When to See a Plastic Surgeon About a Scar

Most scars improve on their own. A confident, well-formed scar at six weeks will keep softening for two years, until it eventually fades into a thin, pale, almost invisible line. That is the natural arc.

But some scars do not follow that arc. They become raised, dark, itchy, tight, or — worst of all — they begin to contract and restrict the tissue around them. Recognising the difference early is the single most important thing a patient can do.

The natural scar lifecycle

A healthy scar passes through three phases:

1. Inflammation (0–3 weeks): Red, raised, warm, slightly tender. Normal.
2. Proliferation (3 weeks – 3 months): Pink, firm, slightly itchy. Collagen being laid down. Normal.
3. Remodelling (3 months – 2 years): Slowly fades, flattens, pales. Normal.

If at any stage a scar deviates from this — gets darker rather than paler, gets thicker rather than thinner, extends beyond the original wound boundaries — that is the warning sign.

Red flags

• Hypertrophic scar: Raised and thickened, but stays within the original wound boundary. Often responds well to silicone sheeting and steroid injections.
• Keloid: Raised, dark, often itchy, and — critically — extends beyond the original wound. South-Asian and African skin types are predisposed. Needs early, layered treatment to control.
• Contracture: The scar tightens and pulls surrounding tissue. Most common across joints (neck, axilla, hand). If left, can cause permanent loss of range of motion.
• Hyperpigmentation: The scar darkens markedly over months rather than fading.

"The window for the best outcome in a scar is roughly six weeks to six months. After two years, we can still improve a scar — but we cannot undo the choices made in the first month."

The window that matters: 6 to 12 weeks

This is the period during which the scar is most amenable to non-surgical intervention. Silicone gel or sheeting, steroid injections (for hypertrophic scars), pressure garments (for burn scars), and laser — all of these work best when started early.

By six months the scar is largely "set". Improvement is still possible, but the tools become more invasive.

What modern scar revision actually involves

If you come to me at six weeks with a developing hypertrophic scar, the protocol is typically:

• Silicone gel applied twice daily for 12 weeks.
• Intralesional triamcinolone injections at 4-week intervals, for two to three cycles.
• Sun protection — strict.
• Possibly fractional laser at 3 months if pigmentation is a concern.

If you come to me at two years with a settled, raised, problematic scar — we're looking at surgical revision: excision, careful re-closure along relaxed skin tension lines, and a controlled scar remodelling protocol thereafter.

Burn scars — a special category

Burn scars deserve their own paragraph. They contract aggressively. They are often pigmented. They cross joints. They can permanently impair function. My training at Safdarjung's burns unit was specifically in this area, and the message I'd impress on every burns patient is: don't wait. The earlier we intervene with pressure garments, scar massage and — where indicated — surgical release, the better the long-term function and appearance.

When is it too late?

It is never entirely too late. I have revised scars 20 years after the original injury with excellent results. But it is always easier earlier. If you have a scar that is bothering you — physically, functionally, or psychologically — come in. There is almost always something we can do.

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