Every surgical incision produces a scar. The realistic goal of scar care is not to eliminate scarring — that is not biologically possible — but to produce scars that are thin, flat, pale, and positioned where they are difficult to notice. With appropriate technique on the surgeon’s side and consistent scar care on the patient’s side, that standard is achievable for most cosmetic procedures.
This guide sets out what affects scar quality, what the evidence supports for scar management, and the practical regime that produces the best long-term scar outcomes. Procedure-specific scar guides are linked at the foot of the page.
What scars are and how they mature
A surgical scar is the skin’s response to injury. It progresses through three overlapping phases:
- Inflammatory phase (0 to 2 weeks). The wound is closed surgically; the body delivers immune cells and growth factors to the site. The scar appears red, raised, and tender.
- Proliferative phase (2 weeks to 3 months). Fibroblasts deposit new collagen in the wound. Scars often look worse during this phase — thicker, redder, sometimes itchy — before they look better. Many patients become concerned at the 6 to 12 week mark, exactly when the scar is at its most prominent.
- Remodelling phase (3 to 18 months). Collagen reorganises and remodels. The scar flattens, fades, and softens. Most of the visible improvement happens between months 3 and 12, with continued subtle changes up to 18 months.
Scars do not finish maturing for at least 12 months, and often longer. Final scar quality cannot be reliably judged before that point. The scar that looks concerning at 8 weeks usually looks unremarkable at 12 months, provided the right care is in place.
Factors that affect scar quality
Several factors influence how a scar heals. Some are determined by the surgeon (incision placement, tension on the closure, suture technique). Others are determined by the patient (smoking, nutrition, scar care adherence, sun exposure). And some are intrinsic — your skin type, your genetic tendency to form hypertrophic scars or keloids, the location of the scar on your body.
The factors most strongly under patient control are:
- Smoking and nicotine. The single biggest influence. Smokers have substantially worse scars than non-smokers, with documented differences in width, redness, and overall quality. Centre for Surgery requires complete cessation of smoking, vaping, and nicotine products for at least 6 weeks before surgery and 6 weeks after. Permanent cessation produces the best long-term outcomes. See the impact of smoking.
- Sun exposure. UV exposure on immature scars causes permanent hyperpigmentation. The 12 months after surgery are the critical window — scars exposed to UV during this period become permanently darker and more visible. SPF 50 sunscreen on the scar is essential, and applies in winter and on cloudy days too.
- Tension on the wound. Activities that pull on the closure during the first 6 weeks produce wider, more visible scars. The activity restrictions set by your surgeon are not just about wound dehiscence — they are about scar quality at the 6 to 12 month mark.
- Adequate nutrition. Protein, vitamin C, zinc, and vitamin A all support collagen synthesis. Patients on highly restrictive diets, those who have lost significant weight rapidly, and those with eating disorders are at higher risk of poor scarring.
- Adherence to scar care regime. Discussed in detail below.
The evidence-based scar care regime
International scar management guidelines, including the consensus recommendations published in successive editions of Plastic and Reconstructive Surgery, identify silicone-based products as the first-line non-invasive treatment for both prevention and treatment of scars. The evidence base spans more than 30 years and multiple randomised trials. No other topical treatment — not vitamin E, not onion extract, not bio-oil, not any of the various proprietary creams — has equivalent supporting evidence.
The standard regime that produces the best long-term scar quality:
Weeks 0 to 2: wound care
During the first two weeks the focus is on clean healing of the closed wound, not scar treatment. Standard guidance:
- Keep the wound dry as instructed (most procedures permit gentle showering from day 2 to 5; specific to procedure).
- Wash with mild unscented soap and water; pat dry, never rub.
- Avoid antibacterial soaps on the wound itself — they kill normal skin flora that supports healing.
- Do not apply any creams, oils, or scar treatments to the wound during this phase.
- Follow dressing-change instructions exactly as provided in your discharge pack.
- Watch for signs of infection (increasing redness, warmth, discharge, fever) and contact the clinic if any develop.
Weeks 2 to 4: transition
Once the wound is fully sealed and the surgeon confirms healing is progressing as expected (usually at the 1- or 3-week appointment), preparation for the scar care phase begins. Sutures, if non-dissolving, are removed at this point. Steri-strips often remain in place for an additional week or two.
From week 4 onwards: silicone treatment
From around 3 to 4 weeks post-operatively, once the surgeon has confirmed the wound is fully closed and dressings are no longer needed, silicone-based scar treatment becomes the central intervention. Two formats are available:
- Silicone gel sheets. Adhesive sheets that adhere to the scar. Most effective on flat areas where they stay in place — abdominoplasty scars, breast surgery scars, body contouring scars. Worn for 12 to 23 hours per day, removed for washing and to allow the skin to breathe briefly. Each sheet typically lasts 1 to 2 weeks before needing replacement.
- Topical silicone gel. A liquid silicone preparation applied as a thin layer twice daily, allowed to dry. More practical for facial scars (rhinoplasty, blepharoplasty, facelift), small or curved areas, or areas where adhesion is difficult.
Both formats work through the same mechanism — hydration of the scar tissue and modulation of fibroblast activity — and have comparable effectiveness. Choice between them is mostly practical. The treatment is continued for at least 6 months for most scars, ideally 12 months for larger or higher-risk scars (abdominoplasty, breast reduction, brachioplasty, thigh lift).
For a detailed discussion of silicone strips specifically, see do silicone strips help cosmetic surgery scars heal better.
Throughout the first 12 months: sun protection
SPF 50 sunscreen on the scar whenever it might be exposed, including through clothing for prolonged sun exposure (cotton T-shirts provide only about SPF 5). For scars in areas not usually exposed, this means thinking about beach holidays, swimwear, and clothing that exposes the scar area. UV-protective clothing is a reasonable alternative for swimwear, particularly for the first summer post-operatively. See the effects of tanning on cosmetic surgery scars.
From week 6 onwards: gentle scar massage
Once the surgeon has confirmed it is appropriate, gentle massage of the scar with the fingertips — small circles, light pressure, for a few minutes once or twice daily — appears to improve scar pliability and reduce adhesions to underlying tissue. The evidence base is weaker than for silicone, but the intervention is harmless and many surgeons recommend it.
What does not work
Several widely marketed scar treatments have either no supporting evidence or evidence that they are less effective than silicone:
- Vitamin E creams. Multiple randomised trials show no benefit, and some patients develop contact dermatitis that worsens scar appearance.
- Bio-oil and similar plant oil products. No evidence of benefit over standard moisturiser.
- Onion extract creams. Mixed evidence; less effective than silicone in head-to-head comparisons.
- “Anti-scar” pressure devices for surgical scars. Some use after burns; limited benefit for elective surgical scars.
- Wheatgrass, aloe vera, coconut oil, and other home remedies. No supporting evidence.
Money spent on these products is better directed at quality silicone gel or sheets, and on reliable SPF 50 sunscreen.
When scars don’t heal as expected
A small proportion of scars develop abnormally. The main categories are:
- Hypertrophic scars. Raised, red, sometimes itchy or painful scars that remain within the boundaries of the original incision. More common in areas of tension (chest, back, shoulders). Usually improve over 1 to 2 years with consistent silicone treatment; resistant cases may benefit from steroid injections.
- Keloid scars. Scars that grow beyond the boundaries of the original wound. More common in people of African, Caribbean, and Asian ancestry, and on certain body locations (chest, earlobes, shoulders). Need active management — steroid injections, occasionally surgical revision combined with adjuvant treatment.
- Atrophic scars. Depressed scars that sit below the surrounding skin level. Less common after cosmetic surgery; more typical of acne scarring.
- Pigmentation changes. Hyperpigmentation (darkening) usually from sun exposure on immature scars; hypopigmentation (lightening) sometimes seen in darker skin types. Difficult to reverse, hence the emphasis on sun protection during the first 12 months.
If your scar is not progressing as expected at the 3 or 6 month review, raise it with the surgeon. Earlier intervention with silicone, steroid injections, or — in selected cases — laser treatments produces better outcomes than waiting.
Advanced scar treatments
For mature scars (12+ months post-operatively) that remain visibly imperfect, several treatments can be considered:
- Steroid injections. Effective for hypertrophic and keloid scars. Administered at 4 to 6 week intervals over several months.
- Laser scar revision. Various wavelengths target different scar characteristics — redness, pigmentation, texture, thickness. Multiple sessions usually required.
- RF microneedling. Combines microneedling with radiofrequency energy to remodel scar tissue. Useful for atrophic and textural scars.
- Surgical scar revision. Selective re-excision of poor-quality scars to allow them to heal again with optimal care. Considered only after 12 to 18 months of conservative management.
Procedure-specific scar guides
Each procedure has its own scar pattern, healing trajectory, and specific care priorities. For detail on your specific procedure:
- Breast augmentation scars
- Breast lift scars
- Breast reduction scars
- Gynaecomastia scars
- Liposuction scars
- Tummy tuck scars
- BBL scars
- Mummy makeover scars
- Facelift scars
- Blepharoplasty scars
Booking a consultation
If you are considering surgery and want to discuss likely scar placement and quality for your specific anatomy, raise it at your consultation — the surgeon will show you typical examples of their own work and explain where incisions will be positioned. To book, call 0207 993 4849 or use the contact form.
Related reading
- Do silicone strips help cosmetic surgery scars heal better?
- The effects of tanning on cosmetic surgery scars
- How long is recovery after cosmetic surgery?
Centre for Surgery · CQC-regulated · GMC specialist-registered surgeons · 95–97 Baker Street, Marylebone, London W1U 6RN · 0207 993 4849 · Book a consultation · Finance from 0% APR
