Scars after biopolymer removal: how they evolve and what can be done

The scar is the known price of this surgery, and it is almost always accepted without argument: anyone who has spent years with pain or with flare-ups of inflammation trades that for a mark without a second thought.

But there is one thing worth knowing that does not get said: this scar does not start on an equal footing with that of any other operation. There are specific reasons, they can be explained, and some of them can be managed.

The general care of any scar is in scar improvement and in the scar protocol after surgery. This page is about what is different here.

Why this scar is different

Three reasons, one leading to the next.

First: tissue is resected, and that leaves the closure under tension. A pocket is not emptied, infiltrated tissue is removed. When a lot is taken out, the edges are brought together under pull. And there lies the problem, because tension on the wound is the local risk factor the literature identifies as the main one for a hypertrophic scar or a keloid forming. The reference review on pathological scars places it alongside systemic, genetic and lifestyle factors, but it is the only one of the four that can be acted on surgically.

There is something encouraging in that: it is also known that manipulating skin tension is effective for preventing and treating scars. In other words, the main link is also the one most open to being worked on.

Second: the bed is not normal skin. The tissue around a biopolymer has spent years with a low-grade foreign body reaction: chronic inflammation and fibrosis. It is not the starting point of planned surgery on healthy tissue.

Third: wound complications are frequent in this surgery, and they leave their mark. In the series of 199 patients having gluteal and lumbar removal, dehiscence — the wound partially opening — appeared in 21.1% of cases, and tissue necrosis in 3.5%. In the series of 35 patients with mild to moderate involvement, a seroma appeared in 40%, at 31 days on average.

A wound that opens, becomes infected or collects fluid heals less well than one that runs its course without incident. That is why post-operative follow-up — which is on the recovery page — is not just a matter of convenience: it is the first measure taken on the scar.

On the face, a different story

The facial approach is different and it is worth saying, because it is what most reassures anyone carrying a permanent filler in their face.

In the largest published series — 231 patients operated on for removal of permanent facial filler — the access routes used are routes already standard in aesthetic surgery, chosen with the explicit aim of avoiding direct excision and an unsightly facial scar. You go in where you already go in to operate on that area, not over the lump.

That does not mean there is no scar. In a series of 50 patients combining drainage of permanent filler with a facelift and fat grafting, five hypertrophic scars were described among the complications recorded.

The detail by area is on the lips and face removal page.

How it develops

A scar is not judged when the stitches come out. It changes over months: first it is red, raised and firm, and with time it flattens, softens and loses colour.

As a guide to the calendar: the studies that measure scar maturation with validated scales usually do so between 3 and 12 months after surgery, and it is over that interval that the changes in colour, relief and pliability are recorded. That is, how it looks at three months is not the result.

The schedule we follow here

We do not wait to see how it turns out before deciding whether anything needs doing: treating the scar is part of the recovery from the outset.

• Months 1, 2 and 3 — the laser protocol. It is the same schedule we apply to any surgical scar at the practice, and the timing is not arbitrary: in the benchmark meta-analysis on surgical scars, starting at a month or earlier improved the scales significantly, while starting after three months was indistinguishable from doing nothing. The window in which laser delivers is short and it is at the beginning, just when the scar still looks bad and it occurs to nobody to treat it.
• ⚠️ Between the first and the third month you are going to think it has got worse. The laser itself produces transient redness and pigmentation changes that dominate the appearance during those weeks and mask the improvement already happening underneath. It is measured, it is to be expected and it is not a reason to abandon the schedule.
• At a year — whether surgical refinement is needed is assessed. A year is the point from which what you see is stable and whatever has not improved is not going to improve on its own. Only then does it make sense to consider revising a widened scar, a step or a contracted area; doing it earlier means operating on tissue that is still reorganising, and it usually turns out worse.

Not every scar ends up needing that last step, and raising it does not mean it is planned: it means there is an appointment in the schedule at which we look, with the scar now mature, at whether it is worth it. How a scar that has already settled is treated is in the scar improvement page.

Two things that are not part of the normal process

• The wound opening, discharging or smelling. That is not a stage of healing: it is something to be seen as soon as possible.
• The scar growing beyond its edges. A scar raised within its boundaries and one that spreads into healthy skin are not the same thing and are not treated the same way.

Skin tone, discussed beforehand and not afterwards

It is a real factor and it is worth putting on the table at the consultation, not discovering at six months.

A prospective study of 40 patients assessing scar maturation at 3 and 12 months with a validated scale found differences by phototype: lighter skin (phototypes I-II) showed the greatest reduction in redness, while in phototypes V-VI the improvement was smaller and the pigmentation got worse. Black and Hispanic patients were less likely to have a favourable pigmentation outcome, and phototypes V-VI were less likely to see the relief improve.

How to read it, without overstating it:

• It is a small study, of 40 breast surgery patients at a single centre, and some of its differences are at the limit of statistical significance.
• The authors themselves do not conclude that anything different should be done in theatre, but something simpler: that the information given and the scar follow-up should be adapted to each patient’s phototype.
• And it is directly relevant here, because a substantial proportion of people carrying biopolymers have medium or high phototypes.

Put plainly: if your skin tends to mark, it is a conversation to have before surgery, along with the care plan.

What can be done

The treatment of a scar that is not developing well is stepped, and the reference review on pathological scars sets it out according to severity:

• If there is severe contracture, surgery is the first option.
• If not, conservative treatments are used: gel sheets, taping, topical and injected agents, oral treatments and camouflage make-up, chosen case by case.
• In any scenario, long-term follow-up. It is an explicit recommendation: whatever the treatment, these scars are monitored for a long time.

How all this is applied in practice — what is done, when and what changes — is in the scar protocol after surgery and in scar improvement.

Frequently asked questions

What will the scar be like?

It depends on how much tissue has to be removed, on the tension it is closed under, on the area and on your skin. On the buttock it is a visible scar accepted in exchange for solving the problem; on the face, the approach is designed so that it does not show.

Why is this scar worse than that of other operations?

Because it combines three things: a closure under tension after removing tissue, a bed with chronic inflammation and fibrosis, and a high rate of wound complications — dehiscence and seroma — which make the result worse.

When will I know how it has turned out?

Not within a few weeks. The studies that measure scar maturation do so between 3 and 12 months, and it is over that interval that the colour, the relief and the pliability change.

My wound has opened a little — is that normal?

It is frequent in this surgery — 21.1% in the series of 199 patients — but it is not a normal stage of healing. It has to be looked at, because a wound that opens heals less well.

I am prone to keloids — can I still have surgery?

It is something to put on the table beforehand. It is not usually a reason not to operate, but it does change the care plan and the follow-up, which is prolonged in any case.

Do creams and silicone sheets work?

Gel sheets are among the conservative options the reference review lists, along with taping, topical and injected agents and oral treatments. They are chosen case by case, not all of them for everyone.

Can a scar that has already turned out badly be treated?

Yes. If there is severe contracture the first option is surgical; if not, conservative treatments are considered. It is set out in scar improvement.

Does the scar affect the final result?

It is part of it, and that is why it is planned from the outset alongside the contour. What it is reasonable to expect overall is in results to expect.

Sources

• Ogawa R. The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids: A 2020 Update of the Algorithms Published 10 Years Ago. Plast Reconstr Surg. 2022;149:79e-94e. A review with methodological quality appraisal of the studies: the risk factors that promote the growth of hypertrophic scars and keloids include local factors (tension on the wound or scar), systemic ones (for example, hypertension), genetic and lifestyle factors; the treatment of a hypertrophic scar depends on the severity of the contracture — if it is severe, surgery is the first option; if not, conservative therapies are indicated; among the conservative ones it lists gel sheets, taping, topical and injected agents, oral agents and camouflage make-up, applied case by case; whatever the treatment, patients should be followed up long term. https://pubmed.ncbi.nlm.nih.gov/34813576/
• Harn HI, Ogawa R, Hsu CK, Hughes MW, Tang MJ, Chuong CM. The tension biology of wound healing. Exp Dermatol. 2019;28:464-471. A review of the role of mechanical forces in skin healing; clinically, manipulating skin tension has been shown to be effective for preventing and treating scarring, though not for tissue regeneration. https://pubmed.ncbi.nlm.nih.gov/29105155/
• Osorio E, Ramírez B, Herrera O, Suarez C, Ciro C, Varela A. Three-flap Technique: Comprehensive Approach for Biopolymer Removal in the Gluteal and Lumbar Regions. Plast Reconstr Surg Glob Open. 2026;14:e7870. A retrospective cohort of 199 patients; among the complications, dehiscence in 21.1% and tissue necrosis in 3.5%. https://pubmed.ncbi.nlm.nih.gov/42495057/
• Eusse Llanos JC, Posada López S. Paramedian open approach for gluteal biopolymers removal: a case series of 35 patients. JPRAS Open. 2025;45. A series of 35 patients with mild to moderate involvement; seroma in 40% with a mean time to formation of 31 days, followed by wound dehiscence and infection. https://pubmed.ncbi.nlm.nih.gov/40837208/
• Pascali M, Chirico F, Rugge L, Rauso R. Aesthetic Surgical Pathway in Permanent Facial Filler Removal. Facial Plast Surg. 2024;40:19-30. A series of 231 patients: the access routes used are routes already standard in aesthetic surgical practice, chosen to avoid direct excision and an unsightly facial scar. https://pubmed.ncbi.nlm.nih.gov/36696919/
• Gadallah A, Etman AG, Mamdouh Abd Elhalim M. Facial Contouring after Permanent Filler Removal with Combined Facelift and Fat Grafting: A Case Series. Plast Reconstr Surg Glob Open. 2023;11:e5456. A series of 50 patients; among the complications recorded, five cases of hypertrophic scarring. https://pubmed.ncbi.nlm.nih.gov/38074500/
• Nguyen AT, Li RA, Adam TH, Mustoe TA, Teven C, Galiano RD. Racial and Skin Tone Differences in Scar Maturation: A Prospective Analysis of Aesthetic and Physiological Outcomes Using the Modified POSAS Scale. Int Wound J. 2026;23:e70889. A prospective observational study of 40 breast surgery patients at a single centre, with scar assessment at 3 and 12 months using the modified POSAS scale; phototypes I-II showed the greatest reduction in vascularity and V-VI the least; pigmentation increased in phototypes V-VI and improved in lighter tones; Black and Hispanic patients were less likely to have favourable pigmentation outcomes and phototypes V-VI less likely to see the relief improve; the authors stress the importance of adapting scar information and interventions to each patient’s phototype and background. https://pubmed.ncbi.nlm.nih.gov/41912279/

Book your consultation

If the scar is what is holding you back, it is a conversation that can be had before surgery: where it would go, how long, under how much tension and what care plan it would have on your skin.

And if you have already had surgery and the scar is not developing as you expected, you do not have to wait for it to “finish maturing” before having it looked at.

Clinical confirmation by the surgeon

Dr Enrique Salmerón González

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624077

Dr Elena García Vilariño

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624503

Last reviewed: 6 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.