Whether it was a surgical incision or an accident that etched the telltale mark across your skin, you’ve likely acquired at least a scar or two during your life. But how you care for the scar in the months after injury can affect how the scar forms and whether it causes long-term problems.
“Scar tissue maturation is a one- to two-year-long process, so you really have to respect the scar early in the process,” explains Dan Enz, PT, SCS, LAT, a physical therapist with the UW Health Sports Rehabilitation Department. “The first stage is the inflammatory stage, which lasts only a couple of days. Then the second stage is the proliferative stage, which usually lasts six weeks — that’s when your body is trying to form the scar. The last stage, which takes up to one to two years, is the tissue maturation/remodeling stage.”
Enz compares the process to crab grass sprouting up in a lawn. “If you think about good Kentucky blue grass, it’s up and down, and that’s how a lot of your tissue is oriented in your body, in a linear fashion,” he explains. “When your body lays scar tissue down, it’s like the crab grass. It’s in an x-formation, with cross links, and as the tissue remodels it starts to become more and more like the longitudinal tissue that you had pre-injury.”
There are good reasons to encourage scar healing, and it’s about more than just cosmetics. “Too much scar tissue can impede movement, especially when the scar is over a structure that’s close to the skin,” Enz explains.
How to minimize problems with scars
Here’s what to know about the factors that influence scar formation and how you can minimize problems:
Not everyone heals the same. As you age, your skin becomes thinner, less elastic and dryer, making it harder for wounds to heal. Some people are also more likely to develop keloid or hypertrophic scars, which are scars that form more dense fibrous tissue, often with discoloration. People under the age of 30 have the greatest risk of these types of scars, and genetics and location of the wound also play a role. The sternal/collar bone area, shoulders, upper arms, earlobes and cheeks are more prone to this type of scarring.
Sun protection is key. Be especially vigilant with scars that are regularly exposed to direct light — for example, on your hands, face, or arms or legs during the summer — for at least the first six months of the scar-healing process. “If you’re not protecting a scar from ultraviolet light with zinc oxide or high-level sunscreen, it can increase scar formation and lead to hyper-pigmentation,” Enz says.
Sun exposure not only affects a scar’s appearance, but also how quickly your tissue heals. “After two or three months, the scar starts to look fairly normal, but if you get burned it can really throw the scar back into the first two stages of healing,” he says.
Scar massage helps prevent adhesion. Scar massage is often used in physical therapy after surgery, but you can easily do it yourself at home. “You’re basically trying to move the scar perpendicular so it’s gliding over the structure or bone underneath so the scar isn’t adhering to whatever is underneath it,” he says. Ideally, massage the area every day for at least four to eight weeks after the injury or surgery.
Consider other scarring treatments. There is some evidence that silicon sheets and gel are helpful in preventing and treating early excessive scarring. Pressure garments are also used at times, especially with burns. Other treatments for excessive scarring include cryotherapy, corticosteroid injections and laser treatments.
Your provider can advise you on any treatments that might be appropriate for your situation. “It is critical to contact your doctor early in the healing process if your scar tissue starts to elevate and extend beyond the scar borders,” Enz says.