Scars: placement, healing and care

By Assoc. Prof. Dr. Ayhan Işık Erdal, MD, FACS, FEBOPRAS · Updated September 2026

The scar is the operation's price, and it deserves the same honesty as the result. Here is where it goes, how it behaves, and what actually improves it — separated from what is merely sold.

The scar in five facts

Placement — the decision made before surgery

The scar's position is the most important cosmetic decision of the operation, and it is made standing, in the garment you wear, with a pen — not on the table. The line follows the lower edge of the band so the band covers it; where the roll continues toward the sides, the incision curves upward with the natural fold under the arm, staying inside the line of a bikini top's side strap. Patients who wear strapless or low-back styles discuss that specifically — a lower line can be planned within the limits the anatomy sets.

Length — decided by your excess, not a template

A small central roll may need a scar spanning the mid-back only; a post-weight-loss roll that wraps toward the sides needs a longer line. A scar shorter than the excess leaves puckers ('dog ears') at its ends or an under-corrected side; the honest trade is a longer, well-placed line over a shorter, compromised one. You see the drawn length before surgery.

How it matures

Weeks 0–6: red, raised, firm; protected by tapes and the vest. Months 2–6: redness peaks around months 2–4 and begins to fade; silicone care is established. Months 6–12: flattening and lightening to pink; massage improves pliability. Months 12–18: the final pale line in most patients; the back's slower scar maturation compared with the face is normal.

What the evidence supports: tension control, silicone (gel or sheet), sun protection and time. What it doesn't: vitamin E oil, expensive creams, or anything promising a scar that vanishes. Spend the effort on the first list.

Care protocol

Weeks 0–2: dressings and tapes as instructed; no stretching. From week 2–3, once sealed: silicone gel twice daily or silicone tape, for at least 3–6 months. From week 6: gentle massage across the line. All year: SPF 50 or clothing over the scar in sun — UV darkens young scars permanently, and the back is exposed in summer. Photos to Dr. Erdal at each remote follow-up; hypertrophic or widening scars are treated early (steroid, laser) rather than late.

The honest limits

Skin type, genetics, tension and compliance all shape the final scar. Slight widening at the points of highest tension — typically the centre and the side ends — is possible and is discussed in advance. Minor scar revision under local anaesthesia after month 12 is available if wanted. Keloid-prone patients are assessed individually and told the truth about the odds.

Questions patients ask

Can the scar be hidden under a bikini?

In most patients yes — the line is planned under the band of the bikini top you bring to the consultation. Very low-back styles may show the scar's side ends; that limit is discussed before, not after.

Does the scar go all the way around?

No. It is a back scar — from the mid-back toward the sides as far as the roll extends. It does not continue onto the chest unless a breast procedure is planned as part of an upper body lift.

What if the scar widens?

Small widening is managed with silicone and time; a persistently wide or raised segment can be revised under local anaesthesia after month 12. It is a minor procedure and is discussed at assessment as part of honest planning.

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