A scar is not a complication
In excisional body contouring, the scar is how the operation works. Skin is removed, and the edges are joined. The join is the scar. There is no version of an abdominoplasty or a brachioplasty without one, and the length of the scar is proportional to the amount of skin removed.
In liposuction the scars are small, at the access points, and are usually placed in creases. They are still permanent, and where energy-assisted techniques are used they can be more noticeable because of heat and friction at the wound edge.
The correct frame is therefore a trade rather than a risk: you are exchanging laxity for a mark. Whether that trade is worth it is a judgement only you can make, and it should be made while looking at where the mark will be.
How scars behave over time
A scar is not finished when the wound closes. Remodelling continues for a year or more, and the appearance changes considerably during that period.
The usual course runs from an initial red or purple, raised, firm and sometimes itchy scar, through a gradual fading and flattening, towards a paler, softer and flatter line. Most of the improvement happens in the first year, and further change can continue beyond it.
This has a practical consequence: a scar at three months is not the scar you will have. Judging it then, and seeking revision on the basis of that judgement, is premature. Our page on when the result is final makes the same point about contour.
What genuinely influences scar quality
Some factors are surgical, some are yours and some are outside anyone's control.
Tension. The most important surgical factor. A closure under high tension widens. Techniques that reduce tension on the skin edge by taking it in deeper layers exist for this reason.
Position. Scars in areas that move a great deal, or that cross lines of tension, behave worse. This is one reason inner arm scars are among the least reliable in the field.
Wound complications. A wound that becomes infected, breaks down or heals slowly produces a worse scar than one that heals cleanly. This is the strongest argument for taking the early restrictions seriously.
Skin type and individual healing. Susceptibility to hypertrophic and keloid scarring varies between individuals and is more common in some skin types. If you or close relatives have a history of thickened or keloid scars, say so at the consultation, because it changes the calculation.
Smoking. Impairs the blood supply on which healing depends and is associated with wound breakdown, which then produces a worse scar.
Sun exposure. A new scar exposed to ultraviolet light can pigment permanently. Covering or protecting a scar during its first year is one of the few aftercare measures with a clear rationale.
What scar treatments can and cannot do
A large market exists in scar products, and the claims outrun the evidence in most of it. A cautious summary is useful.
Silicone sheets and gels are the most widely used measure in mainstream practice for reducing hypertrophic scarring, and they are what most surgeons recommend. They are used for a prolonged period and require consistency.
Massage is commonly advised once the wound is fully healed, on the basis that it softens the scar and improves its pliability.
Pressure is used in some settings, particularly for scars prone to thickening.
Injections and laser are treatments a clinician may offer for established problem scars rather than routine measures. They belong to a review appointment rather than a shopping decision.
What none of these does is guarantee an outcome. If a product or treatment is being sold on the promise of an invisible scar, that is a claim requiring evidence, and the advertising codes require that evidence to be held. Ask for it.
Problem scars and what can be done
Hypertrophic scars are raised, red and firm but stay within the boundary of the original wound. They frequently improve over time, sometimes considerably.
Keloid scars extend beyond the original wound. They are more difficult, more likely to recur after excision, and are managed rather than cured.
Widened scars result from tension and are common where a closure was tight. Revision is possible but the same tension usually still exists, which is why simply cutting out a wide scar frequently produces another one.
Dog-ears are puckers of excess tissue at the end of a scar. They can often be corrected as a minor procedure once things have settled.
Depressed or adherent scars sit below the surrounding surface or are stuck to deeper tissue. They are more difficult and correction is variable.
All of these are worth raising at a review appointment. Some are treatable, some improve with time and some are permanent, and knowing which is which is a clinical judgement rather than a search result.
Setting expectations before rather than after
The most useful preparation for a scar is looking at where it will be, on your own body, before you consent.
Ask the surgeon to mark the planned line while you are standing, in the underwear or clothing you actually wear, and look at it in a mirror. Ask what happens to that line if more skin has to be removed than planned. Ask where the ends will sit.
People who have done this are rarely surprised afterwards. People who have not are the ones who describe the scar as something nobody told them about, when in fact it was on the consent form they signed without reading.
Questions to ask
- Where exactly will the scar be, and can you mark it now?
- How much tension will the closure be under, and what do you do to reduce it?
- Given my skin type and family history, what should I expect?
- What scar care do you want me to do, starting when, and for how long?
- If I am unhappy with the scar at a year, what are my options and what would they cost?
The last question matters because scar revision is a further operation, is not always included, and does not always improve matters. Knowing that before rather than after changes how the first decision is made.