After surgery, many patients notice an area that feels firm, tight, or thick under the skin. Naturally, this can feel concerning. However, in many cases, this firmness is a normal part of scar healing.
At Oregon Cosmetic and Reconstructive Clinic, I spend a lot of time helping patients understand what they are feeling and why. Let’s walk through what post-surgical scar firmness means—and how we treat it.
What Does Scar-Related Firmness Feel Like?
Scar-related swelling often feels like:
A tough or dense area under the skin
Skin that feels less mobile or “stuck down”
Firmness that follows the line of the incision
This happens because healing tissue forms connections between the skin and the layers underneath. As a result, the area may feel tight before it softens over time.
Importantly, this type of firmness is different from a fluid collection.
How Is Scar Firmness Different From Fluid or a Hematoma?
Sometimes swelling comes from fluid buildup rather than scar tissue. Examples include:
Seroma – a pocket of clear fluid
Hematoma – a collection of blood
These often feel:
Like a bubble or pocket
More soft or squishy
Sometimes larger or more sudden in onset
Often, I can tell the difference just by examining the area. However, healing is complex, and sometimes we need more information.
When Ultrasound Helps Clarify What’s Going On
If it’s not clear what’s causing the swelling, ultrasound can be very helpful.
Ultrasound is a safe, painless imaging test that uses sound waves to look under the skin. In the clinic, it allows me to:
See if fluid is present
Confirm whether the firmness is scar tissue
Decide on the best next step for treatment
Because it’s quick and noninvasive, ultrasound often brings peace of mind and clarity.
Treatment: Scar Swelling vs Fluid Swelling
The treatment depends on what’s causing the firmness.
If the Firmness Is From Scar Tissue
This is very common—and usually improves with time. To help healing, I often recommend:
Compression garments to support the tissue
Scar massage to improve mobility
Lymphatic massage to reduce swelling and encourage fluid movement
With consistency, these approaches often make a big difference.
If the Swelling Is From Fluid
Fluid collections may require:
Close observation
Temporary drainage
Compression and follow-up visits
That’s why identifying the cause matters—the treatment path is different.
Healing Takes Time—and Support Helps
Scar tissue changes slowly. Early firmness does not mean something is wrong. Instead, it usually reflects active healing.
My goal is always to:
Explain what you’re feeling
Check carefully when something feels off
Support healing with the least invasive approach possible
If you ever notice new swelling, increased pain, or rapid changes, I encourage you to reach out.
Final Thoughts From Dr. Jenq
Healing is not a straight line. Some firmness after surgery is expected, and with the right support, it often softens beautifully over time.
At Oregon Cosmetic and Reconstructive Clinic, my team and I focus on careful evaluation, clear education, and steady guidance—so you feel supported about what your body is doing as it heals.
— Tina Jenq, MD
