7 Tips For Scar Management

DIY Advice From a Physical Therapist

Scar Management

For some, a scar might be a symbol of pride – a battle wound, so to speak. For others, though, scars don’t rank high on their favorite physical features list. Most of us want to minimize the appearance of scars and the physical consequences that can accompany them – itching, stiffness, tenderness, and pain1,2.

Although scars can occur from wounds and burns, for our purposes here, let’s focus on how best to manage post-surgical scars.

What To Expect With a Post-Surgical Scar

Some surgeries are arthroscopic, leaving behind minimal scarring. Other procedures, such as a total knee replacement, or even a C-section, leave behind a larger, more obvious scar that may take some time to fully heal.

Yes, scars can take months, even years, to fully mature. If healing goes as it should, the scar should be linear and flush with skin, improving in appearance and pliability over time3.

An abnormal scar, however, might be raised and/or widespread. There are 2 types of abnormal scars to watch out for:

  • Hypertrophic Scars: linear hypertrophic scars are raised but tend to stay within the confines of the initial incision4. They contain mostly well-organized Type III collagen5.

The good news is that it is possible for hypertrophic scars to spontaneously improve over time6,7.

  • Keloid Scars: these are excessive scars that grow beyond the confines of the initial incision8. They contain disorganized Type I and II collagen bundles9.

Keloid scars don’t improve on their own and, even after being treated surgically, can recur10,11.

Although they can present differently, most current management strategies for both hypertrophic and keloid scars are similar.

Tips for Scar Management

Your first priority for scar management following surgery should be to prevent abnormal scar formation.

There are treatments that have proven to be effective for scar management such as laser therapy, corticosteroid injections, and even surgery, but these treatments must be performed by professionals and are invasive.

For effective scar management techniques you can perform on your own, here are 7 tips:

  1. Silicone Scar Gel: Silicone Gel or sheeting is universally considered to be the gold standard and first line of defense and treatment for hypertrophic and keloid scars12. There are silicone gel products widely available over-the-counter.

These gels can help with itching as well as reduce the size of scars through occlusion and hydration. I would recommend using a gel as soon as the suture is healed13.

Silicone therapy should be continue for as long as necessary – if there continues to be an increase in scar size14.

2. Onion Extract-Based Gel (Mederma): Quercetin is found in onion extract – a main ingredient in the popular scar treatment Mederma – and has anti-inflammatory and anti-proliferative effects15.

Although Mederma is widely used for scar management, it is important to note that, based on two prominent studies I looked at, the only improvement noted with Mederma use was better collagen organization (a microscopic improvement). There wasn’t any significant benefit in scar appearance or symptoms when compared with no treatment or standard petrolatum ointments16,17.

3. Vitamin E: Vitamin E is believed to reduce the amount of reactive oxygen available during the inflammatory stage of healing.

There have been many case reports18 reporting better scar appearance when vitamin E is used during the healing process. Some studies, however, have found vitamin E to be of no benefit19,20

4. Limit Scar Stretching During Healing: keloid and hypertrophic scars usually occur in areas of the body frequently stretched during natural daily movements21.

To prevent abnormal scar formation, it would be ideal to avoid putting tension on the healing scar to allow it to heal normally.

Yes, this is easier said than done.

However, some methods that might help reduce skin tension and, therefore, promote healing, are tape22, bandages, garments, or silicone gel sheets (see above).

5. Compression: If you experience more widespread hypertrophic or keloid scarring, pressure garments can be worn.

Compression can decrease the production of collagen, decrease swelling, improve itchiness and pain23.

Make sure that the compression garment applies at least 15mm Hg, which is the minimum amount of pressure proven to promote scar maturation24.

Compression can be continued as long as there is abnormal thickening of the scar25.

6. Massage: massage therapy can disrupt fibrotic tissue and increase the pliability of the scar26,27. It can also improve swelling, thickening, and hardening of the scar tissue28.

Generally, it’s safe to start massage therapy 10 to 14 days after primary closure of the incision (talk to your surgeon to be sure). Make sure you don’t start massaging before this because it can actually have the opposite effect we want – there is evidence that mechanical pressure during early phases of wound healing can promote hypertrophic scar formation29.

Before you start to massage the scar, make sure you have clean hands and there’s no bleeding present.

Also, make sure you apply enough pressure to blanch the scar (make it white with pressure). But don’t apply too much pressure to damage the skin – use good judgment.

Use deep friction massage for 10 minutes twice per day, for up to 6 months. Friction massage is performed with the tip of your thumb or fingers in a transverse motion over the scar (like you’re strumming a guitar string).

Make sure to stop massage treatment if there is a break in the skin, excessive discomfort, or an infection.

7. Sunscreen: Be sure to keep your scar out of sunlight as much as possible until the scar has matured.

UV radiation has been shown to increase scar pigmentation, making its appearance worse30,31.

If you’re going to be out in the sun, use maximal sun protection >50 SPF32.

Rather than waiting until a scar becomes either hypertrophic or keloid, early treatment aimed at prevention is key.

Question: What have you found that works best for scar management? You can leave a comment by clicking here.

  1. Van Loey NE, Bremer M, Faber AW, Middelkoop E, Nieuwenhuis MK. Itching following burns: epidemiology and predictors. Br J Dermatol 2008;158:95e100. ↩︎
  2. Bell L, McAdams T, Morgan R, et al. Pruritus in burns: a descriptive study. J Burn Care Rehabil 1988;9:305e8. ↩︎
  3. Son D, Harijan A. Overview of Surgical Scar Prevention and Management. J Korean Med Sci 2014;29(6):751-757. ↩︎
  4. Monstrey S, et al. Updated Scar Management Practical Guidelines: Non-Invasive and Invasive measures. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2014;67(8):1017-1025 ↩︎
  5. Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG. Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med 2011;17: 113e25. ↩︎
  6. Juckett G, Hartman-Adams H. Management of keloids and hypertrophic scars. Am Fam Physician 2009;80:253e60. ↩︎
  7. Alster TS, Tanzi EL. Hypertrophic scars and keloids: etiology and management. Am J Clin Dermatol 2003;4:235e43. ↩︎
  8. Monstrey S, et al. Updated Scar Management Practical Guidelines: Non-Invasive and Invasive measures. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2014;67(8):1017-1025 ↩︎
  9. Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG. Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med 2011;17: 113e25. ↩︎
  10. Juckett G, Hartman-Adams H. Management of keloids and hypertrophic scars. Am Fam Physician 2009;80:253e60. ↩︎
  11. Alster TS, Tanzi EL. Hypertrophic scars and keloids: etiology and management. Am J Clin Dermatol 2003;4:235e43. ↩︎
  12. Monstrey S, et al. Updated Scar Management Practical Guidelines: Non-Invasive and Invasive measures. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2014;67(8):1017-1025. ↩︎
  13. Mustoe TA. Evolution of silicone therapy and mechanism of action in scar management. Aesthetic Plast Surg 2008;32: 82e92. ↩︎
  14. Monstrey S, et al. Updated Scar Management Practical Guidelines: Non-Invasive and Invasive measures. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2014;67(8):1017-1025 ↩︎
  15. Liu A, et al. Current Methods Employed in the Prevention and Minimization of Surgical Scars. Dermatologic Surgery. 2011;37(12):1740-1746. ↩︎
  16. Saulis AS, Mogford JH, Mustoe TA. Effect of Mederma on hypertrophic scarring in the rabbit ear model. Plast Reconstr Surg 2002;110:177-83; discussion 184-6. ↩︎
  17. Chung VQ, et al. Onion extract gel versus petrolatum emollient on new surgical scars: prospective double-blinded study. Dermatol Surg 2006;32:193-7. ↩︎
  18. Liu A, et al. Current Methods Employed in the Prevention and Minimization of Surgical Scars. Dermatologic Surgery. 2011;37(12):1740-1746. ↩︎
  19. Baumann LS, Spencer J. The effects of topical vitamin E on the cosmetic appearance of scars. Dermatol Surg 1999;25:311-5. ↩︎
  20. Van der Veer WM, et al. Topical calcipotriol for preventive treatment of hypertrophic scars; a randomized, double -blind, placebo controlled trial. Arch Dermatol 2009;145:1269-75. ↩︎
  21. Ogawa R. Keloid and hypertrophic scarring may result from a mechanoreceptor or mechanosensitive nociceptor disorder. Med Hypotheses 2008;71:493–500. ↩︎
  22. Atkinson JA, McKenna KT, Barnett AG, McGrath DJ, Rudd M. A randomized, controlled trial to determine the efficacy of paper tape in preventing hypertrophic scar formation in surgical incisions that traverse Langer’s skin tension lines. Plast Reconstr Surg.2005;116:1648–1656; discussion 1657–1658. ↩︎
  23. Ripper S, Renneberg B, Landmann C, Weigel G, Germann G. Adherence to pressure garment therapy in adult burn patients. Burns 2009;35:657e64. ↩︎
  24. Van den Kerckhove E, Stappaerts K, Fieuws S, et al. The assessment of erythema and thickness on burn related scars during pressure garment therapy as a preventive measure for hypertrophic scarring. Burns 2005;31:696–702. ↩︎
  25. Monstrey S, et al. Updated Scar Management Practical Guidelines: Non-Invasive and Invasive measures. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2014;67(8):1017-1025 ↩︎
  26. Chan MW, et al. Mechanical induction of gene expression in connective tissue cells. Methods Cell Biol 2010;98:178-205. ↩︎
  27. Bhadal N, et al. The effect of mechanical strain on protease production by keratinocytes. Br J Dermatol 2008;158:396-8. ↩︎
  28. Thuzar M, et al. The role of massage in scar management: A literature review. Dermatologic Surgery 2012;38(3):414-423. ↩︎
  29. Aarabi S, et al. Mechanical load initiates hypertrophic scar formation through decreased cellular apoptosis. FASEB J 2007;21:3250-61. ↩︎
  30. Haedersdal M, Bech-Thomsen N, Poulsen T, Wulf HC. Ultraviolet exposure influences laser-induced wounds, scars, and hyperpigmentation: a murine study. Plast Reconstr Surg 1998; 101:1315e22. ↩︎
  31. Due E, Rossen K, Sorensen LT, Kliem A, Karlsmark T, Haedersdal M. Effect of UV irradiation on cutaneous cicatrices: a randomized, controlled trial with clinical, skin reflectance, histological, immunohistochemical and biochemical evaluations. Acta Derm Venereol 2007;87: 27e32. ↩︎
  32. Published by. In: Middelkoop E, Monstrey S, Teot L, Vranckx JJ, editors. Scar Management Practical Guidelines. Maca-Cloetens; 2011. pp. 1e109. ↩︎
Get Your FREE eBook!
Why You Have Bad Posture and How To Make It Better
In addition, I'll send you one email per week with a link to new content. No Spam, I promise

Please note: I reserve the right to delete comments that are offensive or off-topic.

  • Louise Deeley

    Hi Michael, thanks for your writings! I wanted to ask if you are ok with me sharing your content on my website (with your name and contact details plus links of course!). In particular I wanted to share the article on kids playing many sports. (I have already shared as is on FB and Twitter) Requires slight changes to get it to present on web without fuzziness but everything will be as you have written, and clearly shown as your work. My web is http://www.inside-performance.com if you are happy to consider and I want to put it here: http://www.inside-performance.com/articles/ Thanks for considering and please let me know your thoughts, Louise

    • Michael Curtis

      You’re very welcome Louise. I’d be happy for you to share the article on your website. The only thing I ask is that you don’t share it in its entirety…Google penalizes my site if you do for not being original content. You can use the intro paragraph and then provide a link to my site for your readers to access the rest of it. I just did this on my own site linking to a guest post somewhere else, it’s a very common practice and one that your readers should have no problem with. Thanks for understanding and thanks for sharing!

      • Louise Deeley

        Hi Michael, I’m not sure if my original reply got to you … and if not, thank you! That’s great, and thanks for the suggestion on a paragraph and link – totally understand and it’s a great way to do it! I shall pop that article up as soon as I get chance – all a bit crazy here at the moment … in a good way! Have a great weekend, thanks again, Louise

        • Michael Curtis

          Sounds good Louise, thanks!

  • Elona Koci

    Hi Michael, thanks for your writings! Personally , I have a scar behind the neck . I have surgically remove a birthmark two years ago , and I haven’t done anything for scar after that . What would you recommand to do ,or maybe in this cases after a long period of time there cannot be anything to improve scar ??Thank you !

    • Michael Curtis

      Thanks Elona! Is the scar abnormal? Is it hypertrophic or keloid (see definitions in my post)? If not, continue to take good care of it with sunscreen and moisturizers. If it is keloid, there’s not a lot out there that can improve it, even Surgery has really bad success rates. If it is hypertrophic, try the silicone gel sheets – it is possible to improve this type of scar!