Scar tissue formation is a natural part of the healing process after an injury. When the skin is damaged, the body triggers a repair process that includes inflammation, new tissue formation, and remodeling of the wound site. This results in a scar at the site of the original injury. For many people, scar tissue feels different from regular skin – it may be a bump, lump or growth. So is scar tissue actually a hard lump? Let’s take a closer look.
What is Scar Tissue?
Scar tissue refers to the fibrous connective tissue that forms at the site of an injury as part of the healing process. Here are some key facts about scar tissue:
- Forms due to excess collagen production during wound healing
- Replaces normal skin tissues destroyed by an injury
- Connective tissue is comprised of collagen fibers, blood vessels, and fibroblasts
- Provides strength to the healed wound area
- Does not contain hair follicles or oil glands like normal skin
When a wound heals, fibroblasts (collagen-producing cells) migrate to the area and start depositing collagen fibers in a random pattern. This initially forms granulation tissue, which is later remodeled into mature scar tissue. The composition and arrangement of the excess collagen gives scar tissue a different texture and appearance compared to surrounding normal skin.
What Does Scar Tissue Feel Like?
The way scar tissue feels can vary greatly depending on the location, severity, age, and type of injury that caused it. Here are some common traits of how scar tissue feels:
- Early scars may feel soft, raised, and lumpy
- Fully matured scars are often flat and smooth, but not flexible
- Can feel firmer, denser, or harder than the surrounding skin
- May feel tight and less elastic than undamaged skin
- Numbness or altered sensation is common
- Appearance ranges from reddish to pale white
- Surface texture is uneven or irregular
The increased collagen density in scar tissue is what gives it a thicker, denser feel compared to regular skin. The lack of hair follicles and oil glands also contributes to its distinctive texture.
What Causes Scar Tissue to Form Lumps or Bumps?
There are several reasons why scar tissue may form noticeable lumps, bumps or irregularities rather than laying flat:
- Insufficient support for deeper wounds – Deeper injuries like surgical incisions or wounds down to fat/muscle require deeper sutures and tissue support to heal flat. Otherwise, scar tissue can bunch up and form ridges.
- Genetics – Some individuals are predisposed to overactive fibroblast activity and excessive collagen production during healing. This results in thicker, rougher scars.
- Size of the original wound – Larger wounds require more collagen deposition to repair, which increases scar tissue buildup.
- Body location – Areas with high tension or movement like joints are prone to thick, irregular scarring due to the mechanical forces.
- Inadequate wound care – Poor wound closure or delayed healing can lead to excessive granulation tissue and scarring.
- Other issues – Factors like wound infections, high inflammation, or re-injury can also increase scar tissue formation.
Essentially, any factor that disrupts the normal wound healing process can lead to abnormal scar development in the form of nodules, ridges, or bands of hardened tissue.
Does Scar Tissue Get Harder Over Time?
Scar tissue often feels harder or firmer over time as it matures and completes the remodeling process. Here is how scar hardness changes with age:
- Immature scars (0-3 months) – Still in the proliferative phase of healing, so may feel soft and mushy.
- Maturing scars (3-12 months) – Progressive collagen cross-linking causes gradual firming and hardening.
- Mature scars (1+ years) – Fully remodeled with organized collagen fibers, creating a tougher texture.
- Aged scars (5+ years) – May soften slightly over years as collagen bundles loosen, but never returns to normal elasticity.
Maximum scar hardness is reached around 8-12 months post-injury. After this point, no further significant collagen deposition occurs. However, the scar tissue never returns to the natural pliability of undamaged skin due to the inherent properties of fibrotic tissue.
Does Scar Tissue Continue Growing Over Time?
For the most part, scar tissue growth is limited to the initial proliferative phase of wound healing in the first few months. The popular notion that scars progressively enlarge years after an injury is generally false. A few exceptions include:
- Keloid scars – These are abnormally aggressive raised scars that expand beyond the original wound borders. They are caused by excessive collagen production.
- Re-injury – Repeated damage to the same area triggers recurring rounds of inflammation and repair, expanding the scar.
- Surgical scars may widen – Some incision scars widen over the first year as collagen fibers realign along natural skin tension lines.
Barring these special circumstances, mature scar tissue is relatively stable in size after the first year. The scar may appear larger over time due to skin laxity or atrophy of surrounding tissues. But the collagenous scar itself does not continuously grow or expand years later.
What Types of Scars Are More Likely to Form Lumps?
Some types of scarring are characterized by pronounced tissue buildup that creates raised, lumpy areas:
Hypertrophic Scars
– Forms due to excessive collagen deposition during healing
– Raised above the skin level, but stays within injury borders
– Often appear red and lumpy for the first few months
– Greatest risk following burns, surgery, piercings, and injuries under tension
Keloid Scars
– Severe overgrowth of scar tissue beyond the original wound site
– Forms hard, irregular nodules that continue to expand over time
– Most common on the chest, shoulders, neck, and jawline
– Mainly affects younger individuals with darker skin tones
Contracture Scars
– Tight bands of scar tissue that limit normal mobility of the skin
– Causes skin puckering and depressed grooves around the scar
– Commonly induced by burn injuries when skin replacement is inadequate
Can Scar Tissue Turn into Cancer?
There is no scientific evidence that scar tissue itself can transform into cancer. The altered collagen in a scar does not undergo malignant changes. However, a rare type of cancer called sarcoma can develop near a scar:
Scar-Associated Sarcoma
– Malignant tumor originating from connective tissues near a scar
– Thought to arise due to chronic inflammation and growth factor stimulation during repeated wound healing
– Typically appears 10-15 years after the initial scar-causing injury
– Represents less than 1% of soft tissue sarcomas diagnosed
So while scars themselves do not become cancerous, the unstable environment of chronic wound healing may rarely induce mutations leading to sarcoma formation in adjacent tissues. But such occurrences are extremely uncommon.
When Should a Scar Lump Be Evaluated by a Doctor?
In most cases, small bumps or ridging within a scar resolve on their own during the maturation process. But any unusual changes warrant medical evaluation, such as:
- Rapid enlargement of the scar lump
- New growth many years after the injury occurred
- Bleeding, oozing, or ulceration
- Hardened tissue feeling deep underneath the scar
- Pain, tenderness, or itching
- Significant impact on movement or function
- Appearance of new lumps elsewhere on the body
While likely benign, it is best to have your doctor assess any bothersome or suspicious scar lump. They may recommend tests like an ultrasound, MRI, or biopsy of the tissue to determine the cause and appropriate treatment.
Treatments to Reduce Scar Tissue Lumps
If scar lumps do not self-resolve or remain symptomatic, a variety of treatments can help soften and flatten them:
Silicone Sheeting
– Worn over the scar to hydrate and compress tissue
– Helps realign collagen fibers to be more flexible
– Up to 12 hours daily use for 8-12 weeks shows best results
Compression Therapy
– Applying gentle pressure can breakdown collagen cross-links
– Custom elastic wraps or adhesive strips provide compression
– Must be used consistently for several months to improve texture
Steroid Injections
– Injection of corticosteroid medication directly into scar nodules
– Works by suppressing local inflammation and collagen production
– Often requires multiple injection sessions for optimal smoothing
Laser Resurfacing
– Ablative lasers vaporize scarred outer skin layers allowing new growth underneath
– Non-ablative lasers target deeper tissues to rebuild collagen
– Typically requires multiple treatments for significant improvement
Surgical Scar Revision
– Excising the scar tissue and suturing the wound closed to promote smoother healing
– May combine with dermabrasion or laser skin resurfacing techniques
– Best for severe, highly symptomatic scars unresponsive to other treatments
Prevention of Thick, Lumpy Scarring
While the lumpy texture of scar tissue is difficult to avoid completely, proper wound care can help minimize thick, raised scarring:
- Good wound closure – Careful suturing/bandaging to support deeper wounds
- Steroid injections – Early use can limit collagen overproduction
- Silicone gel sheeting – Helps flatten scars when applied early on
- Avoid sun exposure – Sun can worsen inflammation and scarring
- Gentle stretching – Helps realign collagen and prevents contracture scars
- Massage – Softens scar tissue by increasing blood flow
Following surgeon instructions for postoperative care is also critical to ensure surgical incisions heal smoothly. With diligent wound care and scar management, it is possible to minimize lumpiness.
Conclusion
Scar tissue often feels harder and firmer compared to normal skin due to its high collagen content deposited during the healing process. Lumps, ridges, and irregularities in scars frequently form because of inadequate support for deeper wounds, high tension locations, genetic tendencies, or other disruptions to ideal healing conditions. While bothersome scar lumps typically flatten out over time, treatments like compression, silicone, steroids, laser therapy, or surgical revision can improve their appearance and texture if desired. Being proactive with early scar care is key to preventing significant scarring. But in general, scar tissue itself does not transform into cancer or continuously expand years later.