You've finally decided to do it. The bone-on-bone grinding in your shoulder has become unbearable, and your surgeon says a total shoulder arthroplasty is the only way to get your life back. But then you start googling. You see pictures of shoulder replacement scars and suddenly, you're a bit freaked out. It looks like a giant zipper running down the front of the arm. Is that normal? Will it always be that purple?
Honestly, the "skin work" is often the part patients obsess over most, even though the titanium and polyethylene inside are doing the heavy lifting. Your skin is the story-teller of your surgery. It’s also a major source of anxiety for anyone who enjoys wearing tank tops or swimming.
The reality is that shoulder scars are highly variable. You might end up with a thin, silver line that’s barely visible after eighteen months, or you might be one of the unlucky ones whose body overreacts with collagen, leaving a raised keloid. It’s not just about the surgeon’s stitch work; it’s about your genetics, your age, and how much you wiggle that arm during the first six weeks.
👉 See also: Testicles in Spanish: Why Context Is Everything When You Talk About Anatomy
The Anatomy of a Standard Shoulder Incision
Most surgeons use what’s called the deltopectoral approach. This is basically the "gold standard" for getting into the joint. They make an incision along the groove between your deltoid muscle and your pectoral muscle. When you look at pictures of shoulder replacement scars, you’ll notice they usually start near the collarbone and run straight down toward the bicep.
It’s usually about five to seven inches long.
Why so big? Well, the surgeon needs to see what they’re doing. They have to move the cephalic vein out of the way—carefully—and then retract the muscles to reach the humerus. If they’re doing a "Reverse Total Shoulder," the incision might be slightly higher or angled differently because the mechanics of that surgery are flipped to compensate for a torn rotator cuff.
I’ve seen some patients get "mini-incisions," but don't hold your breath for that. Most orthopedic surgeons, like those at the Mayo Clinic or HSS, prioritize a "clear view" over a tiny scar. A well-placed implant is way more important than a three-inch scar versus a six-inch one.
The Staples vs. Glue Debate
If you’re looking at photos of a shoulder just three days post-op, it looks gnarly. It’s swollen. It’s bruised. And it’s likely held together by metal staples.
- Staples are fast. They’re incredibly strong and great for high-tension areas. But man, they look scary in photos. They also have a slightly higher risk of leaving those "railroad track" marks if they stay in too long.
- Dermabond or surgical glue is the "pretty" option. It’s basically superglue for humans. It creates a waterproof seal, and when it flakes off, the scar is often flatter.
- Steri-Strips are those little white pieces of tape. They look like nothing, but they do a lot of the work in keeping the skin edges aligned after the deeper sutures are already set.
Why Some Scars Look "Angry" (And When to Worry)
Let’s talk about color. A fresh scar is often bright red or deep purple. That’s just blood flow. Your body is sending a massive amount of resources to that area to rebuild the tissue. If you see a picture of a six-week-old scar that’s still very red, that’s actually normal for many people.
However, there’s a difference between "healing red" and "infection red."
Infection (cellulitis or deep joint infection) usually comes with heat. If the skin feels like a hot stove, or if there’s yellow, foul-smelling drainage, that’s a problem. According to the American Academy of Orthopaedic Surgeons (AAOS), infection occurs in fewer than 1% of cases, but it’s the one thing that can ruin a perfect replacement.
Then there’s the keloid factor. Some people have a genetic predisposition where the scar grows outside the original boundaries of the incision. It becomes thick, rubbery, and sometimes itchy. This is more common in younger patients and people with darker skin tones. If you’re looking at pictures of shoulder replacement scars and see one that looks like a thick cord, that’s likely a hypertrophic scar or a keloid.
The First Six Months: The "Ugly" Phase
Most people hit a point around month three where they get frustrated. The initial excitement of being "done" with surgery wears off, and the scar feels tight. It might even feel "stuck" to the tissue underneath.
This is called adhesions.
Basically, the scar tissue doesn't just form on the skin; it forms in layers all the way down to the bone. If those layers stick together, it can actually limit your range of motion. This is why physical therapists often perform "scar mobilization." It sounds fancy, but it basically involves them (or you) rubbing the scar firmly to break up those internal bonds.
Real-World Healing Timeline
It helps to have a mental map of what you’re looking at when you browse galleries of surgical photos.
- Week 2: The staples come out. The wound is closed but fragile. It looks like a dark pink line. You might still have "scabbing" or crustiness.
- Month 2: The scar might actually look worse than it did at week four. It’s often at its reddest and most raised during this phase.
- Month 6: Fading begins. The edges start to blend with the surrounding skin.
- Year 1: This is the "mature" scar. It should be flat and white or silver. If it’s still red after a year, your body is still actively remodeling it, or you’ve been getting too much sun on it.
Sun Exposure: The Great Scar Ruiner
This is the one thing people mess up. They go to the beach four months after surgery, put on a tank top, and forget the sunscreen.
Fresh scar tissue is incredibly sensitive to UV rays. If you "tan" a healing scar, it can undergo permanent hyperpigmentation. That means it turns a dark brown color and stays that way forever. If you want those pictures of shoulder replacement scars you take later to look like the "good" ones on the internet, you have to keep the incision covered or slathered in zinc oxide for at least the first full year.
Seriously. A year.
Managing Your Expectations
You need to be realistic. You are having a major joint replaced. They are literally sawing off the head of your humerus and replacing it with metal. There will be a scar.
But modern techniques are light-years ahead of what your grandpa had. Surgeons are more mindful of "Langer’s Lines"—the natural orientation of collagen fibers in the skin. By cutting parallel to these lines, they ensure the wound stays under less tension, which results in a thinner scar.
If you’re really worried about the aesthetic, talk to your surgeon about "subcuticular" stitches. These are the ones that stay under the skin and dissolve on their own. They tend to leave the cleanest lines because there are no external holes from needles or staples.
Scar Care Products: What Actually Works?
The market is flooded with "miracle" creams. Most of them are junk.
The only things with solid clinical evidence for improving the appearance of pictures of shoulder replacement scars are silicone sheets or gels. Research shows that silicone helps hydrate the scar and provides a bit of pressure, which signals the body to stop producing so much collagen.
Vitamin E oil is popular, but honestly, some studies suggest it can actually cause contact dermatitis (a rash) in a significant number of people. Stick to the silicone. Or just plain old Vaseline to keep the area from drying out and cracking while it’s still fresh.
Actionable Steps for Better Healing
If you're staring at your shoulder right now or preparing for surgery, here is the "pro-level" way to handle the skin:
- Don't pick the scabs. It’s tempting. Don’t do it. You’ll pull up healing skin and create a wider scar.
- Hydrate from the inside. Your skin can't repair itself if you're dehydrated. Drink water like it's your job.
- Wait for the green light for massage. Do not start rubbing that scar until your surgeon says the incision is 100% closed. Usually, that’s around week 4 or 6.
- Use silicone tape at night. Once the wound is closed, wearing a silicone strip overnight for 2-3 months can significantly flatten the area.
- Monitor the "tether." If you raise your arm and see the skin "puckering" or pulling inward at the scar, you have an adhesion. Talk to your PT about manual release techniques immediately.
- Protect the pigment. Buy a few shirts with sleeves that cover the incision for your first post-op summer. If the sun can't see it, it can't darken it.
Every shoulder tells a story. Some are just a whisper of a line, others are a bold exclamation point. As long as the joint moves and the pain is gone, the scar is just a badge of the hardware that gave you your mobility back.