Understanding scar discoloration after plastic surgery

Most plastic surgery procedures cause some scarring. Patients often determine the success of their surgery by how visible the scars are. Scarring is inevitable with surgery, but there are many different ways to make them less noticeable.

There are many factors that can influence scar color after surgery, including genetics, skin tone, sun exposure, wound healing, scar tension, the types of sutures used during the surgery, the type of surgery performed, the presence of infection, nutrition, vitamin and mineral levels and the type of postsurgical scar treatment.

If you are concerned about scarring after your procedure, it is important to choose a board-certified plastic surgeon who is an ASPS member. They've been trained to help to minimize the appearance of scarring during plastic surgery procedures.

Why does scarring occur after surgery?

Scar discoloration is one of the most common reasons scars are noticeable after surgery. Typically, patients may notice that their scars look darker than the surrounding skin during the first few months after surgery. It is important to understand that fresh scars can often look red, dark, raised or rough as they heal. Some scars can take up to 18 months to fully heal.

Once your scar has fully healed, if you are still unhappy with its appearance, scar revision may be an option. Nothing can truly get rid of a scar, but there are surgical and nonsurgical options to make it less noticeable.

This darkening of the scar may occur as a result of four common processes:

• Extra pigment or scar hyperpigmentation: Your skin may produce more melanin or pigmentation in the scar area. This can be long-lasting and sometimes permanent. Treatments such as skin-lightening creams or exfoliating peels can reduce discoloration.
• Bruising or hemosiderin discoloration: This can happen after bleeding or bruising under the skin. Hemosiderin discoloration commonly occurs in the lower eyelids, face and lower legs. Treatments such as lasers or exfoliation therapy help these scars fade.
• Skin color differences or skin mismatch: Natural variation in skin color in areas like the armpits, breast fold, belly button, pubic area, inner thighs, knees and elbows can make scars stand out. If your plastic surgery procedure involves the removal of large amounts of skin, the scar may show a difference in skin color above and below the incision line. These differences can sometimes cause significant scar visibility along incisions for a tummy tuck, thigh lift, arm lift or breast surgery. Treatments include a combination of skin lighteners, exfoliative treatments, surgery or lasers.
• Redness or post-inflammatory hyperemia: New scars can look pink or red. It is important for your plastic surgeon to distinguish between normal scarring and persistent inflammation that may lead to keloid formation. The gold standard for treatment includes the pulsed dye laser to reduce redness and scar discoloration caused by inflammation.

Scar discoloration may be caused by many factors, some controllable and others uncontrollable. Genetics often plays a large role in how you scar after surgery. You can help scars heal and be less visible by balancing your nutrition, avoiding excess stress or tension on your incision line, reducing microbial contamination, minimizing direct sun exposure and following the guidelines set by your plastic surgeon for your particular surgery.

If, after fully healing, you are still unhappy with your scars, treatments are widely available to help you reduce their appearance. Speak with your plastic surgeon to discuss treatment options.

*Levon Karamanoukian and Jun Yun co-authored this blog