Gender-affirming surgery can be a deeply affirming and transformative experience—one that feels like coming home to ourselves. While surgery brings us closer to our true selves, it also comes with the reality of scarring. Whether scars feel like a mark of pride, a neutral part of healing, or something you’d prefer to minimize, there’s no right or wrong way to feel about them. This guide is here to help you understand what to expect and how to care for your scars in a way that feels right for you.
At last: you’ve had the surgery you’ve been waiting for—whether that’s top surgery, bottom surgery, breast augmentation, facial surgery, or another procedure. The healing process takes time, but you may already be feeling the mental health benefits of this long-awaited step.
Part of recovery includes taking care of your incisions as they heal into scars. For those of us in the trans community, scars can carry many different meanings—some of us embrace them, some feel neutral, and others prefer to reduce their appearance.
No matter how you feel about your scars, you deserve knowledge and resources to care for your body in a way that aligns with your needs.
When a wound or incision occurs, the body initiates a healing process that leads to the formation of fibrous tissue known as a scar. Initially, scar tissue appears raised, and thick, and may be pink, red, or purple. Over time, the scar will change to a shade that is either lighter or darker than the surrounding skin.
Healing begins right after surgery. In the early days, you’ll likely feel sore and will need rest. Your incisions may be closed with stitches, steri-strips, or surgical glue, and you might be instructed to apply antibiotic ointment. Dressings will cover the incision sites, and you may have drains to collect excess fluid. Many surgeons also recommend compression garments to help reduce swelling.
Around the two-week mark, your incisions will start forming scars. By 3 months, they typically begin to soften and lighten. Complete scar healing can take 18 months to 2 years, though the initial incision healing phase is much shorter—about 6 to 8 weeks.
If at any point you experience fever, increasing redness, significant swelling, or pain in your legs, reach out to your care team immediately.
Scar care can start once your incision has fully healed—when it’s completely closed and any scabbing is gone. This typically happens around 4 to 6 weeks after surgery, though it may be as soon as 3 weeks depending on how your body heals. As always, be sure to consult your healthcare team for any questions or concerns you might have with your healing process.
Taking care of your incisions is key for healing and infection prevention, but ongoing scar care is a personal choice. Some of us choose not to do much, while others prioritize minimizing scarring—and both are completely valid! One exception? Scar massage. Regular scar massage can help reduce adhesions (where scar tissue sticks to underlying structures), which can improve range of motion and comfort over time.
If you’re looking to care for your scars, here are four main steps you can take:
You can use something as simple as a fragrance-free lotion, or opt for what is commonly recommended for scar healing, a silicone product. Moisturizing works well in conjunction with scar massage.
Silicone is widely used to improve scar healing. Options include:
Silicone products are available over the counter, and some insurance plans may cover them. If you’re interested in exploring coverage, check out Point of Pride’s article on insurance and gender expression.
Sunscreen is essential for reducing the darkening of scars, especially for the first year after surgery on scars that are exposed to the sun. You should start applying sunscreen once your incision has fully healed.
It's best to use a sunscreen with a high SPF; at minimum, choose one that is SPF 30 and broad spectrum. If you're using a silicone gel, cream, or spray and plan to be in the sun, first apply the sunscreen. Allow it to dry completely before applying the silicone product.
Alternatively, you can cover the scar with a non-clear silicone sheet or tape to protect it from sun exposure. Another option is to apply a waterproof dressing over the scar after using the silicone gel, cream, or spray, which can help you avoid the need for sunscreen if you prefer.
Scar massage is essential for preventing scar tissue from adhering to underlying tissues, which can lead to flexibility and mobility issues. It can also help reduce sensitivity and itchiness, promote healing, and break down collagen or scar tissue.
You can start massaging your scars once your incisions are fully healed and this should continue for at least the first year after surgery. Scar massage should be performed two to three times a day for brief periods of 5 minutes or less. If your scars become inflamed or painful, stop and consult with your care provider. Remember to be gentle with yourself!
It is generally recommended to use silicone scar cream or gel during the massage. Alternatively, you can use a fragrance-free lotion or oil. Here are some additional tips:
If you’re unhappy with your scars, there are options:
Some of us may develop hypertrophic or keloid scars due to excess scar tissue. Hypertrophic scars stay within the incision line, while keloids extend beyond it.
Keloids are more common in people with darker skin tones. Treatment options include silicone therapy, steroid injections, cryotherapy, and even botulinum toxin injections.
Our scars tell stories—of healing, transition, survival, and resilience. For some of us, they are a source of pride; for others, they bring up complicated feelings.
Scarring can also play a role in safety concerns, especially for those of us navigating visibility and passing in different spaces. All of these feelings are valid.
If you’re struggling with how your scars impact your mental health, you’re not alone. Reach out for support—whether that’s from a trusted friend, therapist, or community resources.
Gender-affirming surgery is a powerful, life-changing experience. It’s a step toward aligning our physical selves with who we truly are. Scarring is a natural part of that journey, and however you feel about it is okay.
Empowering yourself with knowledge about scar care can help you make informed choices about your healing. And no matter what, remember this: you are worthy of care, support, and understanding.
We’re grateful to have insights from a dedicated advocate in the field. Thank you to:
Elizabeth Hood, RN, BSN
Seattle, WA & Portland, OR based.
Queer nurse. Social justice advocate. Aspiring freelance health writer.