The Biggest Misperception About Plastic Surgery Scars

Will I have a scar following plastic surgery? How noticeable will it be? When will it disappear? These are among the most frequently asked questions in my Boston plastic surgery practice. If you’re considering cosmetic or reconstructive surgery, you need to understand the process of scar maturation to clear up misperceptions, learn what to expect, and help achieve the best results.

The bottom line is that every patient develops a scar following surgery as part of the natural healing process. Does it ever disappear? Not really. However, having a scar that becomes less pronounced over time or is strategically concealed will make it less noticeable – and in some cases, almost invisible. This is where scar maturation and your doctor’s surgical artistry come into play.

Scars change over time, which I call scar maturation. For the first few weeks after surgery scars are raised, red, and hard. After that they start to become flatter and softer. This is accompanied by fading. To make the timeline clear for patients I specifically say that three months after surgery the scar will still be visible as a red line and that the final result from fading will take a year or longer. I also note that some individuals’ scars fade and flatten faster or more completely than others’. Despite my graphic description patients will still ask, “But, when does the scar disappear?”

To reiterate, scars never disappear; they just fade, flatten, and soften. I think there may be some confusion because some scars seem to disappear. This can occur with a scar in an inconspicuous location in a good healer. Examples are facelift scars around the ear, scars around the nipple from breast augmentation or breast reduction, and scars on the eyelids from blepharoplasty. In each case the scar lies at a natural skin junction making it less noticeable.

I’ve even had patients come back after such procedures and say, “It’s amazing, I don’t have any scars.” Of course they have scars, they just aren’t noticeable.

I also believe that scars fade better on certain parts of the body. The small scar under the nose in an open rhinoplasty seems to fade faster and better than on other parts of the body. By three to four weeks from surgery it is not noticeable and in most patients is totally faded by three to six months. Eyelid and facelift scars also fade better by three months. On the other hand, breast reduction and abdominoplasty (tummy tuck) scars seem to take a full year or longer to fade flatten and soften as much as possible.

So, what can your plastic surgeon do to get the best scars possible? First, strategic placement of the incision at a natural skin junction. This is automatic in a facelift or an eyelid procedure, but in some reconstructive cases, such as the treatment of skin cancer or nevi in my Boston-based plastic surgery practice, I have to design the scar location and pattern. Second, when I have to make incisions in more conspicuous locations I make the incision as short as possible to minimize the scar. (Click here to read about short incision breast reduction.) Third, it goes without saying that every incision be closed meticulously in the operating room; something that I do on every single case.

Of course, patients themselves can significantly affect the outcome of their scar. During the post operative healing period it is important to follow instructions regarding exercise and activities that would place stress on a scar. Stressing or stretching the scar can lead to a widened, lumpy and unsightly scar. I usually recommend restricting exercise for two to six weeks after surgery, depending on the procedure. Some procedures such as breast reduction/augmentation and abdominoplasty require the use of support garments for three to six weeks to support scars.

If you understand these concepts and follow the instructions for your procedure you’ll have a realistic idea of what to expect and can help yourself get the best result possible.