Why do some patients have scars that fade while others last longer?

Question

I have seen some doctors patients' lose their scars within a year, and others have permanent scarring. But I have noticed those whose scars fade, have shorter incisions, it goes just above the ears along the hairline and that their results do not last past 2yrs. Those with scars, their scars run up higher along the hairline to the forehead but their results last and their facelift is more dramatic, they look younger. Why is this? Also, can laser remove all scarring? Is that always an option

Mehmet Surmeli, MD, FEBOPRAS · Answer

Hi,

Scar healing is a highly individualized process influenced by several factors. Genetics play a significant role; some people naturally produce more collagen, leading to thicker or more pronounced scars.

Skin type and color can also affect scarring—darker skin tones are usually more prone to hyperpigmentation or keloid formation.

It is also known that if the tension of the skin closure is high this may lead to worse wound healing and hence wider and more visible scars. 
Also any problem during the wound healing may lead to more visible scars. Other factors include age, ethnic background, nutritional status, and overall health. Lifestyle choices like smoking or sun exposure can impair healing and affect scar appearance as well.

Additionally, meticulous surgical technique and proper post-operative care are crucial. Following wound-care instructions can promote better healing and lead to scars that fade more effectively over time.

My comments and recommendations are solely based on your text and are subject to change. I always recommend a face-to-face consultation with a specialist to plan the treatment.

Best wishes, Dr. Surmeli.

Muhsin Yilmaz, MD, FEBOPRAS · Answer

The length and position of a facelift incision do not necessarily determine how long the result will last. More important is how the deeper facial tissues are repositioned and supported during the operation. A shorter incision can sometimes be appropriate for a patient who has less laxity, while more extensive laxity may require a different incision and surgical plan.
A more dramatic result does not automatically mean a better result either. The goal should be to achieve appropriate lifting while keeping the hairline, ears and scars natural.
As for laser, it can significantly improve the appearance of some scars, but it cannot reliably erase every scar completely. Scar quality depends on your individual healing, genetics, incision placement and surgical technique. Laser can be an option once the scar has matured, but it is not a guarantee.

Semih Yildiz, MD, FEBOPRAS · Answer

Scar visibility after a facelift depends on many things: genetics, skin color and thickness, incision placement, how much tension is placed on the skin, smoking, nutrition, infection, sun exposure, and scar care. A shorter incision does not automatically mean a shorter-lasting result, and a longer incision does not automatically mean better lift. The durability of a facelift is more related to the deeper support work, such as SMAS or deep-plane techniques, tissue quality, and the amount of laxity being corrected.

Longer incisions are sometimes needed to remove more loose skin or treat the neck and hairline properly, so those cases may look more dramatic simply because the starting point and surgical plan were different. Lasers can improve redness, thickness, color mismatch, or texture in some scars, but they cannot remove all scarring or make a scar invisible. The best approach is careful incision placement, minimal skin tension, good aftercare, sun protection, and choosing a surgeon who can explain where your scars would be and why.

Josh Olson, MD · Answer

Great question! Scar behavior is a mix of biological factors, healing mechanics, and how well the incision is protected while it heals. Some people are simply more prone to noticeable scarring than others. Scars also tend to be more stubborn when there's more tension on the incision, reduced blood supply (nicotine is a big culprit here), or a lot of sun exposure during healing.

If someone is scar-prone or worried about visibility, I like to plan proactively—silicone, sun protection, and early follow-up—rather than waiting until a scar has already matured.

If you're unhappy with how a scar is healing, treatments like laser resurfacing, microneedling, and medical-grade scar care can often improve texture and reduce redness once the incision is fully closed and the skin has healed. Still, these measures usually can't erase a scar completely.

Todd Christopher Hobgood, MD · Answer

You’re right that scar healing can vary, but the main factor isn’t simply incision length. Shorter incisions often look less noticeable because they’re placed in well-hidden areas and heal under less tension. Longer incisions give surgeons more access to reposition tissues, which can create a more dramatic and longer-lasting lift. However, these incisions may be more exposed to movement, sun, or tension, which can affect scar visibility.

How scars heal also depends on factors like genetics, skin type, and recovery habits. Protecting the incisions from the sun, using scar therapies (such as silicone gel or sheets), and following your surgeon’s aftercare instructions can all improve healing.

Lasers and other treatments (like microneedling or chemical peels) can soften and blend scars so they’re much less noticeable, but they can’t remove them completely.

Ajaya Kashyap, MD · Answer

Thank you for your query. You have several concerns  that I will try to address. 
Scars and their fading with time depends on the technique of surgery, post operative care as well as skin  factors including the type and genetics. The effect and longevity of facelift surgery depends on the layer that the facelift has been performed  rather than the length of the scars. Shorter incision facelifts can work just as well as longer incisions., and last just as long.  Lasers can certainly improve the scars but not remove them. The scarring is usually better when you have a more experienced surgeon working on a favourable skin type and when all postoperative precautions are taken.

Gary M. Horndeski, MD · Answer

When doing a face lift, it is important to hide the scars behind the ear or in the hairline or at the ear-face junction. This conceals the scars. Everyone responds to scars differently and there is no guarantee on scarring.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

William Portuese, MD · Answer

The  Fitzpatrick skin types all heal differently, but it also depends on placement of the incision, the tension on the incision, and when the sutures are removed after a facelift procedure.

Ronald J. Edelson, MD · Answer

Patients vary in the scarring depending  on both individual scarring and the technique used by the surgeon. A good surgeon will know how to make the scarring as unnoticeable as possible

Zoran Potparic, MD · Answer

It is true that patients show lots of variety regarding the length and type of scars. Although it usually takes a year for scars to mature in the age after 40, some patients have much longer scar maturation process. Most of the scars hidden in the hair, in front and behind the ear,  are barely visible but in some patients, stretched, wide scars are reality. Unfortunately it is impossible to predict exact healing/scar making pattern in all patients. Hope this helps.

Why do some patients have scars that fade while others last longer?

Answers (14)

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