Scar Care

By Nick Peplow·Gender-affirming surgery coordinator

Last reviewed 27 September 2026· How this site is researched

Most FTM surgeries leave a scar you'll care about: the two chest lines of double incision, the forearm or thigh donor site of phalloplasty, the small ports of a hysterectomy. Nothing erases a scar, but what you do in the first year shifts how wide, raised and dark it ends up. This page covers the scar care that works across all of them, in roughly the order the surgeons I work with rate it. The chest-specific detail, scar by technique and tattooing over them, is on top surgery scars.

How a scar matures

An incision closes in the first two weeks or so. Underneath, the body keeps laying down collagen for months, so a scar that looked neat at week two usually gets redder, thicker and more raised through weeks four to twelve. That is normal, and it's the stage where people panic. From about month three it starts to flatten and fade, and most scars are close to final at twelve to eighteen months.

On darker skin, scars tend to heal darker than the surrounding skin (hyperpigmentation) and can take longer to settle. On very fair skin they often stay pink for longer instead.

Two kinds of scar go beyond normal. A hypertrophic scar is raised and firm but stays inside the original line, and it often improves with time and treatment. A keloid grows past the line into healthy skin and doesn't shrink on its own. If you or close family have had keloids, tell your surgeon at the consultation, not after. It can change where they cut and how they close.

Before the wound has closed

Until every part of the incision is closed with no scabs, and your surgeon has said so, the only job is keeping it clean, dry and dressed the way you were shown. For most incisions that's somewhere between two and four weeks. Nipple grafts, a phalloplasty donor site and the T-junction of an inverted-T take longer.

No creams, oils, silicone or tape on an open or scabbed wound. Pulling a scab off early to "get started" is the most common way people set their own scars back.

Silicone

Silicone sheets or gel are the treatment surgeons recommend most consistently and the one with the most evidence behind it. The thinking is that it keeps the scar hydrated under a light seal, which calms the collagen overproduction that makes scars thick.

• Sheets are cut to shape and worn most of the day and night. Packet instructions usually aim for twelve hours or more; you wash and reuse them for a couple of weeks. Cheaper per week, better on flat areas like the chest and abdomen.
• Gel is rubbed on twice a day and dries to a thin film. Easier on awkward or moving areas like the forearm, face and neck, and under clothes.

Start once the wound is closed and your surgeon agrees; on the chest the procedure pages put that at about week three. Keep going for at least three months, ideally six. Consistency matters much more than brand. A plain medical-grade sheet does the same job as the expensive ones. Expect to spend roughly $20–$60 or £15–£40 a month, more for a long donor site. If the skin under a sheet gets red, itchy or spotty, give it a day off and wash the sheet more often.

Tape

Paper or microporous tape laid along a closed incision takes tension off it, and tension is a big part of what makes scars stretch wider. That matters most on the chest, where every arm movement pulls across the line. Surgeons who use it typically have you tape from around week two or three through to week eight or twelve, replacing it when it starts to peel rather than ripping it off. A roll costs a few pounds or dollars.

Tape and silicone can be combined. Some surgeons have you tape first and move to silicone later; others have you put gel under tape. Ask which they want.

Massage

Once the scar is closed and no longer tender, usually from about six weeks, firm massage along and across it for a few minutes a day helps loosen the adhesions that make a scar feel stuck to the tissue underneath. Use a plain moisturiser or silicone gel so your fingers slide. Firm pressure is fine; it shouldn't hurt.

Sun

UV on a scar that is still pink or red can darken it, sometimes for good. For the first year, keep scars covered or use a high-factor sunscreen whenever they see sun, and reapply after swimming. You can go shirtless on a beach. Just do the sunscreen first.

What doesn't do much

Vitamin E, bio-oil, cocoa butter and branded "scar creams" get recommended constantly. Every surgeon I've put the question to gives the same answer: they're moisturisers, and moisturising is fine. They won't hurt closed skin, and a moisturised scar itches less. Just don't expect what silicone does. Vitamin E causes a rash in some people, so stop if the scar turns itchy and red after you start it.

Smoking and nicotine slow wound healing and are the reason some scars open up or widen. Most surgeons ask you to stay off nicotine for several weeks after surgery as well as before.

By procedure

Top surgery. Start tape or silicone as soon as you're cleared, even while the compression vest is still on; many people wear sheets under it. Grafted nipples are their own scar and follow the graft care you were given.

Phalloplasty donor site. This is a skin graft over a large area, not a line. The first months are about graft care, then a compression sleeve or garment, heavy moisturising and strict sun protection, often for a year or more. Silicone helps at the edges and over any raised areas. However well it's cared for, the scar stays visible, so have a realistic conversation about it before choosing a flap.

Hysterectomy and laparoscopic work. Port scars are about a centimetre long and usually fade to almost nothing without special care.

Metoidioplasty and scrotoplasty. The scars sit in skin folds and pubic hair. Scar care here is mostly keeping the area clean and following the surgeon's wound instructions.

Facial surgery. Scalp and hairline incisions can leave a thin line of reduced hair growth along the scar. That is worth asking about before surgery, especially if you keep your hair short.

When a scar needs a doctor

Go back to your surgeon, or ask to be referred to a dermatologist, if a scar becomes noticeably raised and ropey, keeps spreading past the incision line, stays angry red past six months, or itches and hurts more over time rather than less. The usual options are steroid injections into the scar, repeated a few weeks apart; laser for redness or texture; pressure garments; and, once the scar has matured, scar revision. None of these are things to improvise at home.

I've noticed that the people with the best-looking scars at a year are rarely the ones who bought the most products. They're the ones who used a cheap sheet every day for six months and kept the sun off.