When Healing Leaves a Mark: Understanding Scar Tissue After Transplant Surgery

Picture of my scar 2 months after transplant

Undergoing a transplant is a life-changing event. It represents hope, new beginnings, and the opportunity to reclaim your health. But while the surgery itself may be behind you, the healing journey continues long afterward. For many transplant recipients and their families, recovery brings unexpected challenges—one of the most common being scar tissue.

Living with a large surgical scar can be difficult on its own. When pain, tightness, or internal discomfort are added to the mix, it can become especially frustrating.

What Is Scar Tissue and Why Does It Form?

Scar tissue is the body’s natural response to injury. When skin or internal tissues are cut or damaged, the body repairs the area by producing collagen fibers. These fibers form a patch that closes the wound, but the repaired tissue differs from normal tissue in both texture and flexibility.

After a transplant, scar tissue may form:

• Externally, at the incision site

• Internally, within the transplanted organ (the allograft) or between surrounding organs

While scar tissue plays an essential role in healing, it can also cause problems. Because it is less elastic than healthy tissue, it may restrict movement or function. In transplant patients, this can contribute to complications such as reduced blood flow, stiffness of the transplanted organ, or even internal blockages.

I am now 19 years post-transplant, and I still experience pain around my scar. Sometimes it’s external; other times it’s a sharp, internal pain that comes and goes. Surgical intervention is rarely pursued unless issues become severe, as there are far less invasive ways to manage scar tissue. As always, consult your transplant care team before trying anything new.

External Incision Scars

Surgeons typically use a "Mercedes" incision (an upside-down T shape) or a curved subcostal incision (such as the one shown in the photo). Over time, the scar will fade from pink to a silvery-white color. With a little effort, you can reduce scar tissue and help promote healing.

Management:

• Massage: Once the wound is fully closed and approved by your care team, gentle massage can help break up tight or “lumpy” scar tissue and reduce sensitivity.

Primary Massage Techniques

• Circular motions: Use two fingers or your thumb to move the scar in slow, firm circles. Apply enough pressure that the skin moves with your fingers.

• Vertical and horizontal movements: Gently move the skin up and down (parallel to the scar), then side to side (perpendicular).

• Cross-friction: Apply firm pressure and move across the scar line to help loosen adhesions.

• Skin rolling and lifting: Once the scar is more mature, gently pinch and roll it between your fingers to improve flexibility.

Recommended Routine

• When to start: Typically 3–4 weeks after surgery, once stitches or staples are removed and scabs have fallen off—only with your care team’s approval.

• Frequency: 5–10 minutes, 2–3 times per day

• Duration: Continue consistently for 6 months to a year

• Lubrication: Use a mild, fragrance-free moisturizer or oil (such as cocoa butter or E45) to prevent dryness and irritation

Desensitization (For Hypersensitivity)

If your incision area is overly sensitive or painful to touch:

• Texture exposure: Gently rub the area with different materials, starting with soft textures (cotton, silk) and gradually progressing to rougher ones (towels, corduroy) for 2–5 minutes daily.

• Tapping: Lightly tap or stroke the area to help normalize nerve sensation. This is my personal favorite—but find what works for you.

⚠️ Stop immediately and contact your transplant team if you notice signs of infection, including redness, warmth, pus, or worsening pain.

• Silicone Therapy: Silicone sheets and gels are widely used to flatten, soften, and fade raised scars. They work by creating a protective, semi-occlusive barrier over the healing skin.

Benefits of Silicone Products

• Locks in moisture, preventing excessive collagen production

• Helps regulate collagen synthesis and breakdown

• Softens and flattens thick or raised scars

• Reduces redness, discoloration, itching, and tightness

• Protects healing skin from irritation and bacteria

• Non-invasive and well-tolerated for most skin types

Types of Silicone Products

• Sheets or strips: Reusable and cut-to-size

• Gels: Ideal for irregular or moving areas

• Sticks: Convenient for targeted application

• Red Light Therapy: Red light therapy is an emerging, non-invasive treatment that shows significant promise for post-transplant healing. While it wasn’t available when I had my transplant, I’ve since used RLT for other conditions and highly recommend it (with medical approval).

  Potential Benefits

  • Accelerates wound healing

  • Reduces inflammation and pain

  • Improves circulation and oxygen delivery

  • Supports collagen balance and scar reduction

  • Promotes cellular repair and regeneration

  Important Considerations

  • Always discuss RLT with your transplant team

  • Use FDA-approved devices only

  • Treat RLT as a complement—not a replacement—for standard wound care

Sun Protection

Protect your scar from sun exposure for at least one year to prevent permanent darkening. Continued sunscreen use is strongly recommended, as transplant recipients face a significantly higher risk of skin cancer due to immunosuppressive medications.

Numbness

Numbness below the incision is extremely common and often permanent. During surgery, many nerves are cut and may never fully recover. My lower abdomen remains numb to this day. While it has become less noticeable over time, that’s likely due to adaptation rather than nerve regeneration.

Internal Scar Tissue (Fibrosis and Adhesions)

Scar tissue doesn’t only form on the surface.

• Allograft fibrosis: Scar tissue can develop within the transplanted organ due to chronic injury or prolonged ischemia, potentially leading to graft dysfunction.

• Adhesions: Fibrous bands may form between organs, causing pulling sensations, pain, or bowel obstructions.

• Biliary strictures: Scar tissue at bile duct connections may narrow bile flow and often requires endoscopic treatment.

Potential Complications

• Incisional Hernias: About 20% of patients may develop a hernia at the scar site, where abdominal tissue pokes through a weak spot in the muscle.

• Infection Signs: Immediately report significant redness, warmth, increased pain, or fluid leakage that changes from clear/pink to pus-like, as these may indicate an infection.

Emotional Impact of Scars

Scar tissue affects more than just the body—it can impact self-image and emotional well-being. Feelings of frustration, anxiety, or sadness are normal. Personally, I wear my scars as a badge of honor—they are proof that I survived. If scars are difficult to cope with, support groups or counseling can be incredibly helpful.

How Families Can Help

Family members play a critical role in recovery:

• Learn about scar tissue and healing challenges

• Encourage open conversations about pain or concerns

• Assist with exercises, medications, and appointments

• Provide emotional support and advocacy

Looking Ahead

Research continues to advance our understanding of scar tissue formation and healing after transplant surgery. New therapies and techniques aim to improve outcomes and quality of life. Staying informed empowers patients to partner actively with their healthcare teams.

Healing after a transplant leaves both visible and invisible marks. Scar tissue is a natural part of recovery, but with awareness, proactive care, and medical guidance, its impact can be managed—allowing you to focus on living well and fully in your second chance at life.