The first fortnight
Ordinary healing, including the alarming parts
The first forty-eight hours — keep it dry
Leave the dressing alone. No showering that wets it, no swimming, no soaking. After forty-eight hours, clean gently as instructed and re-dress. Showering is usually fine from then; soaking and swimming wait until sutures are out.
Bleeding in the first day is ordinary
Firm continuous pressure for twenty minutes without lifting to check stops nearly all of it. Lifting to look every two minutes is why pressure appears not to work. If it soaks through repeatedly, telephone.
Bruising, and where it travels
Facial wounds bruise and gravity moves the bruise downwards over two or three days, so a forehead excision can produce a black eye. It looks alarming and resolves in a week to ten days.
No lifting or stretching for two weeks
Particularly on the trunk and shoulders where skin is under tension. This is the commonest reason a scar ends up wider than it needed to be, and it is entirely within your control.
Sutures out on time
Five to seven days on the face, ten to fourteen on the trunk and limbs. Face sutures left too long produce the little cross-hatch marks people associate with stitches, so the appointment matters.
After freezing — expect a blister
Often within a day, sometimes large, sometimes blood-filled, which looks dramatic and is not a complication. Leave it intact if you can, since it is a sterile dressing. Let the crust separate on its own; picking it off early is how a mark becomes a scar.
The scar
The next twelve months
Judge nothing before a year
A scar is at its reddest, firmest and most raised at about six weeks and then remodels for six to twelve months. Assessing it at two months is assessing it at its worst, and nobody should be offered revision before a year has passed.
Sun protection on it for twelve months
New scar tissue pigments readily and sun exposure in the first year can darken it permanently. Cover it or use sunscreen on it daily. This is one of the few pieces of scar advice with a clear effect.
Massage from about three weeks
Firm, for a few minutes a day, once the wound is fully healed. Combined with silicone gel or sheeting, which is the other measure with reasonable evidence behind it.
Tell us early if it is thickening
A scar becoming raised, firm, itchy or growing beyond the original wound is treatable, and treating it early works better than treating it late. Do not wait for a review appointment months away — see Scars & Keloids.
Telephone the practice if any of these happen. None of them is likely and all of them are worth a two-minute conversation rather than a wait. We would far rather field a call about ordinary healing than have somebody sit on an infection for a week.
- Increasing pain from day three onwards, rather than steadily settling.
- Redness spreading outwards from the wound, especially with warmth to the touch.
- Swelling that is increasing rather than reducing after day two.
- Pus, or discharge with an odour.
- A fever, or feeling generally unwell.
- Bleeding that soaks through a dressing repeatedly despite twenty minutes of firm pressure.
- A wound edge that has separated.
- Anything, at all, that is worse rather than better after a procedure — telephone rather than waiting for the review.
Questions
Aftercare — the questions we are asked most
When can I shower?
Usually after forty-eight hours, gently, with the wound patted dry afterwards and re-dressed. Soaking, swimming and hot tubs wait until the sutures are out. You will be given the specific instruction for your wound in writing.
Can I go to work the next day?
For a wound on the trunk or a limb, usually yes, provided the job does not involve lifting or stretching that area for two weeks. For a facial wound the limiting factor is the bruising rather than the wound itself, and people vary in how much they mind that.
The blister from freezing is enormous. What do I do?
Usually nothing — leave it intact, since it acts as a sterile dressing, and let it settle. If it is painful or in the way, puncture it at the edge with a clean needle and leave the roof in place. Blood-filled blisters look alarming and are not a complication.
When will I get my result?
About a week, occasionally longer if extra staining is needed. We telephone every result, including the reassuring ones — no news does not mean good news here. If ten days pass without a call, telephone us.
Should I use an antibiotic ointment on it?
Only if you have been told to. Routine antibiotic ointment on a clean surgical wound is not usually necessary and one commonly used ingredient is itself a frequent cause of contact allergy — which produces a red itchy wound that is then mistaken for infection. Follow the written instruction you were given.
The risks, plainly. Every treatment described here has side effects, and some carry real risks. Topical steroids thin skin if they are used at the wrong strength on the wrong site for too long, which is why they are prescribed with a site, a strength and a stopping point rather than handed over indefinitely. Light-based and laser treatment can burn, blister and cause pigment change that lasts months, and that risk is higher on deeper skin tones and on recently tanned skin. Any procedure that breaks the skin can bleed, become infected and leave a scar; on the chest, the shoulders and the jawline, scars are more likely to thicken. Several of the medicines used in this speciality require blood tests, and some cannot be taken during pregnancy. We tell you your own risk rather than the average one, and where the honest answer is that a condition is better left alone, that is the advice you will get.
A named diagnosis and a written plan you leave holding
Book an appointment
Pick a physician and a time from the calendar — it shows only the hours each of them genuinely has free. A new patient appointment is thirty minutes, a full skin examination forty-five, and you leave with a named diagnosis written down. If something on your skin has changed, telephone instead and say that word: it is triaged differently.