The body begins laying down new collagen to rebuild strength in the wound. New blood vessels form to support this rebuilding, which is part of why a scar often looks quite pink or red during this stage. This is also, somewhat counterintuitively, when a scar frequently looks its worst — often somewhere between six and twelve weeks — precisely because so much active rebuilding is happening just beneath the surface. Patients are often alarmed at this stage, worried the scar is ‘getting worse,’ when in fact it’s simply mid-repair.

This is the slow part. The collagen fibres that were laid down somewhat haphazardly during the proliferative phase gradually reorganise into a more orderly, flatter structure. Blood vessel density in the scar reduces, which is why colour fades from pink or red toward a paler tone closer to your surrounding skin. Scars continue to soften, flatten and fade for up to 12 to 18 months after surgery — genuinely useful to know, because it means judging a scar’s final appearance at six weeks is judging it far too early. I ask patients to hold off on final judgement until at least the six-month mark, and ideally closer to twelve.

Genetics play a real role — some people are simply more prone to thicker, raised, or discoloured scarring (including keloid or hypertrophic scarring), regardless of how well the wound is cared for. Wound tension matters too: a scar under more mechanical tension, such as one crossing a joint or a naturally mobile area, tends to widen and thicken more than one in a low-tension area. Wound depth, infection during healing, and even the direction a scar runs relative to natural skin tension lines all play a measurable role in the final result.

Silicone works by hydrating the outer layer of the healing scar and creating a stable, protective barrier over it, which appears to help regulate the collagen production happening underneath and reduce excess blood vessel formation — both of which contribute to a flatter, paler, softer scar over time. We use products from Nokori in our practice. Application generally begins once the incision has fully sealed (no open skin, no scabbing), typically starting from around two weeks post-surgery and continuing consistently for eight to twelve weeks, sometimes longer for scars that are healing with more thickness or tension. Consistency matters more than any single application — silicone needs many hours of daily skin contact to have a meaningful effect, so sporadic use tends to produce disappointing results regardless of the product used.

Bruising around a healing incision is a normal part of the body’s response to surgery, caused by small blood vessels leaking under the skin. It typically resolves over one to three weeks, moving through a fairly predictable colour change from deep purple-blue to green, yellow, and finally fading entirely.

We often recommend Alastin’s InHance serum during this window, which some patients find supports the skin’s appearance while bruising resolves. As with any topical product, individual response varies, and it works best as part of a broader recovery routine rather than in isolation.

Bromelain (an enzyme derived from pineapple stems) and quercetin (a plant-derived antioxidant) are sometimes recommended around the time of surgery. Some patients find they support the body’s natural response to bruising and swelling in the days following a procedure. If we recommend these for you, we’ll give you specific timing — including when to stop before surgery, since some supplements can increase bleeding risk and need to be ceased in advance, typically at least a week or two before your procedure depending on the supplement and the surgery involved. Always check with us, or your GP, before starting any supplement around the time of a procedure, particularly if you take blood-thinning medication or have a bleeding disorder.

A healing scar is far more likely to darken permanently — a process called post-inflammatory hyperpigmentation — if it’s exposed to the sun during its first year, since new scar tissue produces melanin far more reactively than mature skin. Keeping it covered with clothing, or well protected with a broad-spectrum SPF 50+ sunscreen once the skin has closed, is one of the simplest, most effective things you can do, and it’s one of the most commonly overlooked.

Once a wound has properly closed — usually a few weeks in, and only once your surgeon has confirmed it’s ready — gentle, firm massage in small circular motions may help soften the scar, break up excess collagen bundling, and improve its overall texture and mobility, particularly for scars that feel tight or ‘stuck’ to the tissue beneath. We’ll show you the specific technique, direction and pressure to use at your follow-up visit, since this varies depending on where the scar is and how it’s healing.

Occasionally a scar heals with more tension, thickness or discolouration than expected, despite good aftercare. In these cases, further options include steroid injections to soften and flatten a raised or thickened scar, laser treatment to address persistent redness or textural irregularity, or, less commonly, surgical revision for scars that have healed with significant tension or an unfavourable position. This is something we’d discuss at a follow-up if your scar isn’t progressing the way we’d expect for its stage of healing.