Every operation that cuts through the skin leaves a scar. Patients know this, and their questions are practical: where will my scar be, how will it look in a year, what can I do for it, and if it heals badly, can a scar revision correct it? They deserve straight answers before surgery, not after it.
This page explains how a surgical scar matures, where each operation places it, what you can do at home, and how a scar that healed badly is treated, from steroid injections and laser to scar revision surgery.
What a Surgical Scar Is, and What It Is Not
A scar is the skin’s repair of a cut that reaches its deeper layer. Repair tissue is never identical to normal skin, so a scar is permanent: it can become pale, flat and hard to find, but it does not disappear completely. Its final look depends on your genes and skin type, its location, the tension it heals under, and the care it receives. The names patients search for:
- Fresh scar. Pink or red, slightly raised, sometimes itchy: every surgical scar in its first months.
- Mature scar. Pale, flat and soft, usually at twelve to eighteen months.
- Widened scar. Flat but broader than the original line, usually from tension.
- Hypertrophic scar. Raised, red and firm, but staying within the line of the incision.
- Keloid. Scar tissue that grows beyond the edges of the wound into healthy skin.
- Hyperpigmented scar. Darker than the surrounding skin, more common in darker skin and after sun exposure.
- Tethered scar. Pulled inward because it healed attached to deeper tissue, like many cesarean scars.
- Dog ear. A small bulge of skin at the end of a scar.
- Scar revision. Any treatment that improves an existing scar: injections, laser, or an operation that removes the scar and closes the skin again.
A scar that is still red at three months is not a bad scar; it is a young one.
How a Scar Matures: The First Eighteen Months
- Weeks 1 to 3: the wound edges seal. After breast and most body operations the skin is closed in layers with absorbable stitches, so nothing needs removing; eyelid stitches come out at five to seven days.
- Weeks 4 to 8: the scar looks its worst: reddest, sometimes raised and itchy. This is normal.
- Months 3 to 6: the red begins to fade and the scar starts to flatten.
- Months 12 to 18: the scar is pale, flat and soft, and only now can it be judged.
Raised scars are common early on, and many settle. A Dutch study followed 204 patients after breast reduction or open chest surgery: 60 percent developed a raised (hypertrophic) scar, almost all within three months, and at twelve months 32 percent still had one. Younger patients were more prone to it (Mahdavian Delavary 2012). A raised scar at three months often improves, but it is the right moment to start treating it. I judge a scar at twelve months, not at six weeks.
Where Each Operation Leaves Its Scar
Scar position can be planned; scar quality is largely decided by your own healing. I place incisions in natural creases, in the hairline or under underwear wherever possible, and I choose the shortest scar that will actually hold the result.
- Face: a facelift scar runs in front of and around the ear and into the hairline; a wide or visible one can be corrected, as explained in facelift revision. Upper eyelid surgery leaves a scar in the natural crease; a lower lid operated from the inside leaves none on the skin. An open rhinoplasty leaves about five millimeters under the columella, between the nostrils.
- Breast: an augmentation scar sits in the fold under the breast. A breast lift or reduction scar runs around the areola, adds a vertical line for moderate sagging, and adds a scar in the fold (the anchor pattern) for severe sagging and large reductions.
- Abdomen: a full tummy tuck leaves a low scar from hip to hip, under underwear, plus a small scar around the navel. A cesarean scar in the removed skin goes with it.
- Arms and thighs: an arm lift leaves a line along the inner upper arm; a thigh lift leaves one in the groin crease, with a vertical line down the inner thigh when an L or T pattern is needed.
- Liposuction: openings of a few millimeters in skin creases, which fade over about a year.
Why Some Scars Heal Badly
- Tension. Skin closed under pull widens and thickens, which is why the deeper layer, not the skin, should carry the tension.
- Location. Scars on the chest, shoulders, back and upper arms thicken more often than scars on the face.
- Genes and skin type. People of Asian and African descent are much more prone to raised scars and keloids than people with fair skin (Ogawa 2019).
- Healing problems. Infection or a small separation of the wound edges leaves a wider scar.
- Smoking. It slows healing and leaves thicker scars; read my guide to smoking and surgery.
- Sun. Ultraviolet light darkens a young scar, and the color can last.
Hypertrophic Scar or Keloid?
A hypertrophic scar is too much scar tissue inside the line of the incision. It usually appears in the first months and often improves over one to two years. A keloid spreads beyond the wound into healthy skin, can grow for years, and rarely regresses. Keloids are typical on the earlobe after piercing, on the chest and on the shoulders, and they often run in families.
A keloid that is simply cut out tends to come back, so removal is combined with other treatment. Even then, among 5,547 keloids treated with surgery plus one other treatment, about one in five recurred (Ellis 2020). If you have ever formed a keloid, tell me before any operation is planned. I explain the risk openly rather than reassuring you: in keloid-prone skin, every incision needs planning. When I remove a keloid, I follow the surgery with steroid injections into the scar, and radiotherapy is an option I discuss when the patient wants to add it.
Scar Care After Surgery: What Helps
Good scar care is unglamorous. International guidelines recommend reducing tension, taping, keeping the scar hydrated, protecting it from ultraviolet light, and silicone as the first treatment (Monstrey 2014).
Silicone gel or sheets
I start silicone about one month after surgery, once the incision has fully closed and is dry, never on an open wound or a scab. I recommend using a silicone gel and silicone sheets together: the gel during the day, on the face and areas that move, and the sheet or tape at night and on long, flat scars on the body. Use it every day for at least three months, longer while the scar is still red or raised. Silicone tape also holds the scar still, and less tension helps a scar mature (Ogawa 2019).
The evidence is real but not strong. A Cochrane review of 20 trials with 873 people found that silicone gel sheeting roughly halved the rate of raised scars in people prone to them, but the trials were small and at high risk of bias (O’Brien 2013). I recommend silicone because it is safe, simple and the most widely supported option. No cream removes a scar.
Sun protection
Protect a new scar from the sun for the first year: clothing or a silicone sheet on the body, a high-protection sunscreen every day on the face. In a randomized trial on small skin wounds, wounds that healed without stitches and were then exposed to sunlight left darker scars, judged the most disfiguring at twelve weeks (Due 2007).
Massage and avoiding tension
Gentle massage softens a scar and eases tightness and itching. Start only once the incision has fully healed, usually around the fourth week, for a few minutes two or three times a day. The evidence is weak: in a review of ten studies, 27 of 30 surgical scars treated with massage improved, but the methods varied (Shin 2012). For six weeks, avoid heavy lifting and movements that stretch the new scar; tension in these weeks is what widens it.
Treating a Scar That Healed Badly
If a scar is still raised, thickening or widening at three months, it is time to act. The treatment depends on the problem.
- Steroid injections for raised scars. When a scar becomes raised, a steroid injection into the scar calms the inflammation, and the scar flattens and softens over the following weeks, usually after a few injections several weeks apart. If you are in Istanbul or nearby, I do the injections myself; if you live abroad, I write to a doctor near your home with the plan, because this treatment should not wait for a flight. Steroid injections improve raised scars and keloids quickly, though the injection is uncomfortable (Ogawa 2019).
- Laser for red or uneven scars. In a meta-analysis of 12 randomized trials with 475 patients, laser or intense pulsed light started early after surgery improved how surgical scars looked, with few side effects (Wang 2024). I recommend and perform Fotona laser treatment for scars in my clinic in Istanbul; it is a course of sessions, so if you live far away, the same treatment at a laser center near your home is the practical choice. Laser cannot narrow a wide scar.
- Camouflage for pale scars. A mature scar that healed paler than the skin around it does not regain its color; micropigmentation or a tattoo can camouflage it.
- Surgical revision for wide, misplaced or tethered scars. Width, position, a dog ear or a scar pulled inward will not change with time or injections; revision can.
Surgery does not help, or not yet, when the scar is still maturing, when the tension that widened it remains, when the problem is only color, or when a keloid would be removed without further treatment.
Scar Revision: How I Plan It
I revise a scar once it has matured, which usually means six to twelve months after the operation, and longer if it is still red, unless there is a problem that cannot wait. The plan starts with why the scar healed the way it did; a revision that ignores the cause produces the same scar again.
Most scar revisions are small operations. A scar that healed wider or thicker than expected, or a dog ear at the end of a tummy tuck scar, is usually revised under local anesthesia as a day case, in the clinic or in the hospital depending on the scar, and you go home the same day. The old scar is removed and the skin is closed again in layers, so that the deeper layer carries the tension and the skin edges meet without being pulled. When the scar is part of a larger problem, such as a tummy tuck scar placed too high to hide, the correction is a second full operation.
After a revision, scar care starts again from the beginning. Scars from operations done elsewhere are assessed the same way, and I do not comment on the first surgeon. Scars from injuries and burns are covered on my burns and wounds page.
Your Week in Istanbul
Scar care starts on the day of surgery. For most breast and body operations you stay five to seven days:
- Day 0: surgery under general anesthesia in an accredited hospital, with an anesthesiologist present; one night in hospital, two after a tummy tuck or a combined operation.
- Days 1 to 5: at your hotel. Dressings stay clean and dry; nothing goes on a fresh wound. Walk every day, but avoid lifting. My team is in touch with you daily.
- Day 6 or 7: final check the day before you fly, and your scar care instructions for home.
A scar revision under local anesthesia needs a shorter visit. The recovery planner turns your surgery date into a day by day calendar.
Recovery: Your Scar Month by Month
- Weeks 2 to 4: the incision closes and dries; sun protection starts now. Bath, pool and sea wait until around week four. At about one month, start silicone gel and sheets.
- Weeks 4 to 8: the scar looks its worst; keep going.
- Month 3: send me close-up photographs; I follow every scar I am sent. A scar that is thickening or widening is treated now, not later.
- Months 12 to 18: the scar is mature; this is when it is judged, and when a revision is planned if needed.
Risks and Honest Limits
- No scar disappears completely. A good scar fades to a fine, pale line. Anyone who promises a scar nobody will see is selling rather than informing.
- A revision replaces one scar with another. The new scar is usually narrower and better placed, but it goes through the same eighteen months, and skin that tends to scar can heal the same way again.
- Keloids come back, about one in five even after combined treatment (Ellis 2020).
- Treatments have side effects. Overused steroid injections can thin the skin or make it paler; laser causes temporary redness and, rarely, blistering or a color change, more often in darker skin.
- The evidence is modest. Most scar treatments were tested in small trials. What is certain is that tension, sun and smoking make scars worse.
- Sometimes the right advice is to wait. If I do not think a treatment will do more than time will, I will tell you so.
What Shapes the Price and What Is Included
Scar treatment ranges from a few injections to a revision operation. The quotation depends on:
- What the scar needs: injections, laser, a surgical revision, or a combination.
- Size and location: a short scar on the face and a long scar across the abdomen are different operations.
- Anesthesia: local for most small revisions, general when the revision is part of a larger operation.
- Combination with another operation, and the length of your stay in Istanbul.
I quote in writing after seeing your photographs. Every quotation is all inclusive: the surgery, the hospital stay, the anesthesia, medication, the compression garment (if relevant), your accommodation, airport and clinic transfers, and the follow-up visits and post-operative contact in Istanbul.
Before and After: How to Read the Photographs
Scar photographs are easy to flatter: flash washes out redness and distance hides width. Compare close-ups under the same light, look at width and color, and ask when the photograph was taken; the honest photograph of a scar is at twelve months. Look at the scar as closely as at the shape, because you will live with both.
Many patients do not want their photographs published. Results shared with consent are in the before and after gallery; in a video consultation I can show you more cases.
Send your photographs for an assessment. A close-up of the scar in daylight without flash, and a photograph from further away that shows where it is. Add which operation you had and when, what has been tried so far, and whether you or anyone in your family has formed a keloid. Send them on WhatsApp, +90 544 772 0772, or by email, info@mustafaaydinol.com, whichever you prefer.
Frequently Asked Questions
How long does it take for a surgical scar to fade?
Twelve to eighteen months. It looks its worst between weeks four and eight, stays pink for three to six months, and then flattens and fades.
When can I start silicone gel or sheets after surgery?
About one month after surgery, once the incision has fully closed and is dry. I recommend gel and sheets together, every day for at least three months.
Is my scar hypertrophic or a keloid?
A hypertrophic scar stays within the line of the incision and often improves. A keloid spreads beyond it and keeps growing. A good close-up photograph usually shows the difference, and the treatment differs.
How long should I wait before a scar revision?
Until the scar has matured, usually six to twelve months after the operation. Raised scars are treated with injections or laser much earlier; surgery waits.
Can I go in the sun after plastic surgery?
Yes, but keep the scar covered or protected for the first year. Sun darkens a young scar, and that color fades slowly.
About the Surgeon
Dr. Mustafa Aydınol is a plastic, reconstructive and aesthetic surgeon practicing in Istanbul, a member of ISAPS and of the Turkish Society of Plastic Reconstructive and Aesthetic Surgeons. The practice holds Health Tourism Authorization from the Turkish Ministry of Health.
Sources
- Mahdavian Delavary B, van der Veer WM, Ferreira JA, Niessen FB. Formation of hypertrophic scars: evolution and susceptibility. 204 patients after breast reduction or sternotomy; a hypertrophic scar developed in 60 percent within 12 months, 96 percent of them within 3 months; 32 percent still had one at 12 months; younger patients were more susceptible. Journal of Plastic Surgery and Hand Surgery, 2012. DOI
- O’Brien L, Jones DJ. Silicone gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane review of 20 trials with 873 people; in people prone to scarring, silicone gel sheeting reduced hypertrophic scarring (risk ratio 0.46), but the trials were highly susceptible to bias and the evidence is weak. Cochrane Database of Systematic Reviews, 2013. DOI
- Monstrey S, Middelkoop E, Vranckx JJ, et al. Updated scar management practical guidelines: non-invasive and invasive measures. International group of 24 experts; reduce skin tension, tape, hydrate and protect early scars from ultraviolet light; silicone sheeting or gel as first-line prevention and treatment; surgical correction of permanent scars at a later stage. Journal of Plastic, Reconstructive and Aesthetic Surgery, 2014. DOI
- Due E, Rossen K, Sorensen LT, et al. Effect of UV irradiation on cutaneous cicatrices: a randomized, controlled trial with clinical, skin reflectance, histological, immunohistochemical and biochemical evaluations. At 12 weeks, sun-exposed scars of wounds that healed without stitches were darker, scored higher for color and area, and were judged the most disfiguring. Acta Dermato-Venereologica, 2007. DOI
- Shin TM, Bordeaux JS. The role of massage in scar management: a literature review. 10 publications, 144 patients; 45.7 percent improved overall, and 27 of 30 surgical scars improved; regimens varied and the evidence is weak. Dermatologic Surgery, 2012. DOI
- Wang Z, Chen Y, Yang X, Pan B, Xie H, Bi H. Safety and effectiveness of laser or intense pulsed light treatment for early surgical scar: a systematic review and meta-analysis. 12 randomized trials, 475 patients; the laser groups did better than the controls in all studies, with minimal adverse reactions. Aesthetic Plastic Surgery, 2024. DOI
- Ogawa R, Akita S, Akaishi S, et al. Diagnosis and treatment of keloids and hypertrophic scars: Japan Scar Workshop consensus document 2018. Asian and African patients are far more prone to keloids and hypertrophic scars than Caucasians; steroid injections improve symptoms rapidly but are painful; fixation tape and gel sheets reduce tension and promote maturation. Burns and Trauma, 2019. DOI
- Ellis MM, Jones LR, Siddiqui F, Sunkara PR, Ozog DM. The efficacy of surgical excision plus adjuvant multimodal therapies in the treatment of keloids: a systematic review and meta-analysis. 60 articles, 5,547 keloids; recurrence 19 percent after surgery plus one additional treatment and 11.2 percent after surgery plus two or more (difference not significant). Dermatologic Surgery, 2020. DOI
