Medical Oncologist
CION Cancer Clinics
The scar after a tracheostomy closes | CION Cancer Clinics
Once the tracheostomy tube comes out, the hole usually closes on its own within a week or two under an airtight dressing. It leaves a small round or dimpled scar at the base of the neck. The scar starts red and firm and fades slowly over a year or more. This page explains how it heals, how to care for it, and who scar revision may and may not suit. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What will the scar look like once the hole closes?
- How does the opening close, stage by stage?
- Which kind of scar do you have?
- How do you look after the scar while it heals?
- What do families worry about, and what is true?
- Can the scar be improved, and who does that suit?
- Common questions about the scar after a tracheostomy
The short answer
What will the scar look like once the hole closes?
Most people are left with a small, round or slightly dimpled scar at the base of the neck, just above the collarbones. It usually starts red and firm, then fades and softens slowly over a year or more.
Why it looks different from other scars
A tracheostomy hole is not stitched shut on the day the tube comes out. In most cases it is covered with an airtight dressing and allowed to close on its own, from the inside outwards. A wound that heals this way tends to pull in a little as it closes, which is why the scar is often a shallow dip rather than a flat line.
What makes one scar larger than another
How long the tube was in matters. So does the size of the tube, any infection around the opening, and whether the neck has had radiotherapy, which makes skin slower to heal and tighter as it does. Your own skin plays a part too. Some people form thick or raised scars wherever they are cut, and they usually know this from earlier injuries.
This page describes the scar in general. It cannot tell you how your own neck will heal. Your surgical team can, once they have seen the site.From tube out to settled scar
How does the opening close, stage by stage?
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The tube comes out
Once your team is sure you can breathe well without it, the tube is removed. A firm airtight dressing goes over the opening. You may be asked to press on it with a finger when you cough or speak.
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The first days
The hole shrinks quickly. Some air or mucus may bubble through the dressing at first. The dressing is changed whenever it is wet.
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The skin closes over
For most people the opening seals within a week or two. Once no air escapes and the skin is dry, a dressing is usually no longer needed. Your team will tell you when it is safe to wash the area normally.
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The scar is red and firm
For the next few months the scar is often pink, raised and tight. It may feel stuck to the windpipe and move when you swallow. This is normal at this stage.
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The scar matures
Over a year or more it usually turns paler, flatter and softer. Any decision about improving its look is normally left until this stage is reached.
Not sure whether this applies to you?
Ask an oncologist
!
After the tube is out, one thing cannot wait
If breathing becomes noisy or difficult, or the neck or face swells and the skin crackles when pressed, go to the nearest emergency department the same day and say the tracheostomy was recently removed. Do not wait for the dressing change or the next clinic visit. Bleeding that does not stop with gentle pressure needs the same response.
What you may see
Which kind of scar do you have?
Most tracheostomy scars fit one of these patterns.
A small pale dimple
The most common result. A shallow round dip that fades to close to your skin colour. It needs nothing beyond sun protection and time.
A tethered scar
The scar sticks to the windpipe underneath, so it pulls inwards and moves up and down when you swallow. Some people find this bothers them more than the look of the scar itself.
Often seen after
- A tube left in for a long time
- Radiotherapy to the neck
A thick or raised scar
The scar stays raised and red inside the original area. Doctors call this hypertrophic, meaning overgrown. It often settles by itself, if slowly.
A keloid
A firm, shiny scar that spreads beyond the edges of the original wound and can itch. Keloids are more common in darker skin and tend to run in families.
An opening that stays open
Occasionally a small channel remains, and air or mucus leaks when you cough. This is called a fistula. It usually needs a small operation to close it.
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At home
How do you look after the scar while it heals?
Keep the area clean and dry until the skin has fully closed. After that, most of what helps a scar is simple and cheap, and most of it is patience.
What usually helps
Once your team says the skin is sealed, gentle massage with a plain unscented moisturiser can soften a firm scar. Silicone gel or silicone sheets, sold at most chemists, are often suggested for raised scars. Cover the scar or use sunscreen outdoors, because a young scar darkens easily in strong sun and the darker colour can last.
What to avoid
Do not pick at scabs or apply home remedies such as turmeric paste, oils or herbal powders to an open or freshly closed wound. They can irritate the skin or cause infection. Avoid tight collars rubbing on the site in the early weeks. Show your team if the scar becomes hot, swollen, weeps pus or keeps growing.
Commonly believed
What do families worry about, and what is true?
"The hole will stay open for life unless it is stitched."
Most tracheostomy openings close on their own once the tube is out and an airtight dressing is used. Stitching is kept for the smaller group whose opening does not seal, and your team decides that after watching it heal.
"A dimpled scar means something went wrong in the operation."
A slight dip is the normal way this kind of wound heals. It is not a sign of poor surgery or infection.
"We should have the scar fixed as soon as possible."
Operating on a young scar often produces another young scar. Surgeons usually wait until it has matured, and some scars look acceptable by then without any further treatment.
"Once the hole is closed, the tracheostomy no longer matters."
It still matters. Tell every future anaesthetist and surgeon that you had one, because the windpipe may have narrowed a little where the tube sat. They plan the breathing tube with that in mind.
If the scar bothers you
Can the scar be improved, and who does that suit?
Yes, a scar can often be made less noticeable, but it cannot be made to disappear. Every scar revision leaves a new scar. The aim is a flatter, finer line that does not pull on the windpipe.
What is usually offered
Steroid injections into the scar can flatten a raised or keloid scar. A small operation called scar revision cuts out the old scar, frees it from the windpipe and closes the skin in layers. Your centre may offer other methods. Ask what they use, how often they do it and what the scar is likely to look like afterwards.
Who it may not suit
Revision is usually put off if there is a chance you will need a tracheostomy again, for instance during ongoing cancer treatment or when more surgery on the head and neck is planned. Skin that has had radiotherapy heals less predictably. People who form keloids may end up with a larger scar than the one they started with.
What this page cannot tell you
Whether your own scar will fade well, or whether revision is worth it for you, depends on your skin, your treatment plan and what bothers you about it. That is a conversation with your surgical team.
Questions we are asked
Common questions about the scar after a tracheostomy
How long does the tracheostomy hole take to close?
For most people the opening seals within a week or two of the tube coming out. It can take longer if the tube was in for many months, if the neck has had radiotherapy or if the area becomes infected. Your team checks it at each visit and will tell you if it is healing more slowly than expected.
Air bubbles out of the dressing when I cough. Is that normal?
A little air or mucus escaping in the first few days is common. Press a clean finger on the dressing when you cough or talk. If air is still leaking after a couple of weeks, or the skin around it swells and crackles, contact your team, because the opening may need attention.
Will the scar go away completely?
No scar goes away completely, but most tracheostomy scars fade a great deal. The red, firm stage usually lasts some months. After a year or more many scars are pale, soft and hard to notice unless someone looks closely. Protecting it from the sun helps it fade evenly.
Why does my scar move when I swallow?
The scar has healed stuck to the windpipe underneath, which rises and falls when you swallow. This is called a tethered scar. It is not harmful. If the pulling bothers you once the scar has matured, ask your surgical team whether a small revision operation to free it could help in your case.
When can I bathe normally and wash the area?
Keep water off the dressing until your team confirms the opening has fully sealed. Water must not run into an opening that is still connected to the windpipe. Once the skin is closed and dry, you can usually wash the scar gently with soap and water and pat it dry.
Can I wear a chain or a high collar over the scar?
Once the skin has sealed, yes, though a rough or tight collar rubbing the young scar can keep it red for longer. Soft fabric is kinder. Many people use a scarf, a dupatta or a loose collar while the scar is still pink, and stop bothering once it has faded.
Does scar revision need a hospital stay?
It depends on what is being done. Steroid injections are given in clinic. A revision operation is small, but it works close to the windpipe, so some centres keep you in for a short stay. Ask your centre how they do it, what anaesthetic is used and how the new wound is cared for.
Is scar revision covered by insurance or Aarogyasri?
Cover for a scar operation varies. Where it treats a real problem, such as an opening that will not close or a scar pulling on the windpipe, schemes and insurers are more likely to cover it than for looks alone. Aarogyasri, CGHS, ECHS and EHS are accepted. Call the helpline and we will help check your cover.
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Sources
- NHS — Tracheostomy
- NHS — Scars
- National Cancer Institute — Head and Neck Cancers
- Cancer.Net — Head and Neck Cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Decannulation: Getting the Tube OutThe step that comes before the opening closesWound, Stitches and ScarsGeneral scar care after any cancer operationTemporary vs Permanent TracheostomyWhy some openings are meant to close and others are notBathing and Water Safety With a TracheostomyKeeping water out while the opening is still healing
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