Doç. Dr. Ayhan Işık Erdal · Plastic Surgery, FACS, FEBOPRAS
Published: 8 May 2026 ·
About the surgeon
Quick answer
Start silicone gel once all incisions are closed (typically week 3-4) and continue for 6 months. Apply twice daily, evenly across all incision lines.
Sun protection is critical for the first 12 months — UV exposure on healing scars causes permanent darkening and pigmentation changes. Use clothing coverage and high SPF.
Laser treatments can improve scars from month 3 onwards. They're optional, not essential — most scars heal well with silicone and sun protection alone.
1. How scars form and mature
A surgical scar goes through three biological phases:
Inflammatory phase (days 0-21)
The wound closes via a temporary fibrin matrix. Scars are red, slightly raised, sometimes itchy. Collagen production begins.
Proliferative phase (weeks 3-12)
Type III collagen is laid down — disorganized, plentiful, responsible for the firm raised feel of new scars. This phase is when scars look "worst" in terms of redness and thickness.
Maturation phase (months 3-18)
Type III collagen is gradually replaced by type I collagen, organized along stress lines. Scars flatten, fade, and become less visible. The endpoint is reached at approximately 18 months.
Scar care interventions work by influencing this remodeling process — particularly the proliferative and maturation phases.
2. Silicone — the evidence-based mainstay
Silicone gel and silicone sheeting are the most studied and effective non-prescription scar treatment available. Mechanism (simplified): silicone creates a protective film that maintains hydration and pressure, signaling the body to reduce excess collagen production.
Silicone gel
- Apply a thin layer twice daily across all incisions
- Allow 5 minutes to dry before clothing contacts the area
- Continue for minimum 3 months, ideally 6 months
- Start: once incisions are completely closed and surgeon-approved (typically week 3-4)
- Brand isn't critical — generic medical-grade silicone gel is effective
Silicone sheeting
- Cut to fit the scar shape
- Apply for 12-24 hours per day
- Wash daily; replace when no longer adheres well (typically every 1-2 weeks)
- Less convenient than gel for vertical scars (under bra strap)
- Often more effective for hypertrophic scars
Realistic expectations from silicone
- Reduces hypertrophy (raised scarring) significantly
- Accelerates colour fade somewhat
- Doesn't make a properly healing scar invisible
- Most useful for patients prone to thick scarring
3. Sun protection — non-negotiable
UV exposure on healing scars causes:
- Permanent hyperpigmentation (darkening)
- Increased redness that doesn't fade
- Disrupted collagen remodeling
This isn't theoretical — scars exposed to summer sun in the first 6 months can look noticeably darker for years.
Practical sun protection
- For the first 6 months: keep scars completely covered when outdoors (clothing, swim shirts)
- From 6-12 months: high SPF (50+) sunscreen if scars will be exposed
- After 12 months: regular SPF 30+ as part of normal skin care
- Avoid direct sunbathing of the chest for the entire first 12 months
- Solarium/sunbeds: avoided entirely — concentrated UV is worse than sun
4. What NOT to use
Marketed as scar treatments but lacking evidence:
- Vitamin E oil — actually associated with worse outcomes in some studies
- Lemon juice — irritates skin, no benefit, increases pigmentation under UV
- Onion extract — modest evidence, vastly inferior to silicone
- "Natural" oils (coconut, argan, etc.) — moisturize but don't influence scar biology meaningfully
- Aloe vera — soothing if irritated; not scar-modifying
You can use these as moisturizers if you enjoy them, but understand they're not "treating" the scar in any clinically significant way.
5. Massage
Scar massage starts at week 4-6 (once incisions are fully closed):
- Apply firm but not painful pressure along and across the scar
- 2-3 minutes per scar, twice daily
- Use silicone gel or unscented moisturizer as a glide
- Helps mobilize scar tissue, reduce adhesions to underlying tissue, and may improve sensation
- Continue for 3-6 months
6. Laser treatments — optional refinements
Laser is not first-line treatment — silicone, sun protection, and time do most of the work. But certain laser modalities can improve scar appearance from month 3 onwards.
Pulsed dye laser (PDL)
- Targets the redness in scars
- 3-5 sessions, 4-6 weeks apart
- Effective from month 3-12
- Mild discomfort during treatment; transient bruising
Fractional ablative laser (CO2, Er:YAG)
- Targets scar texture and thickness
- 1-3 sessions starting from month 6+
- More downtime per session (5-10 days redness)
- Most effective for hypertrophic scars not responding to silicone alone
Non-ablative fractional laser
- Less downtime, gentler than ablative
- Multiple sessions needed
- Modest improvements; safer for darker skin types
Realistic expectations from laser
- Improves scars that are already healing reasonably
- Cannot transform a poorly-healing scar into perfection
- Most useful at the maturation phase, not in early healing
- Cumulative cost can be significant; weigh against marginal improvement
7. Hypertrophic and keloid scars — special management
Hypertrophic scars
Raised scars that stay within the original incision boundaries. More common in:
- Patients with darker skin tones
- Areas of high tension (the "T-junction" of Wise pattern reductions is the classic example)
- Family history of difficult scarring
Treatment
- Aggressive silicone use from week 3
- Pressure dressings or pressure garments
- Steroid injection (triamcinolone) every 4-6 weeks for 3-4 sessions if not improving
- Laser as adjunct
Keloid scars
Scars that extend beyond original incision boundaries. Genetic predisposition is the main risk factor — more common in patients of African, Asian, and Hispanic descent. Can occur even with optimal scar care.
Treatment
- Steroid injection (mainstay)
- Cryotherapy combined with steroid
- 5-FU or bleomycin injection in resistant cases
- Surgical excision is generally avoided (high recurrence) unless combined with post-excision radiation
Pre-emptive prevention in high-risk patients
- Identification at consultation (family history, prior keloid)
- Steroid injection at 2-4 weeks post-op (preventive, not just reactive)
- Aggressive silicone protocol from week 3
- Specific incision strategy to minimize tension
8. Timeline of typical scar healing
| Time point | Typical appearance |
|---|
| Week 1-2 | Steri-strips or sutures visible; scars beneath red and slightly tender |
| Week 3-6 | Scars red, raised, may itch; this is the "worst-looking" phase |
| Month 3 | Still red but less raised; texture starting to soften |
| Month 6 | Pink rather than red; starting to flatten |
| Month 9 | Pale pink; mostly flat; less noticeable |
| Month 12 | Pale, flat, well-blended in most patients |
| Month 18 | Final mature scar — the result for life |
9. When to seek additional treatment
- Scars that are still actively raised and red at 6 months
- Scars that are widening (becoming broader than the original incision)
- Scars with significant itching, pain, or functional limitation at 3+ months
- Scars showing keloid behavior (extending beyond boundaries)
- Scars that bother you cosmetically at 12 months despite good basic care
Most can be improved. Don't accept a suboptimal scar without trying targeted treatment.
10. Realistic expectations — by skin type and genetics
Scar quality is not entirely under anyone's control. The honest spectrum:
- Best 20% of patients: Scars largely invisible at 12 months under most lighting. Minimal intervention needed beyond basic care.
- Middle 60% of patients: Scars visible on close inspection but not at conversational distance. Pale, flat, well-blended.
- Bottom 20% of patients: Scars more visible — slightly thicker, slightly redder, slightly more pigmented. Often improved by silicone, laser, and sometimes minor revision.
- Bottom 5% of patients: Hypertrophic or keloid issues requiring active management. Often improved substantially but rarely "invisible."
Set expectations at "the middle 60%" rather than "the best 20%." Anyone who promises invisible scars is overselling.
Frequently asked
When can I start using silicone gel?
Once all incisions are completely closed and the surgeon confirms no open or draining areas. Typically week 3-4 post-op. Starting earlier (when incisions are still healing) can interfere with closure.
Is expensive silicone better than budget brands?
Not significantly. The active ingredient (medical-grade silicone polymer) is similar across price points. Look for products labeled 'medical grade silicone' or 'CPX cyclomethicone'. Major price differences usually reflect packaging and marketing, not effectiveness.
Can I tan or sunbathe in summer with healing scars?
Not in the first 6 months. After 6 months, with high SPF and limited exposure, occasional sun is fine. Direct sunbathing of the chest area is best avoided for the full first year. Solariums are worse than sun and avoided entirely.
My scars are itching — is something wrong?
Itching is normal during weeks 3-12 — it's a sign of nerve regeneration and active healing. Avoid scratching. Cool compresses, antihistamines if severe, and silicone gel all help. Itching that's accompanied by redness, swelling, or drainage is concerning and should be reviewed.
Should I do laser treatments routinely?
No. Most scars heal well with silicone and sun protection alone. Laser is reserved for scars that aren't progressing well at month 3-6, or for refinement at month 6-12. Routine laser for every patient isn't supported by evidence.
How visible will my scars be in a swimsuit at 12 months?
For most patients, scars at 12 months are pale and flat, visible on close inspection but not at distance. The vertical scar runs down to the inframammary fold and is largely hidden by a swimsuit cup. The horizontal scar (in Wise pattern) sits in the breast crease and is hidden in any reasonably full-coverage swimsuit. The peri-areolar scar blends into the natural areolar edge.
Important: This article provides general medical education and does not replace individual consultation. Treatment decisions vary by patient. The surgeon's clinical judgment, based on examination, takes precedence over any general guidance.
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