Scar tissue forms as part of the natural healing process after an injury, surgery, burn, or inflammation of tissue. Scars occur when the dermis (the thick, middle layer of the skin) is damaged and the collagen fibers that connect the skin are disrupted. As the skin heals, new collagen fibers form to mend the injury, but these fibers are laid down rapidly and randomly, resulting in a fibrous band of scar tissue that lacks theorganization and structure of normal skin.
While scars are a natural part of the healing process, they can sometimes cause pain, limited mobility, tightness, itching, tingling, swelling, disfigurement, and poor self-image. Fortunately, there are ways to minimize, improve, soften, or even dissolve scar tissue.
What is Scar Tissue?
Scar tissue consists mostly of fibrous tissue made up of the protein collagen. Over time, scar tissue typically becomes paler and flatter, and may shrink slightly. However, scars never completely disappear.
There are several types of scars:
Hypertrophic Scars
Hypertrophic scars are raised, red scars that remain within the boundary of the original injury. They often improve and fade over one to two years.
Keloid Scars
Keloids are raised, red scars that extend beyond the original injury site. They may keep growing weeks after the injury has healed. Keloids do not disappear on their own and often require treatment to stop the scar from growing.
Contracture Scars
Contracture scars tighten the skin, causing limited range of motion and decreased flexibility. They typically occur after burns.
What Causes Scar Tissue Buildup?
When skin is damaged from an injury, incision, or wound, the body sends collagen fibers, fibrous tissue, and blood vessels to the area to close, heal, and protect the wound. In healthy skin tissue, the collagen matrix made of different proteins forms a basketweave pattern. However, in scar tissue, the collagen matrix is unorganized. The fibers are thick, rigid, and align in a single direction. As a result, scar tissue is inflexible and lacks the elasticity and strength of undamaged skin.
Factors that can contribute to excessive scar tissue formation include:
- Size, depth, and location of the original injury or incision
- Age – Children and younger adults tend to develop thicker scars
- Genetics – Some people are predisposed to developing keloids
- Race – Darker skin is more prone to raised scars
- Delayed wound healing
- Infection
- Chronic irritation or inflammation
- Tension on the wound
- Poor surgical techniques that damage healthy tissue
Problems Caused by Scar Tissue
While scarring is a natural part of the healing process, excessive scar tissue can sometimes cause troublesome symptoms, including:
Pain
Scar tissue lacks proper nerve connections found in undamaged skin tissue. Nerve fibers can become trapped in the scar tissue, resulting in chronic pain.
Limited Range of Motion
Scar tissue is less flexible than normal skin. When scar tissue crosses joints, it can limit mobility and range of motion. This is especially problematic with burn scars.
Weakness
Thick, inflexible scar tissue can restrict normal muscle movement, resulting in loss of strength and function.
Tightness
Scar tissue often contracts and hardens over time, resulting in tight, rigid skin. This can cause discomfort and restricted movement.
Numbness
Due to lack of proper nerve connections, scar tissue may lack normal sensation. Some scars are completely numb.
Tingling or Itching
Abnormal nerve connections in scar tissue can cause tingling, burning sensations, or constant itching.
Complications with Surgery
Scar tissue deep in the body (called adhesions) can make future surgeries more difficult and increase the risk of complications.
| Problem | Description |
|---|---|
| Pain | Scar tissue lacks proper nerve connections, resulting in chronic pain as fibers become trapped. |
| Limited mobility | Scar tissue is inflexible, limiting range of motion when crossing joints. |
| Weakness | Thick scar tissue restricts muscle movement, causing weakness. |
| Tightness | Scar tissue contracts over time, resulting in tight, rigid skin. |
| Numbness | Scar tissue lacks normal sensation due to improper nerve connections. |
| Tingling/itching | Abnormal nerve connections cause burning, tingling sensations. |
| Surgical complications | Internal scar tissue (adhesions) increase complication risks. |
When to Seek Treatment for Scar Tissue
Most scars will gradually fade and flatten over time without needing intervention. However, treatment may be warranted if the scar is:
- Painful
- Very thick, raised, or red
- Greater than 1 centimeter wide
- Restricting movement or circulation
- Growing bigger than the original injury (keloid)
- Causing significant discomfort or emotional distress
Seek medical advice to discuss scar revision options if the scar interferes with daily activities, range of motion, or quality of life.
Non-Invasive Scar Treatments
Several non-invasive methods are available to help soften, flatten, smooth, and reduce scar tissue over time. These include:
Silicone Sheeting
Silicone sheets are worn over scars to increase hydration and soften scar tissue, prevent excess collagen buildup, and flatten and fade scars. Silicone may also relieve itching. It is considered a first-line treatment for hypertrophic and keloid scars.
Silicone Gel
Silicone gel is applied directly to new scars to hydrate scar tissue and reduce inflammation. It may help prevent raised or excessive scarring when used on newer wounds.
Compression Therapy
Compression with tape, silicone sheets, or custom compression garments can flatten and prevent scars from growing. Compression is often used to treat keloids and hypertrophic scars.
Corticosteroid Injections
Injecting steroids directly into scar tissue can reduce inflammation, skin thickness, itching, and pain. Multiple injections are often required for optimal results.
Cryotherapy
Freezing scars with liquid nitrogen can reduce scar bulk, thickness, and pigmentation. It may relieve pain and itching as well. Multiple treatments are usually needed.
Laser Therapy
Laser treatments apply targeted light energy to resurface, remodel, and reduce scars with minimal discomfort and downtime. Several types of lasers are used to improve scar appearance.
Radiation Therapy
Low dose radiation is sometimes used to prevent recurrence of severe keloid scars. When delivered after scar revision surgery, radiation therapy can reduce regrowth.
Scar Massage
Gentle massage helps break down internal scar tissue and makes scars smoother and more pliable. It may also relieve tightness and pain.
| Treatment | Methods | Benefits |
|---|---|---|
| Silicone Sheeting | Worn over scars | Hydrates, softens, flattens scars |
| Silicone Gel | Applied to new scars | Reduces inflammation and scarring |
| Compression Therapy | Tape, sheets, garments | Flattens and prevents growth |
| Steroid Injections | Injections into scar | Reduces inflammation and symptoms |
| Cryotherapy | Liquid nitrogen freezing | Reduces scar thickness and pigmentation |
| Laser Therapy | Targeted light energy | Resurfaces and reduces scars |
| Radiation Therapy | Low dose radiation | Prevents recurrence of keloids |
| Massage | Gentle massage | Breaks down internal scar tissue |
Medical Procedures to Remove Scar Tissue
Several medical and surgical options are available for removing problematic scar tissue. Common techniques include:
Surgical Excision
Surgical removal of the scar may be done for larger, thicker, or deeper scars causing functional problems or poor cosmetic appearance. The incision is closed with stitches.
Dermabrasion
This procedure uses a special instrument to sand down and remove the top layers of scarred skin. New skin grows over for smoother texture.
Laser Resurfacing
A carbon dioxide laser removes outer layers of damaged skin to improve scar appearance and texture. The procedure requires anesthesia.
Chemical Peels
Applying concentrated acids removes damaged skin layers to reduce the surface appearance of scars. Light chemical peels can be done in a doctor’s office.
Steroid Injections
For raised or thickened scars, corticosteroid injections can reduce collagen overgrowth, inflammation, redness, and thickness.
Fillers
Injectable fillers like collagen or fat can be used to plump up sunken or pitted scars for a smoother appearance. Results are temporary.
Subcision
For sunken or depressed scars, a needle is used to detach tethered scar tissue from deeper structures. This releases the scar.
| Procedure | Methods | Benefits |
|---|---|---|
| Surgical Excision | Cutting out scar tissue | Removes problematic scars |
| Dermabrasion | Sanding top skin layers | Smooths and resurfaces skin |
| Laser Resurfacing | Carbon dioxide laser | Removes damaged skin for smoothing |
| Chemical Peels | Applying acids | Reduces surface scar appearance |
| Steroid Injections | Injections into scar | Reduces collagen overgrowth and inflammation |
| Fillers | Collagen or fat injections | Fills in sunken or pitted scars |
| Subcision | Detaching scar tissue | Releases depressed scars |
Preventing New Scar Formation
While existing scar tissue is difficult to eliminate completely, there are steps that can be taken to prevent or minimize scarring from future injuries and surgeries:
- Have proper wound closure – When possible, wounds should be closed with sutures or medical glue to promote faster healing with less scarring.
- Follow wound care instructions – Keep the area clean and change dressings regularly to prevent infection.
- Avoid sun exposure – The sun can damage healing skin and worsen scarring. Use sunscreen on closed wounds.
- Treat wounds with silicone – Apply silicone gel or sheets over closed incisions to reduce inflammation.
- Avoid picking scabs – Let wounds heal naturally to prevent worsening scars.
- Massage the area – Gentle massage can help prevent tight, rigid scars.
- Use compression – Wearing compression garments may prevent hypertrophic and keloid scars from growing.
- Start scar treatments early – Begin scar reduction therapies once any sutures or staples are removed.
Following surgeon’s instructions for incision care and using evidence-based scar therapies in the early stages of healing can optimize outcomes after surgery or injuries. However, even with proper wound care, some degree of permanent scarring is expected with deeper cuts, burns, or surgical incisions.
Conclusion
Scar tissue will always form to some extent after skin injuries, surgery, or trauma as part of the natural healing process. While most scars improve gradually on their own over several months, excessive scarring can sometimes cause functional problems or undesirable cosmetic results. A variety of non-invasive treatments are available to reduce the appearance, thickness, and discomfort associated with scars. For severely troublesome scars, surgical removal or revision may be an option. With time and the right scar therapies, many scars will soften and fade to a barely visible mark. However, scars are permanent and it is impossible to completely eliminate all traces of scar tissue once it has formed. The best approach is to minimize scarring from the outset with proper wound care and early use of scar-minimizing treatments.