Why does a teenager with surgical scar shame avoid PE, the pool and summer? A practical guide to what parents and teachers can say, and what to avoid saying.
When June arrives, everyone in the class talks about their summer plans: the beach, the pool, the summer house, days spent in shorts and T-shirts. One teenager, however, goes quiet during these conversations. On their chest, abdomen, back or leg there is a scar from an operation months ago, and that scar is the reason they wear long sleeves despite the heat, slip away from the changing room in PE and find excuses to turn down their friends' invitations to the pool. Surgical scar shame is a feeling that can deepen especially during adolescence, an age when young people feel their bodies are constantly being judged by their peers. In this article I look at why a young person wants to hide their scar, how this shame narrows daily life, what parents and teachers should and should not say, and when professional support may be helpful. For questions about the medical or cosmetic assessment of the scar, the young person's doctor should be consulted; this article is concerned only with its emotional weight.
What Is Surgical Scar Shame?
Surgical scar shame is the intense discomfort a person feels about the scar from an operation being seen, questioned or judged by others. This shame is often less about the scar itself than about the meaning it carries: a visible reminder of the illness, of difficult days in hospital, of being "different".
For teenagers this experience is particularly challenging, because during this period:
- The body changes rapidly, and the young person may already feel estranged from it.
- Fitting in with the peer group and being accepted matter more than ever.
- Appearance becomes a value that is constantly compared on social media.
- The need for privacy grows; the young person is uncomfortable with their body being discussed.
Scars left after heart, spinal, abdominal or orthopaedic operations, burn treatment or repeated surgical procedures are among the situations where this feeling is seen most often. You can read more about the place of body-related worries in adolescence in the article on body image.
What Are the Signs of Surgical Scar Shame?
Young people rarely put this feeling into words; they show it through behaviour. Signs that parents and teachers may notice include:
- Wearing long sleeves, high necklines or long trousers even in hot weather
- Avoiding PE lessons, or changing before or after everyone else in the changing room
- Finding excuses not to take part in activities such as the pool, the beach, a sports club or a school trip
- Standing at particular angles in photos or avoiding being photographed
- Getting angry, crying or changing the subject immediately when asked about the scar
- Avoiding looking in the mirror or, on the contrary, constantly checking the scar
- Generally withdrawing from social settings with friends
Some of these behaviours may also be a natural part of a young person's need for privacy. What matters is how far the avoidance is narrowing their life. A teenager who chooses to stay at home rather than go to the beach with friends in summer, who gives up swimming after loving it for years, or who says they are ill on school photo day may be starting to lose far more than the scar itself.
What Causes Surgical Scar Shame?
Peer reactions
A friend's thoughtless question, "What's that? Gross!", or a moment of teasing in the changing room can stay in a young person's mind for a long time. Even a single negative experience can turn into an expectation that all their peers will think the same way. If there is teasing, name-calling or exclusion, it needs to be treated as a bullying matter; the article on peer bullying can offer guidance on this.
A reminder of the illness experience
The scar can be a daily reminder of the fear, pain and uncertainty the young person went through. Some teenagers feel almost as if they are reliving their days in hospital whenever they see the scar. In such cases there may be an unprocessed struggle beneath the shame.
Pressure for beauty and a "perfect body"
The "perfect" bodies presented on social media through filters and edited photos lead young people to see their own bodies as flawed. Within this comparison, a scar is easily labelled a "flaw".
Having lost control over the body
Throughout surgery and treatment, the young person experienced many decisions about their body being made by others: examinations, incisions, dressings, a body that was constantly seen and touched. Adolescence, by contrast, is a time when young people want a say over their own bodies. For some teenagers, hiding the scar can be a way of taking back this lost control. Seen in this light, the wish to hide it is not only a sign of shame but may also carry the message "I now decide who sees my body." When families try to understand this wish rather than seeing it as a problem, the young person feels less alone.
How it is talked about at home
The way the family talks about the scar also has an effect. Well-meant remarks such as "Let's make sure nobody sees it" or "Let's cover that up, what a pity" can give the young person the message that the scar is something to be hidden.
What Should You Say to a Teen with Surgical Scar Shame, and What Should You Avoid?
Fictional examples of sentences that support, and those that may hurt without meaning to:
Sentences that support:
- "Whether you show your scar or not is entirely your decision. Whatever you choose, I'm behind you."
- "If you'd like to think about what to say when someone asks, we can come up with an answer together."
- "If you don't want to go to the pool, I understand. If you want to go but find it hard, we can talk about how to make it easier."
- "This scar might remind you of a really difficult time. If you ever want to talk about that time, I'm here."
Sentences to avoid:
- "You're exaggerating, nobody is looking at your scar." This belittles the young person's experience and pushes them to hide their feelings.
- "That scar is your medal of courage, you should be proud." Although well meant, it pressures the young person to feel a certain way. Some teenagers find this meaning for themselves in time; but imposed from outside, it can become a burden.
- "When you're older we'll get something done and fix it." This reinforces the message that the scar is something that "needs fixing". Conversations about medical or cosmetic options should take place at the young person's own wish and with their doctor.
- "The things I went through at your age! Is this really a problem?" Comparison leaves the young person feeling misunderstood.
- Showing and describing the scar in front of relatives. Requests during a holiday visit such as "Go on, show us where you had the operation" violate the young person's privacy. The young person should decide who knows what about their body.
Accepting a scar does not mean having to love it; it means allowing it to become small enough not to stand in the way of the rest of your life.
Differences by Age: Child, Teenager and Young Adult
Young children
Pre-school and primary-age children usually approach a surgical scar with curiosity; sometimes they may even show it proudly to their friends. At this age, shame tends to emerge in response to the reactions of adults or older children. Giving the child a simple explanation such as "This is where the doctors made your heart better" and talking about the scar as a natural part of their body can reduce shame that might otherwise develop later.
Teenagers
Adolescence, the focus of this article, is when the shame is felt most intensely. When talking with a teenager, the most important principle is to leave control with them: they should decide what to wear, who to show their scar to and how to answer questions. The parent's role is not to make decisions for them, but to widen their options.
Young adults
The scar from an operation in childhood can take on new meanings in young adulthood: job interviews, new social circles, close relationships. During this period some people begin to embrace their scars as part of their own story, while for others the shame may continue. Both are understandable.
Practical Support at School and in Social Life
Working with the school
A short conversation with the PE teacher or the school counsellor, with the young person's consent, can prevent many problems. For example, arrangements such as being able to change in a separate cubicle, flexibility in the choice of sportswear, or the teacher stepping in when questions about the scar come up during the lesson can be discussed. These should be done quietly, in a way that does not make the young person feel they are getting "special treatment".
Preparing for questions
Preparing short answers with the young person that they can use in different situations gives them strength:
- Short and informative: "I had an operation, I'm fine now."
- Boundary-setting: "I don't want to talk about it."
- Humorous (if it suits the young person's style): "Long story, I'll tell you one day."
The young person decides which answer to choose; the aim is that they do not freeze when the question comes.
Gradually reducing avoidance
If the young person wants to, approaching the situations they avoid in small steps can help: first going to the pool with family only, then with a trusted friend, then in a busier setting. These steps should be taken at the young person's pace, never by force.
Talking with siblings and relatives
The young person's sensitivity should be protected not only at school but at home as well. Younger siblings may ask curious questions, cousins may bring up the scar while joking around, and grandparents may sadly say "Oh, my poor dear" and want to touch it. A brief reminder to the wider family, with the young person's consent, helps: "He doesn't really like talking about the scar; let's only talk about it if he brings it up." This small step can help the young person take part more comfortably in family gatherings and holiday visits.
Reviewing their relationship with social media
Talking about how the accounts the young person follows make them feel can reduce the effect of comparison. Some young people find a community they feel close to in the accounts of people who have similar experiences and share them openly.
When Should You Seek Professional Support?
Some discomfort about a surgical scar is natural for many young people and may lessen over time. However, it may be helpful to see a mental health professional in the following situations:
- Avoidance behaviours markedly narrowing the young person's school, sport and friendship life
- Thoughts about the scar occupying much of the day
- Intense low mood, withdrawal, a marked drop in school performance
- Recurring nightmares or intensely frightening memories about the hospital period
- Marked changes in eating patterns or excessive controlling behaviour towards the body
- Self-harming behaviour or expressions of hopelessness such as "I don't want to live like this"
If the young person wants to harm themselves or has thoughts of ending their life, take it seriously and do not wait; in an emergency, call 112 (emergency services) or go to the nearest emergency department.
How Is Surgical Scar Shame Addressed in Therapy?
Therapy can help a young person build a more peaceful relationship with their body and with the illness they went through. Within cognitive behavioural therapy, thoughts such as "Everyone is looking at my scar" or "Nobody will accept me with this scar" are noticed and tested against reality. Approaching avoided situations gradually, and with the young person's agreement, helps reduce anxiety.
If the illness and surgery themselves have left traumatic marks, talking about and making sense of that experience in a safe setting also becomes part of the process. Self-compassion work can help the young person develop a gentler way of speaking to themselves.
When working with teenagers, privacy and autonomy are especially important; what the young person shares is not passed on to the family without their permission unless there is a safety risk. In the course of adolescent counselling, separate sessions with parents can be held where needed to help the family develop an approach that suits the young person's needs. For teenagers who are hesitant to come to face-to-face sessions, online sessions can also be a starting point.
Frequently Asked Questions
My daughter wears long sleeves even in summer. Should I interfere?
The decision about what to wear should be hers. Rather than putting pressure on her through her clothing, it is more helpful to show that you are curious about how she feels. If you notice she is uncomfortable in the heat, you can look together for options that are both comfortable and make her feel safe.
My son won't even show his scar to me. Is this normal?
The need for privacy increases in adolescence; on its own this is not a cause for concern. However, if he also completely avoids talking about the scar, it is important to keep the door open without pressuring him, letting him know, "We can talk whenever you want."
Will the shame go away as the scar fades over time?
For some young people, the shame may lessen as the scar's appearance changes; but shame is not always proportional to how the scar looks. Sometimes a small scar causes great distress, while someone with a prominent scar may be at peace with it. This is why attending to the emotional side matters.
As a teacher, what should I do if I notice teasing about a scar in class?
Stop the situation calmly but clearly, and then talk separately with the student who was teasing. It is important not to force the targeted student to explain themselves in front of the class, and to get in touch with the family. If it happens again, the school's anti-bullying procedures should come into play.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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