By definition, any plastic surgery operation requires incisions to create its final result. Sometimes the incision is a big part of the final outcome and in others it is merely an access point from which to do the significant part of the procedure. In either case, incisions are what patients see and focus on….and sometimes even judge the success of the endeavor.
Incisional healing and its appearance along the way is a process. While many patients know that it takes time to see the final outcome, the vast majority do not really understand how and why an incision or scar changes over time. In my Indianapolis plastic surgery practice, I make it a point to review this process particularly at the first postoperative appointment.
Immediately after surgery and for the first week or two, an incision will look quite pristine. It will appear as a fine line with no redness. It appears this way because it is being held together by sutures but no real healing is taking place. Redness soon sets in and small blood vessels and capillaries grow into the incision area to bring healing nutrients. This is why once beautiful looking scars turn darker and redder, more ‘inflamed’ if you will beginning about 3 weeks after surgery. This is expected and an essential phase that is needed towards a healed wound.
Once the incision turns red, the redness may continue to get darker and a brighter red. This signifies that healing is progressing as more and more tiny blood vessels grow into the incisional area. This is not a sign of infection or that anything is wrong as many patients erroneously (and understandably) believe. These blood vessels are necessary to help bring the cells in that lay down collagen, the building blocks of healing and scar formation.
While this incisional and now scar redness will eventually fade, it will take months before some fading will become more evident. The fading of the redness is a sign that the abundance of blood vessels are no longer needed as sufficient ‘mortar’ is now present to hold the wound together. As the strength of the wound increases, so decreases the redness. While every incision is different amongst patients and body locations (this process is much faster in the face than the body), fading will not usually start until about 6 months or so after surgery. Final fading and blending of the scar into a color that is closer to the surrounding uninjured skin averages around a year or so.
In darker pigmented patients, redness is not usually seen. Rather it will appear as a darkening or hyperpigmentation of the edges of the incision. The timing of this incision darkening is the same as that of redness that appears in lighter-colored skin.
Understanding this ‘coloring’ of incisions and subsequent scars is important for patients to avoid anxiety about the appearance of their surgical incisions. There are some topical products and light therapies that may be beneficial in shortening the resolution of this visible part of the healing process.
Dr. Barry Eppley