Scar Treatment After Surgery: What's Normal and When to Intervene

Let's talk about scars and surgery — what's normal, what you should do, and when more treatment is just more treatment.

Right after surgery, everything actually looks pretty good. Usually four to six weeks out, the scars have initially healed and are hard to see. This is why a lot of surgeons show "after" photos at this time period — because the scars are at their best.

But the natural history of scarring is that after this point, scars tend to get a little thicker and pink, then gradually fade with time. It usually takes about two years for scars to fully mature if you're doing nothing at all. And just like anything in life, some people are quick healers and some are slow.

If your scar is behaving as it should and progressing in the expected way, the best thing to do is:

• Use a good quality silicone scar gel
• Avoid sun exposure
• Give your body some tincture of time to allow the scar to mature

It's important to keep your surgeon in the loop with your concerns. You want them to check your scar and determine if you're an outlier who needs intervention.

The problems we intervene on are:

• Hypertrophic scars — thick, red, inflammatory scars that are worse than expected
• Pigmented scars — scars that have darkened beyond what's normal
• Texture irregularity — if you run your hand down your scar and it's lumpy, bumpy, or uneven instead of smooth

For all patients, I typically recommend a scar gel and sun protection as a baseline. But the specific intervention depends on your scar:

• Thick/hypertrophic scars → usually start with injectables (like steroid injections)
• Pigmented scars → topical treatments are the starting point
• Texture irregularity → resurfacing like microneedling or laser

Many patients have a combination of these issues, so we tailor treatment to each individual.

Sometimes everything is going well — the patient just doesn't like waiting and wants things to move faster. You can certainly consider interventions to speed things up, but you have to understand there's risk to intervention.

If your scar looks fine for its stage and is just fading slower than you'd like, a laser treatment carries potential complications. We have lasers that take pinks and reds out faster, lasers that smooth texture — there are all kinds of options.

I've never seen a long-term, randomized study that found any particular intervention led to superior scars. That's what we're all waiting for — I would love some intervention where if we start it early, we know your scar is going to be better than if we just left it alone.

So it's important to talk about the risk and benefits of every treatment. The expense may not be worth it. Figure out what's best for you and your scars.