In summary
- Scarring is a certain outcome of any full-thickness incision. What surgical planning and aftercare influence is how a scar forms and matures, rather than whether one forms at all.
- Scars remodel for 12 to 18 months and sometimes longer, so appearance at six weeks is a poor guide to the final result. Tension across the wound, its location, and individual healing biology all shape how pronounced a scar becomes.
- Surgeons work to reduce scar visibility through incision placement along natural skin tension lines, layered closure that offloads tension from the skin edges, and structured post-operative care including silicone, tension support and sun protection.
Every surgical incision leaves a scar. That is the honest starting point for any conversation about scarring, and it is where a useful discussion with your surgeon begins. Human skin cannot regenerate itself perfectly after a full-thickness injury. It repairs instead, laying down replacement tissue that differs structurally from what was there before.
What can be influenced is how that scar forms, how it matures, and how visible it becomes over time. Much of surgical planning and post-operative care is directed at precisely that.
How wounds heal
Wound healing follows a well-described sequence, although the stages overlap rather than running neatly one after another.
In the first hours, the body controls bleeding and forms a clot that acts as a temporary scaffold. Over the following days, inflammatory cells arrive to clear debris and manage the risk of infection. This phase accounts for the early redness, swelling and warmth around an incision.
From roughly day three to week three, the proliferative phase takes over. Fibroblasts migrate into the wound and begin producing collagen, new blood vessels form, and the surface re-epithelialises. Collagen at this stage is laid down quickly and in relatively disorganised bundles, which is why young scars often appear raised and red.
The final phase, remodelling, is by far the longest. Over roughly 12 to 18 months, and sometimes longer, the body gradually replaces that early collagen with stronger, better-aligned fibres. Scars generally soften, flatten and fade across this period. A scar assessed at six weeks tells you very little about how it will look at eighteen months.
Why some scars are more pronounced
Several factors influence the result, and only some of them sit within anyone’s control.
Tension is among the most significant. Skin under sustained mechanical stress signals fibroblasts to keep producing collagen, which tends to produce wider, thicker scars. This helps explain why scars across the chest, shoulders and back often behave differently from scars on the eyelid or in the crease of the elbow.
Individual biology matters a great deal. Some people are predisposed to hypertrophic scars, which remain within the original wound margins, or keloid scars, which extend beyond them. Both occur more commonly in younger patients, in people with darker skin types, and in those with a personal or family history of abnormal scarring.
Other contributors are modifiable: smoking, poorly controlled diabetes, some medications, nutritional status, and any complication that delays healing, such as infection, haematoma or wound separation. A wound that heals slowly will generally scar more.
Planning the incision
The first decision made about a scar happens before any incision is made.
Where the anatomy allows, incisions are planned along relaxed skin tension lines, the natural directions in which skin folds and creases. Incisions aligned this way sit under less tension and tend to mature more favourably.
Surgeons also use anatomical camouflage, placing incisions within the hairline, along the natural crease beneath the breast, inside the eyelid, at a junction between two skin textures, or within a fold that closes over the line. The scar remains. It is simply positioned where the eye is less likely to travel.
Incision length involves genuine trade-offs. A shorter incision may be the poorer option if it restricts access, increases tension on the closure, or limits the surgeon’s ability to achieve the agreed result.
Closure technique
How a wound is closed matters as much as where it is opened.
Layered closure is standard practice in plastic surgery. Sutures placed in the deep dermis and underlying tissue carry the mechanical load, so the skin edges themselves come together under minimal tension. The surface layer is then closed for alignment rather than strength, often with a continuous subcuticular suture that avoids cross-hatch marks.
Careful tissue handling contributes throughout. Gentle retraction, precise control of bleeding, judicious use of diathermy and accurate approximation of the skin edges all reduce the inflammatory burden the wound has to resolve.
Post-operative scar management
Scar care continues well after the sutures come out.
Silicone, as gel or sheeting, has the most consistent evidence base among topical options for managing hypertrophic scarring, and is commonly recommended once the wound has fully closed. Paper tape applied along the line of the scar can help offload tension during the early months.
Sun protection also matters. Ultraviolet exposure on an immature scar can cause lasting pigmentation changes, so covering the area or applying a high-SPF sunscreen through the first year is standard advice.
Where a scar becomes raised, itchy or thickened, further options may be discussed. These can include corticosteroid injections, pressure therapy, laser treatment and, in selected cases, surgical scar revision. Timing influences the value of each, and these decisions are best made with your treating surgeon.
Realistic expectations
All surgery carries risks. Scarring is a certain consequence of surgery rather than a possible complication, and outcomes vary between individuals. No technique, product or protocol can guarantee how a particular person will heal.
If you are considering a procedure, discuss your scarring history, your skin type and your expectations openly at consultation. In Australia, patients seeking cosmetic surgery require a referral from a general practitioner or other specialist medical practitioner who works independently of the operating surgeon, along with a minimum of two pre-operative consultations. Those requirements exist so that any decision is made with a full understanding of what surgery involves.
Frequently asked questions
How long does a scar take to settle?
Most scars continue to change for 12 to 18 months, and occasionally longer. Redness and firmness typically peak within the first few months and reduce from there. Assessing the final appearance before about a year tends to give a misleading impression.
Will my scar fade completely?
Scars are permanent. They usually become paler, flatter and less noticeable over time, though the tissue itself remains. How far a particular scar fades depends on its location, the tension across it, and individual healing biology.
When can I start using silicone?
Silicone gel or sheeting is generally started once the wound has fully closed and any scabbing has resolved, which is often around two to three weeks after surgery. Your surgeon will advise on timing for your particular wound.
Does scar massage help?
Massage is widely used and may assist with comfort and pliability, though the evidence supporting it is weaker than the evidence for silicone. It should begin only once the wound has healed and your surgeon has confirmed it is appropriate.
Why does a scar need sun protection?
Immature scar tissue pigments readily. Ultraviolet exposure during the first year can cause darkening that persists long after the scar would otherwise have faded, so covering the area or using a high-SPF sunscreen is recommended.
What happens if my scar becomes thick or raised?
Raise it at your review appointment. Depending on the type of scar, its age and its location, options such as corticosteroid injection, pressure therapy, laser treatment or scar revision surgery may be considered. Keloid scarring in particular benefits from early assessment.
Can scarring be avoided altogether?
No. Any incision through the full thickness of the skin produces a scar. Surgical planning and aftercare influence how that scar looks and behaves, though the scar itself is unavoidable.
Glossary of terms
Collagen: The structural protein that forms the framework of skin and scar tissue. Early scar collagen is disorganised and gradually reorganises during remodelling.
Dermis: The deeper layer of skin beneath the surface epidermis. It contains collagen, blood vessels and the cells responsible for repair.
Diathermy: The use of controlled electrical current to seal small blood vessels during surgery. Judicious use limits tissue injury around the wound.
Fibroblast: The cell responsible for producing collagen during healing. Fibroblast activity is influenced by tension across the wound.
Haematoma: A collection of blood beneath the skin or within a surgical site. It can delay healing and increase the risk of a more pronounced scar.
Hypertrophic scar: A raised, thickened scar that stays within the boundaries of the original wound. These often improve gradually over time.
Keloid scar: A raised scar that extends beyond the original wound margins into surrounding skin. Keloids are more common in some skin types and can recur after treatment.
Proliferative phase: The stage of healing, roughly days three to twenty-one, in which new collagen, blood vessels and surface skin are produced.
Re-epithelialisation: The process by which the surface layer of skin closes over a wound.
Relaxed skin tension lines: The natural directions in which skin folds and creases. Incisions aligned with these lines sit under less tension.
Remodelling: The final and longest phase of healing, during which the body reorganises scar collagen into stronger, better-aligned fibres.
Scar revision: A surgical procedure that removes or repositions an existing scar to alter its appearance. It replaces one scar with another rather than removing scarring entirely.
Subcuticular suture: A stitch placed just beneath the skin surface and run continuously along the wound, which avoids the cross-hatch marks associated with surface stitches.
