Scar Care Following Plastic Surgery

“When will we talk about how to take care of my scars?” This is by far one of the most common questions I get from patients—often before surgery has even happened! So, I figured it was time to talk about this and put my philosophy on scar care down on paper once and for all. But first, let’s do away with some common scar “myths.”

Table of Contents

• Common Scar Myths
• The 4S Approach to Scar Care
• #1. Silicone
• #2. Sunblock
• #3–4. MaSSage
• 4S Scar Care Summary

Common Scar Myths

Myth #1: It’s possible to do surgery without scars. Unless you’re a fetus, nope. Not true. Any time the skin gets cut, a scar develops. Scars are your body’s natural defense mechanism against infection and its way of restoring the protective barrier of your skin. While some surgeons may offer “scarless surgery,” you now know (if you didn’t already) that there is no such thing. What is really meant by such a claim is either that no true surgery is being performed, or the scars are hidden in natural tension lines within the skin.

Myth #2: I had a really bad scar following my last surgery, so I must only scar badly. The good news: This is not necessarily true. There are many factors that determine how a scar heals such as genetics, what caused the scar (trauma vs. controlled surgery), infection, where the scar is on the body (scars across joints rarely heal well, whereas scars over areas with little motion tend to heal better), what sutures were used to close the incision, and the skill with which the incision was closed. 

Myth #3: All my surgical scars have healed well, so my scars following this surgery will be no different. This is likely true, but not 100 percent guaranteed. As I said above, many factors influence how a scar heals, and while it’s a good bet you will scar minimally if you have in the past, it’s not written in the stars.

Myth 4: There’s nothing I can do to influence how well my scars heal, and they’re just going to do what they’re going to do. FALSE. FALSE. FALSE. If you’re this much of a Debbie Downer, let’s turn that frown upside down—keep reading. 

The 4S Approach to Scar Care

The essence of scar care can be broken down into what I call the 4S approach: 

• Silicone
• Sunblock
• MaSSage

If you’re a “just-get-to-the-point” type of person, you can skip below and go to the 4S Scar Care Summary at the end of the blog. 

#1. Silicone

Silicone is the only product proven to improve scar healing. Other, expensive products likely won’t hurt scar healing, but just know that all the money you spend on them may not be worth it, as their successful treatment of scars is not backed by science. No one really knows how silicone works, but it does.

Silicone comes in three different forms, all of which can be purchased over the counter:

• Silicone tape: This sticks the best, but the adhesive may cause a skin reaction.
• Silicone sheets: Simply cut and apply them, but keep in mind they doesn’t always stick as well as tape.
• Silicone gel: Goes on as a gel and dries to a film; it’s easy to apply, but it may take a while to dry and can get on your clothes.

I tell patients to experiment with a few products and find whichever one works best for them. There really isn’t an advantage of one over the other. 

So, when should I put silicone on my scars, and how often?

I typically tell patients to start putting silicone on their scars once all the crusting is gone and there are no “raw areas.” This is typically around two weeks after surgery. Ideally, silicone is applied twice a day for at least three to four months. 

#2. Sunblock

While the sun is incredibly important for our health, too much exposure to it can be bad for our skin. Sunrays contain many different types of light, the most dangerous of which is invisible ultraviolet (UV) light. Unprotected sun exposure can lead to premature skin aging, including wrinkles and sunspots, burns, or other skin damage, and may even cause skin cancer over many years. Any dermatologist will tell you that if you could only do one thing to protect your skin from damage and a prematurely aged appearance, it would be using sunblock.

I can’t stress the use of sunblock following surgery enough. Why? Because prolonged exposure to the sun can cause a fresh scar to darken—permanently. UV rays cause our skin to produce melanin, a pigment that gives our skin its characteristic color (darker-skinned individuals have more melanin in their skin naturally). Since early scar tissue is thinner than normal skin tissue, there is more UV light that gets through this barrier, causing more melanin and more pigment to develop. 

So, when should I put sunblock on my scars?

As with silicone, I typically tell patients to start putting sunblock on their scars once all the crusting is gone and there are no “raw areas.” This again is typically about two weeks following your procedure. Scars on more visible parts of the body, such as the face, are going to see more sun and should be protected every time you go outside. 

But it’s always cloudy in Seattle. Do I really need to wear sunblock?

Yes! Remember that even on cloudy days, UV light doesn’t go away. In fact, there may even be more of it. So always wear your sunblock whenever you go outside, particularly on highly visible scars.

My scars will always be under clothing, so do I still need sunblock? 

Clothing does act as a barrier to the sun, so in general, scars under clothing are more protected from the sun than sun-exposed scars. That said, UV light can still penetrate clothing, so I still recommend sunblock over scars, even when covered by clothing, in highly sunny areas (like on your Hawaiian vacation). This is particularly true if you are wearing thin clothing, such as a bathing suit. In very sunny environments, clothing with UV protection will offer the best barrier against the sun.

Is there a specific type of sunblock I should get? 

This is a great question. There are two types of sunblock: mineral and chemical. Mineral sunblocks (such as zinc oxide) reflect UV rays away from the skin. Chemical sunblocks absorb UV rays and dissipate that energy as heat. Though they are harder to rub into the skin, it is generally accepted that mineral sunblocks work better. If you can’t tolerate these products, for whatever reason, chemical sunblocks are just fine. Make sure that whatever you purchase has both UV-A and UV-B protection.

The other feature of sunblocks that causes confusion is the sun protection factor, or SPF. Most people think that the higher the SPF, the more protection against the sun. While that is technically true, you can see from the picture below that anything over SPF 30 has very little added protection (think of it like adding a sixth or seventh coat of paint to your new wall—you probably won’t notice any difference). 

#3–4. MaSSage

Scar massage is a very simple and effective way to promote scar maturation after surgery. Scars are made of collagen. First, the collagen that forms is dense and stiff. Over the course of roughly a year (less on the face), your body breaks down the dense collagen and replaces it with softer collagen. 

Scar massage helps by breaking down dense collagen and squeezing extra fluid or swelling out of the scar. This makes the scar softer, which improves mobility and can reduce pain. 

How do I massage my scars?

Plan on starting scar massage at roughly the same time that you start wearing sunblock and applying silicone (when there are no more raw areas, crusting, or drainage; roughly two weeks). Scar massage should be done at least twice a day for one to two minutes. I always tell patients to do it in bed when they first wake up and when they lie down to go to sleep. 

As illustrated below, massage should be done with two fingers along the length of the scar, in a circular motion and in a back-and-forth pattern.

How hard should I massage my scars?

Scar massage should be slightly uncomfortable. If you don’t feel any pressure or mild stretching, then you’re probably not doing it hard enough. If it is exceedingly painful (like a deep tissue massage), it is probably best to wait an additional week to begin or ease up a little. 

How long before I know what my scars are going to look like?

It takes a year for a scar to soften, flatten, and fade to the point where it is not going to change anymore. Scar redness is always the last to fully disappear. This will be a gradual process, so be patient! Following the 4S approach will give you the best chance at having a thin, white scar that is barely perceptible. 

4S Scar Care Summary

1. Silicone

• Comes as a tape, gel or sheet, all of which are over the counter.
• Start applying about two weeks following surgery once there are no more “raw” areas, scabbing, or drainage.
• Apply twice a day for at least three to four months.

2. Sunblock

• Mineral-based (such as zinc oxide) provide better coverage, though chemical-based are easier to apply.
• Make sure whatever you purchase has UV-A and UV-B protection.
• Like silicone, it should start being applied about two weeks following surgery once there are no more “raw” areas, scabbing, or drainage.
• Use products that have an SPF of 30. Products with SPF that exceeds 30 has very little added benefit.
• Remember it is the invisible ultraviolet (UV) light that causes harm to scars, so apply it even when it’s cloudy or hazy, particularly on sun-exposed scars (i.e., the face).
• Use for at least six months following surgery. 

3. MaSSage 

• Like silicone and sunblock, start the scar massage when there are no more “raw” areas, scabbing, or drainage.
• Pressure should be firm and slightly uncomfortable, but not painful. If it is too painful, lessen the massage pressure or wait additional time before beginning the massage.
• A gentle stretching sensation is normal.
• Massage should be done at least twice per day.
• Massage should be done along the scar, in circular motions overlying the scar and back and forth against the scar.
• Continue scar massage for at least three to four months following surgery.