How Skin Tone and Type Influence Cosmetic Surgery Scarring

Scars are an unavoidable consequence of cosmetic surgery, but they’re not something you should fear. Due to the surgical techniques used, the vast majority of scars are in locations that are not easily visible and most eventually fade away to almost nothing.

However, skin tone and type can affect the appearance of scars on your body. All skin types follow the same biological healing process, but there are differences in collagen levels and skin level tightness that can impact scarring on black, Asian and white skin.

With that in mind, we discuss the factors that affect the appearance of cosmetic surgery scars on black and dark skin, the different types of scars that can occur and the role of the Fitzpatrick Scale.

How can scarring present after cosmetic surgery?

Scars after cosmetic surgery present as a visible line that may be raised or appear bumpy. Immediately after the surgery, a scar is at its most visible. It will usually be red and swollen with visible stitches or staples. Over time, as the wound heals, the scar will flatten out in texture and fade to a gentler pink or purple colour, and on white skin, the scar will lighten to a flesh colour.

Scars on black or brown skin can appear darker than the skin around them due to how melanin production is affected during the healing process. This is called hyperpigmentation. The darkness around the incision site will usually fade over time, but it’s possible the skin may never return to its original colour.

Scars on dark skin can also appear lighter than the surrounding skin due to hypopigmentation. In most cases, the skin will return to its original colour as the affected area heals and produces melanin again. However, it can take weeks or even months to fully recover.

Why scarring isn’t something to fear

Regardless of the procedure, a good surgeon will hide incisions in natural creases and inconspicuous places to make them less noticeable. For example, facelift scars can be found in the hairline and behind the ears, and breast enhancement incisions are typically made in the creases under the breast, around the edge of the areola or within the armpit crease.

Cosmetic surgeons also use layered wound closure and dissolving sutures to reduce scarring. There are also things you can do at home to minimise the appearance of scars, and professional treatments, such as laser therapy, silicone gels, chemical peels and steroid creams, that can soften, flatten and reduce discolouration.

What are the factors that affect scaring?

Several factors affect how scars heal and appear after cosmetic surgery.

Genetics

Genetics plays a major role in scar formation. It influences the healing process, with certain genetic variations leading to larger and more noticeable scars. For example, individuals are more likely to develop keloids (thick, raised scars) if they have a history of them in the family.

Genetic differences in collagen production and skin elasticity can also affect scarring. Genes related to excessive collagen production can lead to raised scars, while genetic factors related to skin thickness and elasticity influence how well a scar heals. Your surgeon will discuss your family history and previous scarring with you, and that may influence the surgical technique they use.

Lifestyle

Your lifestyle also impacts scar formation, with poor lifestyle choices potentially leading to slower healing and increased scar visibility. Smoking should be avoided before and in the months after surgery as it reduces blood flow to the incision site, which hinders the healing process and increases the risk of complications.

It’s also best to keep scars out of direct sunlight when they are new or still healing, as it can make them appear darker and more noticeable. You should cover the scar with clothing or apply a high-SPF sunscreen.

Positive lifestyle choices for scar healing include drinking lots of water, eating a balanced diet containing plenty of protein, zinc, iron and vitamin C, and avoiding exercises that put pressure on the incision site in the first few months after surgery.

Ethnicity

Different ethnicities have distinct skin characteristics that can affect the formation and appearance of scars after cosmetic surgery. For example, people with black skin are more at risk of hyperpigmentation and keloid scarring. Keloids are thick, raised scars that can be itchy and painful and grow over the original incision boundary. You’re also more likely to see hypertrophic scars on dark skin.

Given these risks, patients with darker skin tones should consult surgeons with specific experience treating diverse skin types. They will discuss scarring concerns and how to manage scars after surgery.

What is the Fitzpatrick Scale?

The Fitzpatrick Scale groups different types of skin based on the amount of melanin they contain. Melanin is the pigment that gives skin its colour and protects it from the sun’s harmful UV rays. The Fitzpatrick Scale includes six skin types, with Type 1 being the palest and Type 6 the darkest.

Dermatologists use the Fitzpatrick Scale to determine the risks posed to different skin types by sunburn, skin cancer, scarring abnormalities and hyperpigmentation. The scale shows the risks of abnormal scarring and hyperpigmentation increase as the skin gets darker.

How do different skin tones and types affect cosmetic surgery scars?

The vast majority of cosmetic surgery patients we treat heal without any complications related to scarring, regardless of their skin type. However, as the Fitzpatrick Scale suggests, we do see more complications with scars on black and brown skin. Those complications include:

Hyperpigmentation – Dark skin contains more melanin than light skin, making it more susceptible to post-inflammatory hyperpigmentation. That can lead to pigmentary changes such as darkened patches or spots around the incision. Hyperpigmentation can fade over months or even years but may never disappear.
Hypopigmentation – Hypopigmentation has the opposite effect, leading to lighter skin patches at the incision site. It usually resolves itself after a few months as the affected area heals and the skin cells produce melanin again.
Hypertrophic scars – Hypertrophic scars are red, raised and thickened scars caused by excessive collagen deposits that more commonly affect dark skin. They usually improve within 12 to 24 months, becoming smaller, flatter and less noticeable, but may never disappear.
Keloid scars – Keloid scars are similar to hypertrophic scars in appearance and are 15 times more likely to affect patients with black skin. They are thick, red scars that can be itchy and even painful, but unlike a hypertrophic scar, they can extend beyond the original incision area. Keloid scars do not improve on their own and may require treatment to minimise their appearance and manage discomfort.

Why certain areas of the body are more prone to scarring

Certain areas of the body are also more prone to abnormal scarring. Incisions anywhere create a surgical scar. However, the chest, upper back, shoulders and ears carry a greater risk of keloid or hypertrophic scarring, particularly on black and dark skin. Keloid and hypertrophic facial scarring is unusual for any skin type as the healing process progresses more quickly.

The reason these areas are prone to abnormal scarring is due to the natural tension of the skin. That can cause the cells that produce collagen (fibroblasts) to pull in multiple directions, creating thicker and more noticeable scars.

Parts of the body frequently exposed to the sun are also at a greater risk of hyperpigmentation. That includes areas such as the face, neck, chest and tops of the arms. That’s why surgeons recommend you cover up and use a strong SPF sunscreen for at least a year after your procedure.

What can you do to minimise scarring after surgery?

Every cosmetic procedure at Enhance Medical includes comprehensive aftercare for 12 months. Before your procedure, your surgeon will explain the steps you can take at home to minimise scarring and reduce the risk of complications. That includes:

Protecting the scar from the sun and wearing an SPF 30 or higher sunscreen for at least a year after the procedure
Gently massaging the scar twice daily using a water-based cream to soften the scar tissue
Avoiding any activities that put pressure on or strain the incision site
Wearing loose clothing around the scar to avoid any damage to the skin or irritation
Avoiding smoking or drinking excessively after the procedure to reduce the risk of slow healing
Applying silicone sheets or gels to the incision site to moisturise the scar and help it heal

The aftercare provided by your surgeon and patient care coordinator also plays a vital part in the process. We schedule regular post-operative appointments to monitor your progress and provide you with a 24-hour emergency contact number for your nursing team. If you notice any sign of a scarring abnormality, you can request an appointment at any time throughout your aftercare period.

Safe, affordable and high-quality cosmetic surgery at Enhance Medical

At Enhance Medical, our surgeons have decades of experience treating patients of all skin types and tones. We take the time to discuss surgery outcomes, expectations and the associated risks. We understand the best surgical techniques to reduce the risk of abnormal scarring on black and dark skin and would be delighted to share results from previous patients. Find out more about cosmetic surgery at Enhance Medical and book a free consultation with our team.

Posted on 17th March 202517th March 2025 Posted in Body, Breast, Face