Consultant Plastic, Reconstructive and Aesthetic Surgeon

Scar Healing following Surgery

After surgery, a scar goes through a number of phases before it is fully mature.

In the early days following surgery, a dressing protects the wound. After removal of the dressing, the initial scar is usually quite narrow and may have a few small crusts on the surface. At this stage, the scar can be washed with regular soap and water, which will usually dissolve these small crusts. A simple moisturiser, such as E45 or emulsifying ointment, can be applied on a daily basis to help soften the skin around the scar. During this phase it may be possible to feel “lumps” at intervals under the surface of the skin. These usually represent internal sutures, which can be felt for the first six or eight weeks following surgery. After this time they dissolve, and the scar becomes smoother.

Mature woman with healing scar 1, 2, 3 weeks and one month after Mohs surgery for Basal Cell Carcinoma

A few weeks following surgery, the line of the scar will become red. This is a normal part of the healing process, and due to new blood vessels growing into the scar. This redness usually remains in a scar for 6-12 months, and possibly longer. During this stage, I would still recommend using a simple moisturiser, as the skin around a scar is generally drier and may be more scaly compared to normal skin. There is no proven, scientific benefit from Bio-oils, Vitamin E oils or many other agents marketed for scars. Many of these substances are extremely oily, and many sit on the surface of the skin with little being absorbed. There is, therefore, unproven benefit to the skin from the active agent.  There is some evidence that silicone gels may have limited benefit, and occasionally laser is used to speed up the maturing process. Most scars will eventually reach the next (third) stage, whether or not these treatments are used.

The third phase is the maturing phase, during which time the scar becomes pale and soft, about 12-18 months after surgery. While the scar will never disappear entirely, it becomes much less conspicuous and starts to blend with the surrounding skin.

Some scars behave abnormally, and form hypertrophic or keloid scars. These scars are typically larger than the initial wound, and remain red, raised and lumpy compared to the surrounding surface. The small percentage of scars that fall into this category may require treatment to improve their appearance. If a scar is behaving like this, further attention should be sought to see whether treatment is necessary.