Scar Care After Surgery: What Actually Works in the First Year

First, the wound has to close

Nothing in this guide starts until the wound is fully healed: no scab, no open edges, no weeping, stitches or clips out and the skin knitted across the whole line. For most surgical wounds that is two to three weeks. Until then the job is wound care, which is simpler than people make it: keep the dressing on for as long as you were told, keep it clean and dry, do not put creams, powders or anything else on the incision, and do not pick at scabs or pull at stitches.

Showering is usually fine after the first day or two, with the wound uncovered or under a waterproof dressing depending on what you were told; baths and swimming wait until it is closed, because soaking softens the edges. Pat the area dry rather than rubbing. Our guide on showering without getting the wound wet covers the practicalities.

Contact your team if the wound becomes redder or more painful, opens, leaks cloudy or smelly fluid, or you develop a temperature. An infected wound heals slower and scars worse, and it is treatable if caught early.

How a scar behaves over the first year

A new scar is red or purple, slightly raised, firm and often itchy. That is normal and it is not the finished article. Over the following months it flattens, softens and fades towards skin colour or paler. On darker skin, scars may go darker rather than red, and the fading takes the same time. The whole process takes twelve to eighteen months, sometimes two years, and a scar that looks angry at three months is usually well on its way by twelve.

Two things can go wrong with the process. A hypertrophic scar stays raised and firm within the line of the original wound; it usually settles eventually but slowly. A keloid grows beyond the edges of the wound into a smooth, hard lump, does not settle on its own, and is more common on the chest, shoulders and earlobes and in people with darker skin. Both are worth showing to a doctor early, because the treatments work better on a young scar than an old one.

What helps

Three things have evidence behind them, and none of them is expensive.

Silicone. Silicone sheets and gels are the one over-the-counter scar treatment that clinical guidance actually recommends, for softening and flattening scars and for reducing the chance of a raised one. Sheets are worn over the scar for twelve or more hours a day, washed and reused for a couple of weeks each, for two to three months. Gel does the same job on scars where a sheet will not stay put, such as a joint, the face or a curved area. Start once the wound is fully closed, not before, and stop if the skin underneath becomes irritated.

Massage. Once the wound is healed, massaging the scar firmly with a plain moisturiser or water-based cream for a few minutes, a few times a day, helps it soften and stops it sticking to the tissue underneath. Use enough pressure to blanch the scar slightly, and work in small circles along its length. This is uncomfortable at first and gets easier. It matters most for scars over joints and in the palm, where a stuck scar limits movement.

Sun protection. A new scar has no protection against ultraviolet light and will tan darker than the skin around it, permanently. Keep it covered when you are in the sun for the first year: clothing, a dressing, or a high-factor sunscreen, SPF 30 at the very least and SPF 50 if the scar is on your face or somewhere that will see a lot of sun. A sunscreen stick is the easiest way to cover a small scar every morning without thinking about it.

What does not help, and what to skip

Vitamin E oil, cocoa butter, bio-oils and most “scar creams” have not been shown to change how a scar ends up, and some cause skin reactions. They are pleasant moisturisers and fine to massage with, but the massage is doing the work, not the ingredient. Anything that promises to remove a scar is overpromising, because a scar cannot be removed, only improved.

Do not put anything on a wound that has not closed. Do not pick, scratch or peel. Do not tan a new scar, and do not use sunbeds. Do not stretch or load a healing scar hard in the first weeks, particularly over a joint or the abdomen, where tension along the line makes a scar wider.

Scars that need a doctor

See your doctor, or ask at your surgical follow-up, if a scar is:

Raised and growing beyond the edges of the original wound, or becoming hard and lumpy.

Painful, very itchy or tight in a way that limits movement, especially over a joint or in the hand.

Red, hot, swollen or leaking at any point, which points to infection rather than scarring.

Bothering you in a way that affects how you feel or what you wear. That is a legitimate reason to ask, and there are treatments, from steroid injections and pressure garments to laser and skin camouflage, that a GP or surgeon can arrange.

A simple routine

For most surgical scars the whole plan fits on a card. Weeks one to three: wound care only, keep it clean and dry, no creams. Once closed: silicone sheet or gel daily for two to three months, massage a few times a day, sunscreen or cover every day you are outside, for a year. Watch for a scar that is raising, spreading or hurting, and show it to someone early rather than late. Then leave it alone and let a year do the rest.