Medically reviewed by Jeff Zhao, DO
Patients do not always ask about the scar out loud, but I can usually tell when it is on their mind. It is a completely reasonable concern. A shoulder replacement scar is something you will see every day, and you deserve a clear picture of what it will look like before surgery. The short answer is yes, shoulder replacement does leave a scar. For most of my patients in Sunnyvale and Kaufman, though, that scar fades considerably over the first year or two and becomes much less noticeable than they feared. In this post, I explain where the incision is made, why it is the size it is, how it tends to change as it heals, and what you can do to help it look its best.
Key Takeaways
- Shoulder replacement is typically done through a single incision on the front of the shoulder, and the resulting scar usually fades and flattens over 12 to 18 months.
- Genetics, skin type, smoking, and how the incision is cared for can all affect how a scar heals.
- Sun protection, scar massage once the incision has healed, and silicone gel products may help a scar look its best.
Where the Incision Is Made
For both total shoulder replacement and reverse shoulder replacement, I typically make the incision over the front of the shoulder. It usually runs from near the collarbone down toward the upper arm, following the natural groove between the deltoid muscle and the chest muscle.
That location has a few advantages. It lets me reach the joint through the natural gap between the deltoid and chest muscles. This may help protect the deltoid, a muscle that powers shoulder movement. It also places the scar toward the front and slightly inside the shoulder, where it tends to be less visible from the side and back.
The incision is usually somewhere in the range of three to six inches long. The exact length depends on your body size, how much muscle and soft tissue covers the joint, and whether this is a first surgery or a revision. If you have had shoulder surgery before, I often try to use the existing scar rather than create a new one.
Why the Incision Is Not Smaller
This is a fair question. Many shoulder procedures, like rotator cuff repairs, are now done arthroscopically through a few small poke holes. Shoulder replacement is different. I am removing damaged bone, preparing the socket, and placing implants that need to sit in precisely the right position. That requires enough room to see and protect the surrounding nerves, blood vessels, and tendons.
My view is that a slightly longer, well-healed scar is a far better trade than a cramped incision that compromises implant position. The success of a shoulder replacement depends in large part on how well the components are aligned. That alignment can affect how the shoulder feels and functions for years. I will always make the incision the size it needs to be to do the operation well.
How the Incision Is Closed
At the end of surgery, the deeper tissues are closed in layers, and the skin is closed on top. The method varies. It often involves stitches placed beneath the skin that dissolve on their own, sometimes combined with skin glue or small adhesive strips. In some cases, staples or stitches that need to be removed are used instead. Those are commonly taken out around 10 to 14 days after surgery.
A closure beneath the skin tends to leave a thin, clean line without the small cross-hatch marks that external stitches or staples can sometimes leave behind.
What Your Scar Will Look Like as It Heals
A shoulder replacement scar changes a lot over time, and the version you see at your first follow-up visit is not the version you will live with. Here is how the healing process generally unfolds.
The First Few Weeks
Early on, the incision is usually pink or red, slightly raised, and may be a bit swollen. Some bruising around the shoulder and down the arm is common and tends to fade over a couple of weeks. Most patients also notice a patch of numbness on the skin next to the incision. Small skin nerves are unavoidably cut during surgery, and that numb area usually shrinks over the following months, although a small patch may remain.
Months One Through Six
During this phase, the scar is actively remodeling. It may look darker, feel firm or ropy, and itch as it heals. This is when many patients worry that the scar is “getting worse.” In most cases, it is simply part of the normal healing process.
Six to Eighteen Months
Over the rest of the first year and into the second, most scars gradually flatten, soften, and fade to a pale or skin-toned line. The final appearance usually settles somewhere between 12 and 18 months after surgery.
What Affects How a Scar Heals
Some factors that influence scarring are within your control, and some are not. Your genetics play a major role. If you have had thick, raised scars in the past, or if you have a family history of keloids, you may be more likely to form a thicker scar. People with darker skin tones also tend to have a higher risk of keloids and of a scar that heals darker than the surrounding skin.
Other factors that can make a scar heal less favorably include smoking, poorly controlled diabetes, infection, and tension or pressure on the incision during early healing. Of those, smoking is the one I push hardest on. Smoking reduces blood flow to healing skin. I encourage every patient who smokes to quit well before surgery, for the sake of the incision and the rest of their recovery.
What I See in My Patients
Most of my shoulder replacement patients are dealing with years of arthritis pain. The scar is rarely what they talk about at their one-year visit. What I hear instead is that they can sleep through the night, reach the top shelf, or get back to golf. That said, some patients are bothered by a thicker or darker scar, and I take that seriously rather than brushing it off.
The other thing I notice here in North Texas is the sun. Patients who spend the first summer after surgery outdoors without covering or protecting the scar tend to end up with a darker, more noticeable line. I bring this up with every patient whose surgery lands in spring or early summer.
My Approach to Caring for Your Scar
As an osteopathic physician, I was trained to treat the whole person, not just the joint. For me, that means taking your concerns about how your shoulder looks as seriously as how it moves. After surgery, here is the scar care plan I generally recommend:
- Keep the incision clean and dry until I clear you to shower normally, and avoid soaking in a bath, pool, or hot tub until it has fully healed.
- Start scar massage once the incision is completely closed and I have checked it. Gentle, firm pressure along the scar for a few minutes a couple of times a day may help soften it.
- Consider silicone gel sheets or gel. Among over-the-counter scar products, silicone has some of the strongest research support for improving the look of scars.
- Protect the scar from the sun for at least the first year, using clothing or a broad-spectrum sunscreen of SPF 30 or higher.
Your sling will be part of your life for the first several weeks, too, so let me know if the strap rubs near the incision.
When a Scar Needs More Attention
Please call my office if you notice increasing redness that spreads away from the incision, drainage that continues or starts after the first few days, an incision that opens, or a fever. These can be signs of infection and should be evaluated promptly.
For scars that remain raised, thick, or itchy after healing, options such as steroid injections, laser treatments, or a scar revision may be worth discussing. In most cases, I recommend waiting until the scar has had at least a year to mature before considering revision. Many scars that look concerning at four months look quite different at twelve.
Summary
Shoulder replacement leaves a scar a few inches long on the front of the shoulder. It starts pink and raised, then usually fades gradually over 12 to 18 months. Genetics, smoking, sun exposure, and scar care all influence the final look, and simple steps like sun protection, massage, and silicone may help.
If you are weighing shoulder replacement and the scar is one of your concerns, bring it up at your consultation. I am glad to show you where the incision would go and talk through what to expect based on your skin and history. You can request an appointment at my Sunnyvale or Kaufman office.
Frequently Asked Questions
How big is a shoulder replacement scar?
The incision is usually around three to six inches long on the front of the shoulder. The exact length depends on your body size, the type of replacement, and whether you have had surgery on that shoulder before.
Does reverse shoulder replacement leave a different scar than a total shoulder replacement?
In my practice, both procedures are typically done through the same front-of-the-shoulder incision, so the scars usually look very similar.
How long does it take for a shoulder replacement scar to fade?
Most scars look red or pink for the first few months, then gradually flatten and fade. The final appearance usually settles around 12 to 18 months after surgery.
Why is the skin around my incision numb?
Small skin nerves are cut when the incision is made. The numb patch often shrinks over several months, although a small area of numbness may remain long term.
Can I get a shoulder replacement scar removed later?
A scar cannot be erased completely, but a thick or bothersome scar may be improved with treatments like steroid injections, laser, or scar revision. I usually recommend waiting at least a year for the scar to mature before considering these options.
