There are different kinds of scars and ways to improve them.

Different kinds of scars

Contractures

can form when your body closes a large wound by pulling the skin around the edges in toward the centre. This is called "contraction", and it can make tight bands of scar tissue, called "contractures". A contracture is usually corrected by cutting out the scar and replacing it with a skin graft or a skin flap. Sometimes Z-plasty may be used.

Hypertrophic Scars

can form if the body makes too much collagen when healing a wound. They are pink, firm, raised bands, which may be itchy or painful, within the boundaries (edges) of the original injury. They usually develop within the first four to eight weeks after injury, and may go on getting thicker for up to six months, although they usually improve over the next year or two. Hypertrophic scars can often be improved by a plastic surgeon cutting away some of the scar tissue, and sometimes by using Z-plasty. Steroid injections directly into the scar at intervals for up to two years afterwards can prevent the thick scar from forming again. Laser surgery can also improve hypertrophic scars.

Keloid Scars

can form if the body goes on making collagen after a wound has healed. They are thick, puckered clusters of scar tissue which grow beyond the edges of the original injury. They may be itchy or painful, and are often red or darker in colour than the skin around them. They may carry on growing indefinitely and may not improve in appearance over time. Redness, itching, and pain are often treated by giving steroid injections directly into the scar tissue, and this may also shrink the scar. Keloids can be surgically removed, but they have a stubborn tendency to grow back again, sometimes even larger than before. Because of this, the surgeon may combine the scar removal with steroid treatment or radiation therapy, and the patient may need to wear a pressure garment for up to a year. Even so, the keloid may come back, needing repeated procedures every few years. Laser surgery, cryosurgery, injections of a long-acting cortisone, and interferon injections have all also been used to treat keloids.

Stretched Scars

can form if the skin around a wound is put under tension (pulled on) while the wound is still healing. The scar may appear normal at first, but can widen over a period of weeks or months.

Sunken Scars

can form when a deep wound heals. Sometimes there may have been a loss of fat at the site of the wound, or the healed skin may be stuck to something underneath, such as muscles. This can leave a depression or pit where the scar has formed, with the skin around it higher than the scar.

Scar management

Scar management is the attempt to control how scars form and develop; trying to prevent deformity, optimise function and improve appearance.

Exercise Therapy

uses specific stylised movements to help reduce scar tissue formation and break down scar tissue which has already formed, helping to maintain and improve strength and mobility.

Injections

directly into the scar of steroids, cortisone, or interferon, usually repeated at intervals over a period of time, can help shrink and flatten a raised scar. They may also be used to prevent hypertrophic or keloid scars from forming again after corrective surgery.

Pressure or Compression Therapy

involves the careful application of tight-fitting garments, bandages, inserts, splints, and casts to an area where a burn injury has occurred.

Pressure garments,

usually custom-made from an elastic material, are most often used for burn scars that cover a large area. They are worn day and night for up to two years, and help to prevent excessive scarring. They work best when applied as soon as the burns have healed, but can help even if first used up to two years after the injury.

Pressure bandages

may be used instead of pressure garments on smaller scars or in early scar management.

Inserts

are worn under a person's pressure garments. They can be made from a variety of materials, from soft foams to hard plastics, and are designed to tightly conform to different parts of the body in order to provide more even pressure.

Splints and Casts

are custom-made or fitted to provide support and protection, and to maintain or increase the range of movement in joints by preventing contractures.

Radiation Therapy

to reduce the recurrence rate of hypertrophic and keloid scars after surgery, works in about 70% of cases, but is reserved for the most serious cases because of the possibility of long-term side effects from radiation.

Scar Massage

generally done at least twice a day, helps to soften scars and can help prevent contractures. It can also help to relieve itching and pain. Only gentle massage should be done to newly-healed skin, because the skin is fragile and may blister or break down. As the skin becomes stronger, greater pressure can be used.

Silicone Gel Sheets

are helpful in flattening, softening and fading red and raised scars. They are applied to healed wounds on clean skin and can be worn constantly, held in place by tubigrip, pressure garments, splints or adhesive tape.

Surgery

of various kinds can be used to improve scars. (The different kinds of surgery are shown on the Surgery for Scars page.)