is the normal inflammatory reaction of maturation, at its peak at about 2 months. Its intensity varies greatly from one person to another, and above all with age: the younger the person, the more marked it is, and it may be almost absent in an older person.
• From 3 to 12 months: the redness fades, and the scar flattens and softens.
• At about 1 year: it has become white, supple and painless. This maturation takes about 12 months, at least 6 months, and sometimes more than 2 years.

3. What determines the quality of a scar?

The final appearance of a scar involves an element of uncertainty. It may be fine and discreet along its whole length, wide and thick, or alternate between discreet areas and less attractive ones. The result depends on each person’s skin (age, skin colour, personal tendency), the area of the body, the tension on the scar, smoking and the care given during maturation.

A scar contains no hair and no sweat glands. Sensation around the scar is often reduced, then improves over the two years following the procedure.

Choosing a qualified, experienced and reputable surgeon reduces these risks, and in some cases eliminates them.

4. How to look after your scar

During maturation, a few simple measures help produce a good-quality scar:

• stop smoking, which delays healing and encourages inflamed scars (see the article on smoking);
• protect the scar from the sun throughout the first year (total sunblock or clothing), to prevent it from turning permanently brown;
• massage it with a repair cream once the wound has fully closed, from about the 3rd week;
• if the surgeon advises it, apply a silicone gel or silicone sheet for several months.

5. Hypertrophic scar or keloid: what is the difference?

A hypertrophic scar is thick, red and raised, but stays within the limits of the incision; it often improves with time and care. A keloid scar spreads beyond the limits of the scar, does not regress on its own and can recur after surgical revision. It is more common on darker skin and in certain areas: the earlobe, the front of the chest, the shoulders.

See: abnormal scarring (hypertrophic, keloid, tethered, wide and pigmented scars).

6. Can a scar be improved?

A scar cannot disappear. It is, however, possible to improve an imperfection (a wide, pigmented, thick, tethered or depressed scar) or a hypertrophic or keloid scar. The methods are tailored to each case, and the plastic surgeon will explain the treatment plan to you:

• massage;
• silicone gel or silicone sheet;
• corticosteroid injections;
• vascular laser, carried out at the practice;
• surgical scar revision.

The quality of a scar cannot be judged, and surgical revision is not considered, until at least one year after the procedure.

7. When to seek advice

Seek advice without delay if you notice redness spreading around the scar, warmth, discharge, the scar opening, or fever. Also report a scar that grows beyond its edges.

See also: Abnormal scarring · Why stop smoking before cosmetic surgery? · How to prepare your skin before cosmetic surgery

Frequently asked questions