Scars
A scar is new tissue the body makes to close a wound. It is never identical to the original skin: it has no follicles or glands and its collagen is organised…
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A scar is new tissue the body makes to close a wound. It is never identical to the original skin: it has no follicles or glands and its collagen is organised differently. No scar disappears completely, but its final appearance depends greatly on what is done in the first few months, and that is where you can genuinely make a difference.
Types
- normotrophic: flat, level with the skin and roughly the colour of its surroundings. The best possible result;
- hypertrophic: raised and red, but within the boundaries of the wound; it usually flattens over one to two years;
- keloid: grows beyond the edges of the original wound, does not resolve on its own and tends to recur;
- atrophic: sunken, typical of acne and chickenpox;
- contracture: from burns; the tissue tightens and can restrict joint movement;
- hyper- or hypopigmented: darker or lighter than the surrounding skin.
How a scar matures
Understanding the timescale saves a lot of anxiety and a lot of premature treatment.
- 0–3 weeks: the wound closes;
- 1–3 months: the scar is red, raised and often itchy. This is its worst phase, and it is normal;
- 3–12 months: it begins to flatten and lose colour;
- up to 18–24 months: it is still maturing; the final result is not judged before then.
This is why corrective surgery on a scar is not considered before a year: what looks like a disaster at three months is often acceptable at eighteen.
What affects the outcome
- the depth and tension of the wound;
- the site: shoulders, breastbone and upper back heal worse; eyelids and inner arms better;
- infection during healing, which worsens the result considerably;
- age: younger people scar more exuberantly;
- skin tone: darker skin carries a higher risk of keloids and of pigment change;
- smoking, which reduces oxygen supply to the wound;
- nutritional deficiencies, particularly of protein, vitamin C and zinc;
- diabetes and conditions that slow healing;
- sun exposure on a fresh scar;
- individual and family predisposition.
What to do in the first months
This is where most of the benefit lies, and it is simple.
- look after the wound so it does not become infected, and keep it in a moist environment under a dressing rather than letting a hard crust form;
- silicone sheets or gel from the point the wound has closed, at around 2–3 weeks, for 12–24 hours a day over 3–6 months. This has the best evidence;
- paper tape across the scar to reduce tension, particularly useful over areas of movement;
- strict sun protection for at least a year: sun fixes pigmentation persistently and is the commonest mistake;
- massage the scar for a couple of minutes daily once closed, with a cream, using circular movements;
- daily moisturising;
- do not smoke;
- avoid strain that stretches the area during the first weeks.
Later treatments
- corticosteroid injections for hypertrophic scars and keloids;
- vascular laser for persistent redness;
- fractional laser for texture and atrophic scars;
- microneedling for acne scarring;
- chemical peels for superficial scars;
- fillers for depressed scars;
- subcision for atrophic scars tethered to deeper tissue;
- revision surgery and Z-plasty for contracted or badly oriented scars;
- camouflage make-up or medical tattooing where colour is the main problem.
When to see a doctor
- the scar is growing beyond the edges of the wound;
- it itches or hurts persistently;
- it restricts joint movement;
- it ulcerates, bleeds or changes appearance;
- there are signs of infection: redness, warmth, pus, fever;
- it is affecting you psychologically — reason enough;
- you have had keloids before and are due to have surgery: prevention should be planned;
- more than a year has passed and the result still limits you.
Common questions
Can a scar be removed? Not completely. Its colour, height and texture can be improved substantially.
Do pharmacy creams work? Silicone has supporting evidence. Vitamin E and onion extract have little.
When can I have an unsightly scar revised? Not before 12 months, unless there is a functional problem.
Why has it turned red and itchy? That is the normal maturation phase of the first months.
Can I tan the scar? No. New scar tissue pigments unevenly and permanently in the sun.
Online consultation
In an online consultation the doctor reviews photographs, identifies the type of scar, advises what to do at the stage you are at, gives realistic timescales so you do not rush decisions, and explains which techniques make sense in your particular case.
This material is for information only and does not replace a medical consultation.
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Reviewed on Jul 6, 2026
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