A surgical scar keeps changing for 12 to 18 months, and can go on fading for up to two years. Red, raised and itchy in the first few months is NORMAL. It is not a sign the scar will stay that way.
Three things make a real difference while the scar is young:
- Massage, once the wound is fully closed and your team agrees
- Silicone gel or sheets, worn most of the day for at least two months
- Sun protection for at least the first year
Your surgeon’s wound instructions come first. If they give you a different start date or routine, use theirs.
How a scar heals
- Weeks 0 to 2: the wound seals. Stitches or clips usually come out at around 10 to 14 days
- Weeks 2 to 8: the body lays down new collagen (the protein scar tissue is made of) fast. The scar often looks pinker, thicker and more raised than it did at first, and it itches
- Months 2 to 6: the collagen starts to reorganize. The scar begins to soften and flatten
- Months 6 to 18: the color fades from red or purple toward a pale line close to your skin tone. A scar is “mature” when it is pale, flat and soft
The young, red phase is when massage, silicone and sun protection work best. Once a scar is mature, they do much less.
When to start massage
Start only when the wound is FULLY closed: no scabs, no open spots, no oozing, and the stitches or clips are out. For most people that is somewhere around two to four weeks after surgery. Check with your surgeon or physical therapist first, especially after surgery near a joint or where the skin is under tension.
How to massage a scar
- Use a plain, unperfumed moisturizer so your fingers glide without skidding. Wash your hands first
- Press firmly with one or two fingertips, enough that the scar turns pale under your finger. It can feel tight or odd, but it shouldn’t be sharply painful
- Small circles along the whole length, working from one end of the scar to the other
- Then up and down, across the scar, and then along it, so the skin moves in every direction
- Once it’s comfortable, pinch and roll: gently lift the scar between thumb and finger and roll it, to free it from the tissue underneath. A scar that moves freely is less likely to feel tight when you bend the joint
- A few times a day, up to 10 minutes each time
- Stop and check with your team if the scar cracks, bleeds, blisters or starts to look angry
This matters most where a scar crosses a joint, such as the front of the knee or the ankle. A scar that sticks down can pull every time you bend. See knee replacement recovery week by week and bunion surgery recovery.
Your scar is still being built for a year. What you do in the first few months shapes how it ends up.
Silicone gel or sheets
- What it does: silicone keeps the scar hydrated and helps stop it becoming thick and raised. Of all the scar products, it has the best evidence
- When to start: once the wound is fully closed, same as massage. Never on an open wound
- How long each day: aim for at least 12 hours a day. Sheets are easiest overnight. Gel suits scars that bend or rub on clothing
- How many months: at least two months, longer if the scar is still red or raised
- Massage first, silicone after: take the sheet off, massage, clean and dry the skin, then put the sheet or gel back on
- Stop if you get a rash or the skin breaks down under the sheet
Sun protection
A young scar burns easily and can darken permanently in the sun. For at least the first year, keep it covered with clothing, or use a broad-spectrum sunscreen of SPF 30 or higher on it and reapply through the day. The NHS guide to scars gives the same advice.
Numbness around the scar
A numb patch next to the scar is very common. Small skin nerves are cut when the surgeon opens the skin. After a knee replacement, it is usually on the outer side of the knee.
The patch often shrinks over 6 to 12 months as nerves recover. Whatever is left after about a year is likely to stay, but it doesn’t affect how the joint works.
- Oversensitive scar: if light touch or clothing feels unpleasant, rub the area gently with different textures, such as a soft cloth then a towel, several times a day. This helps the nerves settle
- Protect numb skin from heat packs and ice, because you won’t feel it if it’s too hot or too cold
Hypertrophic scars and keloids
- Hypertrophic scar: raised, firm and red, but stays within the line of the original wound. It usually flattens and fades with time, and silicone and pressure help
- Keloid: raised, hard and shiny, and keeps GROWING beyond the edges of the original wound. It doesn’t usually fade on its own. Keloids are more common in people with darker skin and in people who have had one before
If you have had a keloid before, tell your surgeon before surgery so they can plan scar care early. Longer scars, such as after spinal fusion, need the same care along their whole length.
Call your surgeon today if
- Redness is spreading out from the wound, or the area feels hot
- The wound is leaking pus or cloudy fluid, or smells bad
- The wound opens up, even a small part of it
- Pain around the wound is getting WORSE instead of better
- You have a fever or shivers, or feel generally unwell
Get it checked if
- The scar is growing beyond the edges of the original wound
- It is still getting thicker, redder or more raised after about three months
- It is very itchy or painful and stopping you sleeping
- A tight scar is stopping a joint bending or straightening
A scar often looks its worst in the first few months and keeps improving for a year or more, so start early and keep going.