How to Prevent or Minimize Surgery Scars

Table of Contents
View All
Table of Contents

If you are planning to have surgery, you may be surprised to know that scarring can be reduced or prevented after your procedure. While some scarring is inevitable, you can help minimize scarring with good incision care and other methods of scar prevention.

This article explains the causes and risk factors for scarring after surgery. In addition, it offers suggestions for preventing scars and caring for your wound.

What Causes Surgical Scars?

Woman's stomach with C-section scar

Westend 61 / Getty Images

Whenever the skin is damaged, there is the possibility of scarring. A surgical incision typically requires cutting through all of the layers of the skin. The scar develops as part of the healing process.

First, blood platelets are sent to the incision site to prevent blood loss. The platelets bind together to form a scab. This is known as hemostasis. 

Then, the inflammatory response kicks in, and infection-fighting white blood cells arrive. This causes redness, swelling, and warmth around the incision. 

The next phase is cell proliferation: The skin and vessels create new cells. As this happens, the edges of the incision will fold into the middle and be replaced with new, thicker tissue that is rich in collagen—a protein that gives skin elasticity. Too much or too little collagen during this phase of healing will impact the scar's appearance. 

Once the incision is healed, the tissue undergoes a maturation process. The reddish-pink scar tissue will slowly fade over the next several months. Its final color may be darker or lighter than the surrounding tissue.

Surgical scars are typically raised (hypertrophic) at first but often flatten on their own within the first year. Flat scars are known as cicatrix.

Keloids, a type of hypertrophic scar, can also develop during the healing process and may take up to a year to form. Unlike typical raised scars, keloids will not go away on their own. If they restrict movement or you are bothered by the appearance, talk to your healthcare provider about treatment options. 

Surgery scars are inevitable, regardless of your surgeon's skill, the reason for surgery, or where the incision is located. However, there are steps during your recovery that may help minimize or prevent scarring.

How Long Does It Take for Surgical Scars to Fade?


While it varies from person to person, on average, surgical scars will fade from reddish (in the early stages of formation) to pink or flesh-colored in seven months. Some scars may take up to two years to become less noticeable.

Proper Wound Care Minimizes Scarring

The way in which you care for the incision affects how your skin heals. With the right care, it’s possible to minimize scarring.

Good incision care to prevent infection is one of the best ways to reduce scarring after surgery. This includes:

  • Rest: If your healthcare provider suggests that you rest for two weeks, resist the urge to go back to work after one week of healing. Exhausting yourself can slow recovery.
  • Perform proper wound care: Taking the steps your surgeon recommends may be the most critical thing you can do to prevent scars. Avoid ointments and other remedies unless your doctor prescribes them, and follow other general incision care techniques to increase the likelihood of healing without scars.
  • Identify infection quickly: Seek help from your healthcare provider immediately if you notice any signs of infection. An infection can seriously impair healing and contribute to scarring.
  • Reduce stress on your incision: Avoid lifting, bending, or doing anything that stretches or puts tension on your incision, including driving. This stress can pull the incision apart and delay healing. Often this makes the wound larger than it needs to be, which increases the size of your scar.
  • Avoid exposure to sunlight: Keep the sun off your incision whenever possible. If your scar is in a place that is difficult to cover, such as your face, use sunscreen after your incision heals. Your surgeon can tell you when to apply ointments, but it is usually safe to do so when the sutures are removed, or the incision has closed completely.

Risk Factors for Scarring

Certain things beyond your control influence your ability to heal without scarring. Unfortunately, you can not change these risk factors, but knowing what they are can help you understand the likelihood of scarring after your procedure.

Age

As you age, your skin becomes thinner and less elastic. That is because collagen (which makes the skin flexible) reduces as we age. This change results in the fat layer under your skin becoming thinner. Therefore, skin does not heal as well or as quickly as we age.

In addition to collagen changes, some other things that make scarring more likely as you get older include:

  • Sun exposure
  • Smoking
  • Pollutants

On the upside, the imperfections that occur over time, like dark spots and wrinkles, actually help conceal scars that might be more obvious on younger skin.

Race

Some races are more likely to scar. For example, people of African descent are more likely to form hypertrophic and keloid scars. These scars are an overgrowth of scar tissue at the site of an injury.

This photo contains content that some people may find graphic or disturbing.

Hypertrophic sternotomy scar
Hypertrophic scar on sternum.

DermNet / CC BY-NC-ND

In general, scars typically remain very thin. How light or dark they appear depends on your skin color. For example:

  • Light skin: Scars are typically close to an exact match to the surrounding skin color and often fade away with time on people with lighter skin.
  • Dark skin: Those with darker skin may notice that their scars are darker than the surrounding tissue.

Genetic (Inherited) Tendency to Scar

If your parents or siblings tend to scar heavily, you are likely to do the same. Therefore, if you have a family tendency to scar badly, consider discussing this with your surgeon.

Size and Depth of Your Incision

A large incision is much more likely to leave a scar than a small one. The deeper and longer the cut, the longer the healing process and the greater the opportunity for scarring. That's because a larger incision may be exposed to more stress as you move, which can result in slower healing.

Incision Placement

The location of the surgical incision can also make a scar appear more or less prominent. In some surgeries, your surgeon can modify incision placement to reduce scar visibility. You may be able to talk to your surgeon about where they place the incision to either hide or help minimize scars.

For example, doctors can perform a cesarean section with a vertical incision, which may be more pronounced, or a horizontal incision, which a bikini may disguise.

How Quickly Your Skin Heals

You may be one of the genetically blessed people who seem to heal quickly and easily with minimal scarring. Or, you may have skin that tends to heal slowly.

Sometimes slow-healing skin can be the result of an underlying medical condition, like diabetes. Regardless, healing speed is individual and can change with illness or injury.

Prevention

The good news is there are some factors you can control, which may help you prevent scars. Some ways are simple, like following the instructions your surgeon gives you to the letter. Others, like avoiding smoking, may not be so easy.

Quit Smoking

Not only does smoking increase your risk for scars, but it can also slow your overall healing. The American College of Surgeons advises that if you quit four weeks before your surgery and don't smoke for four weeks after, you can lower your rate of wound complications by 50%. 

Some surgeons will not schedule a procedure if you continue smoking. For example, someone having elective foot surgery may need to quit smoking six weeks before surgery and continue for three months.

The surgeon may perform a cotinine test to verify that you're not smoking. (Cotinine, which can be detected in urine, is a chemical your body makes after you are exposed to nicotine.) A study of 256 people at one surgery center suggests that mandatory smoking cessation policies can limit wound healing complications.

Stay Hydrated

Dehydration happens when you are not taking in enough fluids. In severe cases, this can cause electrolyte imbalances and heart problems. In less severe cases, you will feel thirsty and generally unwell.

Stay well hydrated to feel your best and create the optimal environment for healing. You will know if you are well-hydrated when your urine is almost colorless or light in color. 

Since alcohol and caffeine tend to dehydrate your body, including your skin, avoid both while recovering. Instead, focus on non-caffeinated beverages.

Improve Nutrition

Protein makes up the building blocks of healing skin. Therefore, it is essential to provide your body with adequate protein to allow your skin to heal. So, eat a balanced diet with an emphasis on protein.

Some common protein choices include:

  • Chicken
  • Pork
  • Fish
  • Seafood
  • Beef
  • Dairy products
  • Nuts and legumes

If you do not eat meat, soy products provide an excellent alternative as a lean protein source.

Maintain a Healthy Weight

If you have excess weight, you may be at greater risk of scarring. That's because the fat under your skin can work against your surgeon's best efforts to close your incision seamlessly.

Manage Chronic Illness

Diabetes and many other illnesses can slow healing. For the best possible outcome, be sure your condition is well-controlled before surgery and during your recovery.

For example, high glucose levels slow healing. So, if you have diabetes, work hard to keep your blood glucose levels within normal limits.

Surgical Scar Treatments

If you are concerned about scarring, consider discussing scar minimization and prevention with your surgeon. Your surgeon may be able to prescribe additional treatments that lower your chances of scarring.

Onion Extract Gel

Several over-the-counter treatments help fade scars. One is onion extract gel, available as Mederma and Mederma Advanced Scar Gel.

Studies show allantoin, a compound in onion extract, helps improve pigmentation and pliability of surgical scars.

Silicone Wound Treatment

Silicone wound dressings feel similar to a thick plastic wrap that you would use in the kitchen. There are a couple of ways to apply silicone dressings, including:

  • Silicone sheets: These are applied directly to the wound and stay there.
  • Silicone gel: This is applied directly over the scar and is left to dry in place.

Studies have shown that silicone can help reduce scarring, and surgeons commonly use it after plastic surgery. Ask your surgeon if silicone dressings are a good option for you.

Polyurethane Dressing

Similar to silicone dressings, polyurethane dressing helps to reduce scarring. Studies show when worn for six weeks after surgery, this moist, flexible pad helps to prevent raised scars. It is even more effective when worn with a pressure garment.

Polyurethane dressing is also used to treat raised scars and help to reduce the color, hardness, and size of a surgical scar.

Prescription Medications

If you tend to scar badly, your surgeon may be able to prescribe cleansers, ointments, or a wound care routine to help.

Medication can also be prescribed to treat keloids and hypertrophic scars. In particular, a chemotherapy medication called 5-Fluorouracil has been shown to be effective in treating raised scar tissue.

Massage

More healthcare providers are recommending scar tissue massage. Physical therapists typically perform this type of massage. However, be sure to wait until after the wound closes and any staples or sutures are removed.

Massaging an incision and the surrounding tissue may even out any bumps or lumps that remain after the healing process. Your physical therapist can usually show you how to massage your scar at home. Be sure to use ample lotion so that your fingers don’t “stick” to your skin but slide freely.

Steroid Injections

If you are prone to forming keloid scars, talk to your surgeon about having a steroid injection. Steroids may help prevent the formation of another keloid.

Laser Treatments

Laser therapy or pulse-dye light treatments help to minimize the appearance of scarring. According to the American Academy of Dermatology (AAD), laser treatments can help decrease post-surgical scarring, prevent raised scars and keloids, lessen the color of scars and reduce pain, itch, hardness, and swelling.

If you are considering laser treatment, it is important to make sure the process is done by a board-certified dermatologist. Done correctly, laser therapy is a safe treatment option with few side effects.

Cryosurgery

Cryosurgery freezes the scar, slowly destroying the scar tissue. This helps to reduce the size of a raised scar or keloid and decrease pain, itch, hardness, and discoloration. According to AAD, cryotherapy can reduce the size of a scar by 50% or more after one treatment.

Scar Surgery

If all other treatments fail, scar surgery is an option. For this procedure, a dermatologic surgeon cuts out the scar.

Scar surgery is especially useful when a scar limits your movement. Removing the scar tissue can help increase your ability to move.

However, the scar may return after it’s removed. To prevent this, you may also be treated with steroid injections, which can improve results.

Summary

Some scarring after a surgical incision is inevitable. But there are some things you can do to prevent or reduce the visibility of scarring.

Post-surgical wound care is the most important factor in minimizing scars. Keeping existing health conditions under control, eating a nourishing diet, and staying hydrated can all help.

Risk factors such as age, skin color, genetics, and the depth of your incision increase the likelihood of scarring. Treatments to help reduce the appearance of scars include topical onion extract, silicone or polyurethane sheets, corticosteroids, and laser treatments.

27 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Block L, Gosain A, King TW. Emerging therapies for scar preventionAdvances in Wound Care. 2015;4(10):607-614. doi:10.1089/wound.2015.0646

  2. Johns Hopkins Medicine. Everyday cuts and scrapes: How to prevent scarring.

  3. American Academy of Dermatology. Scars: Overview.

  4. American Academy of Dermatology. Scars: Signs and symptoms

  5. National Health Service. Scars.

  6. Ubbink DT, Brölmann FE, Go PM, Vermeulen H. Evidence-based care of acute wounds: a perspectiveAdv Wound Care (New Rochelle). 2015;4(5):286‐294. doi:10.1089/wound.2014.0592

  7. American Academy of Dermatology. Proper wound care: How to minimize a scar

  8. Dreifke MB, Jayasuriya AA, Jayasuriya AC. Current wound healing procedures and potential careMater Sci Eng C Mater Biol Appl. 2015;48:651‐662. doi:10.1016/j.msec.2014.12.068

  9. Al-Shaqsi S, Al-Bulushi T. Cutaneous scar prevention and management: overview of current therapiesSQUMJ. 2016;16(1):e3-8. doi:10.18295/squmj.2016.16.01.002

  10. Gould L, Abadir P, Brem H, et al. Chronic wound repair and healing in older adults: current status and future researchJ Am Geriatr Soc. 2015;63(3):427-438. doi:10.1111/jgs.13332

  11. Van Putte L, De Schrijver S, Moortgat P. The effects of advanced glycation end products (Ages) on dermal wound healing and scar formation: a systematic reviewScars, Burns & Healing. 2016;2:205951311667682. doi:10.1177/2059513116676828

  12. McDaniel JC, Browning KK. Smoking, chronic wound healing, and implications for evidence-based practiceJournal of Wound, Ostomy & Continence Nursing. 2014;41(5):415-423. doi:10.1097/WON.0000000000000057

  13. Amici JM, Seité S, Le Floc’h C, Le Dantec G, Demessant A, Taieb C. Scars and environmental factors: Results from a real‐life studyJEADV Clinical Practice. 2023;2(1):170-171.doi:10.1002/jvc2.112

  14. Son D, Harijan A. Overview of surgical scar prevention and management. J Korean Med Sci. 2014;29(6):751-7. doi:10.3346/jkms.2014.29.6.751

  15. Glass DA. Current understanding of the genetic causes of keloid formationJournal of Investigative Dermatology Symposium Proceedings. 2017;18(2):S50-S53. doi:10.1016/j.jisp.2016.10.024

  16. Rennekampff HO, Tenenhaus M. Theoretical basis for optimal surgical incision planning to reduce hypertrophic scar formation [published online ahead of print, 2020 Mar 17]Med Hypotheses. 2020;140:109672. doi:10.1016/j.mehy.2020.109672

  17. Liu Y, Liu Y, He W, Mu X, Wu X, Deng J, et al. Fibroblasts: Immunomodulatory factors in refractory diabetic wound healing. Front Immunol. 2022 Aug 5;13:918223. doi: 10.3389/fimmu.2022.918223.

  18. American College of Surgeons. Quit Smoking Before Surgery.

  19. Rozinthe A, Ode Q, Subtil F, Fessy MH, Besse JL. Impact of smoking cessation on healing after foot and ankle surgery. Orthop Traumatol Surg Res. 2022 Nov;108(7):103338. doi:10.1016/j.otsr.2022.103338.

  20. Watso JC, Farquhar WB. Hydration status and cardiovascular functionNutrients. 2019;11(8):1866. doi:10.3390/nu11081866

  21. Commander S, Chamata E, Cox J, Dickey R, Lee E. Update on postsurgical scar managementSeminars in Plastic Surgery. 2016;30(03):122-128. doi:10.1055/s-0036-1584824

  22. Conti V, Corbi G, Iannaccone T, et al. Effectiveness and tolerability of a patch containing onion extract and allantoin for Cesarean section scars. Front Pharmacol. 2020;11:569514. doi:10.3389/fphar.2020.569514

  23. Bleasdale B, Finnegan S, Murray K, Kelly S, Percival SL. The use of silicone adhesives for scar reductionAdv Wound Care (New Rochelle). 2015;4(7):422‐430. doi:10.1089/wound.2015.0625

  24. American Academy of Dermatology. Scars: Diagnosis and Treatment

  25. Ibrahim A, Chalhoub RS. 5-fu for problematic scarring: a review of the literature. Ann Burns Fire Disasters. 2018;31(2):133-137.

  26. Deflorin C, Hohenauer E, Stoop R, van Daele U, Clijsen R, Taeymans J. Physical management of scar tissue: a systematic review and meta-analysisThe Journal of Alternative and Complementary Medicine. 2020;26(10):854-865. doi:10.1089/acm.2020.0109

  27. Danielsen PL, Ru W, Ågren MS, et al. Radiotherapy and corticosteroids for preventing and treating keloid scars. Cochrane Wounds Group, ed. Cochrane Database of Systematic Reviews. Published online April 27, 2017. doi:10.1002/14651858.CD010883.pub2

Additional Reading

By Jennifer Whitlock, RN, MSN, FN
Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.