Scar Tissue and Scars: Formation, Problems, and Treatment

A scar on the shoulder and upper arm
A scar on the shoulder and upper arm | Source

Scar Tissue and Its Function

Scar tissue forms in injured areas of our bodies and replaces cells that have been destroyed. It appears either inside the body or on its surface and is a normal part of the body's healing process whenever we have a significant injury. Scar tissue acts as a barrier and protects the place that was injured, but it unfortunately lacks the functionality of the original tissue and has low elasticity. On the surface of the body it may be a cosmetic problem or even be disfiguring.

Scar tissue on our skin looks different from the surrounding area and is usually referred to as a “scar". Some people develop hypertrophic scars on their skin. These are larger than normal and have a lumpy appearance. Keloid scars are raised and spread beyond the wound. Atrophic scars are sunken and form depressions in the skin. Inside the body, scar tissue in the form of adhesions or fibrosis may cause problems.

Structure of the Skin

The epidermis of the skin is continually being shed from the body and renewed. Skin scars form when the dermis is damaged and collagen fibres (not shown) fill the injured area.
The epidermis of the skin is continually being shed from the body and renewed. Skin scars form when the dermis is damaged and collagen fibres (not shown) fill the injured area. | Source

Scars on the skin can be embarrassing for some people, but extensive scar tissue formation inside or next to organs may interfere with the organ’s function.

Scar Tissue Structure

Scar tissue is made of fibrous connective tissue. Connective tissue supports and connects body structures and holds them in place. Fibrous connective tissue contains fibres made of a protein called collagen. It also contains cells called fibroblasts, which make the collagen, as well as water and carbohydrates.

Fibrous connective tissue is sometimes known as dense connective tissue because the collagen fibres are densely packed and there are comparatively few cells present. It's a normal component of the body and is present in uninjured areas. Researchers have discovered that the connective tissue in scars has a slightly different structure from normal fibrous connective tissue.

A minor scar one year after the injury that caused it. Most scars fade with time.
A minor scar one year after the injury that caused it. Most scars fade with time. | Source

Scars on the Skin

Causes of Skin Scars: Scars may be caused by wounds such as burns, surgical incisions, physical injury, chemical injury, infections, diseases, inflammation and acne. Not all wounds cause scars. There must be significant damage to the body before scar formation is triggered. Some people tend to form scars more easily than others, however.

Scar Appearance: Scars on the skin are red when they are first made due to an increased blood flow as the wound heals. Over time, the blood supply decreases and the scar becomes paler. Scars may take many months or even years to reach their final form.

Skin scars are thicker than their surroundings. The scar lacks hair, sweat glands, and melanin (the chemical which protects the skin from ultraviolet radiation).

How Do Scars Form?

Reducing Scar Formation

The first structure that forms in a wound is the blood clot which prevents blood loss. The blood clot may be replaced by scar tissue. Skin scarring can be reduced by making sure that the edges of a wound are brought close together during the healing process. When the edges of a wound gape, scar tissue will be formed to fill in the gap.

Good wound dressings, good nutrition, and appropriate medications (such as antibiotics) can help to protect and defend an injured area. The amount of scarring and the final appearance of a scar depend mainly on genetics and age, however. Older people tend to scar more easily than younger people. Their bodies are less likely to form enough normal skin cells to replace the ones that have died in an injury.

Although we can help our bodies to reduce scar formation, it's hard to completely avoid scars. Surgeons are well aware of the body's tendency to scar. They often try to make their incisions in a direction or a place that will minimize scarring or that will minimize a scar's visibility.

Stretch marks on the abdominal skin of an obese male
Stretch marks on the abdominal skin of an obese male | Source

Stretch marks are a type of skin scar. They often develop due to stretching of the skin during rapid weight gain. In some cases, as in pregnancy, their formation is influenced by hormones.

Abnormal Skin Scars

Hypertrophic Scars: In a hypertrophic scar too much collagen is made. The scar forms a raised area or lump above the wounded area of the skin. The lump is often pink in its early stages and may be itchy.

Keloid Scars: Keloid scars grow beyond the wound, forming a reddish tumour. This tumour is benign (not cancerous) and consists mainly of collagen. Keloid scars may form as a response to injury, but in some people they form spontaneously, with no known cause. They may be itchy and create a burning sensation.

Atrophic Scars: Atrophic scars look like pits in the skin and may be formed during skin problems such as acne and chicken pox. In this case, not enough connective tissue is formed to fill in the wound.

A Dermatologist Discusses Raised Scars

Scar Treatment

In general, scars on the skin can’t be completely removed once they form, but they can be treated to make them less noticeable. The improvement in appearance may be very significant. Scar treatments generally require weeks or months to be effective, however. Most scars fade to some extent on their own as time passes.

A doctor should be consulted for advice about treating scars. Some common treatments include the following.

  • Pressure applied to a scar or silicone sheets placed over the scar often improve its appearance. These treatments flatten raised scars and make scars paler.
  • Doctors may inject corticosteroids into a raised scar to inhibit collagen synthesis and reduce inflammation.
  • Surgical techniques can remove some scars, but the body may make a fresh scar as it heals itself from the surgical wound. However, the new scar may look better than the old scar.
  • In dermabrasion, the surface layer of scarred skin is removed in an abrasive process. Laser surgery can be used to remove the raised surface of a hypertophic or keloid scar.
  • A different type of laser treatment can improve the appearance of acne scars. The treatment stimulates the formation of new collagen, which partially fills in the pitted areas.
  • Skin grafts may be used to cover some scars, such as those created by burns.

Anyone who wants to improve the appearance of scars should seek a doctor's advice. A doctor will know the safest and latest techniques for treating scars. He or she will also be able to recommend the best treatment for a patient's individual situation.

Adhesions that formed after abdominal surgery
Adhesions that formed after abdominal surgery | Source

Scar Tissue Inside the Body

Some Causes of Internal Scar Tissue: As a result of trauma, fibrous bands or sheets may form inside the body. These bands are known as adhesions because they join structures or different parts of the same structure together. Adhesions arise due to the inflammation caused by conditions such as surgery and infections.

Another type of internal scar tissue is fibrosis, or the buildup up of excess fibrous connective tissue in a particular location in the body. Fibrosis may occur inside organs. Sometimes the cause of the fibre buildup isn't known, but in other cases it appears after an injury and acts as scar tissue.

Scar tissue production in the heart may be caused by a heart attack and the accompanying death of heart muscle. Cirrhosis of the liver, a condition in which the normal liver tissues are gradually replaced by scar tissue, may result from excessive alcohol consumption, hepatitis C or obesity.

Some Effects of Internal Scar Tissue: Adhesions often cause no symptoms, but they sometimes produce pain and other problems. Adhesions may cause organs to change their shape or move out of their correct positions. They may also prevent the movement of a structure that should be moving.

Scar tissue in the heart may increase the chance of an irregular heartbeat (arrhythmia) because the damaged tissue interferes with the electrical signal that triggers the heartbeat. The liver has many vital functions. Cirrhosis of the liver is a very serious condition, since the scar tissue can’t perform the liver’s normal jobs.

The liver is located in the upper abdominal cavity.
The liver is located in the upper abdominal cavity. | Source

The liver is a large organ that appears to consist of two lobes when viewed from the front of a person's body. When it's viewed from the back, four lobes can be seen.

Treatments for Internal Scar Tissue

Adhesions may improve on their own. The can also be removed surgically. However, there is a risk that new adhesions will develop after the surgery. Doctors sometimes place a thin barrier material around an organ during surgery. The barrier prevents the attachment of adhesions and eventually dissolves.

Doctors do have some techniques for dealing with scar tissue in hearts, livers and other organs, but extensive scar tissue is hard to manage. Cirrhosis of the liver is especially serious. Once the process starts, the replacement of liver tissue with scar tissue is progressive. It's much easier to prevent cirrhosis than to treat it.

Cirrhosis of the Liver and Its Effects

Dealing With Scars

Scar tissue formation in our bodies is unavoidable, but the good news is that there are steps that we can take to prevent or reduce the process. Proper wound treatment and a healthy lifestyle can decrease the probability of scar tissue formation or decrease the amount of scar tissue that's made.

If scars do form, medical treatments can often improve their appearance and even remove some of the scar tissue. Makeup can hide many skin scars that can't be completely removed. In addition, clinical trials are being performed to test new scar treatments that may be more effective than the current ones.

More Information About Scars

The National Institutes of Health has created a webpage containing information about different types of scars. The page also contains a link to a list of clinical trials of scar treatments.

© 2011 Linda Crampton

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Comments 26 comments

GetSmart profile image

GetSmart 5 years ago

I have a few scars that I would love not to see so much of! Very interesting article. Thanks!

AliciaC profile image

AliciaC 5 years ago from British Columbia, Canada Author

Hi, GetSmart. I've been lucky with scars so far - I have one small scar that isn't very noticeable, so I'm not worried about it. Thanks for the visit and the comment!

thougtforce profile image

thougtforce 5 years ago from Sweden

Great article about scars! Every scar is a reminder of the event that created the scar, some memories a good, others are bad. Interesting to read why some people get bad scares that are very visible while some people don't. Sadly I belong to the group that gets ugly and very visible scars. But I have learned to live with them, they are a part of me.


AliciaC profile image

AliciaC 5 years ago from British Columbia, Canada Author

Hi Tina. You're right - my scar reminds me of the incident I experienced as a teenager that created the scar, and also reminds me of how lucky I was to suffer from nothing more serious than a scar as result of the incident! Thanks for the comment.

b. Malin profile image

b. Malin 5 years ago

Wow, another Interesting Hub on Scars and Scar tissues, and Internal Scars Alicia. I too have some Scars. Its so good to read the improved methods for getting rid of some scaring. I've seen they even make an "over the counter" treatment, I'm not sure how good it is.

AliciaC profile image

AliciaC 5 years ago from British Columbia, Canada Author

Thank you very much for the visit and the comment, b. Malin. It is good that improved methods of scar tissue treatment are being created. Some stores and companies do sell over the counter scar treatments. I've read that these treatments may work, but some researchers think that it's the pressure on the scar and the moist healing environment created by the dressings that's improving the appearance of the scar. It will be interesting to see if scientists can discover for certain why scars improve with these treatments!

pam g. 4 years ago

Recently had gallbladder removed: surgeon said extensive scar tissue over liver, small intestines and omentum. What would cause this: only previous operation a tubal ligation through navel?

AliciaC profile image

AliciaC 4 years ago from British Columbia, Canada Author

Hi, pam g. There are several possible reasons for internal scar tissue, as I mention in my hub. I'm a biology teacher, not a doctor, so you should ask your surgeon or doctor what could have caused the scar tissue in your particular case.

STEVEW13 profile image

STEVEW13 4 years ago from Norwich, England

This is a very interesting hub, I have a friend who has some scarring that they are very conscious of and who I know was recently looking up information in them. I will certainly be forwarding this on to her. Thanks for sharing

AliciaC profile image

AliciaC 4 years ago from British Columbia, Canada Author

Thank you for the comment and for forwarding this hub to your friend, STEVEW13! I hope that your friend is able to get some help for her scar.

dr sitaram kanujia 3 years ago

iwant to know duration of healinng process of scar &its medicolegal importance

AliciaC profile image

AliciaC 3 years ago from British Columbia, Canada Author

Thank you for your visit, dr sitaram kanuja. I am neither a doctor nor a lawyer, so I cannot describe exactly how long a scar will take to heal or give any medicolegal information. These are questions that you should ask your doctor. The doctor may be able to make an estimate of scar duration if he or she sees a specific scar and knows your medical history. The doctor will also be able to suggest the best treatment.

MIMI 3 years ago

Hi, my son en i were in a road accident about two months ago, recently he has developed rashes on the scar, what cn i do about it,what could be the cause?

AliciaC profile image

AliciaC 3 years ago from British Columbia, Canada Author

Hi, MIMI. I'm sorry about the car accident. I'm afraid you'll have to consult a doctor about your son's rash. I'm not a doctor myself, so I can't give medical advice to individuals. I'm sure your physician will be able to help you, though,

dalima@2 2 years ago

I've lots of scars on my legs ,these scars remind's me of my teanage life. I was very rough when i was a child, these scars piss me up when ever i look at. What can I do to make the scars lessnoticable

AliciaC profile image

AliciaC 2 years ago from British Columbia, Canada Author

Hi, dalima@2. I'm sorry about your annoying scars. There are treatments that may improve the appearance of scars, as I describe in my article, but you need to visit a doctor to try these treatments. Good luck.

Fifi 2 years ago

I've got lots of scars on my legs ,these remind's me of my teenage period. I was careless when I was a child, these scars makes me feel ashamed to expose legs. What do I do about it.

AliciaC profile image

AliciaC 2 years ago from British Columbia, Canada Author

As I said to the previous commenter, I'm sorry about your scars. I can't help a specific problem, however, because I'm not a doctor. Please visit your physician for help.

ERNESTA MBOGO 5 months ago

I had a TL 6 years ago and those adhesions have formed its uncomfortable and as the doctor says if you insist on surgery it might cause other adhesions i have learned to live with it

AliciaC profile image

AliciaC 5 months ago from British Columbia, Canada Author

I hope a solution is found for your situation one day, Ernesta. Thank you for the comment.

Nickel Quarter profile image

Nickel Quarter 2 months ago

After a visit to an Urgent Care for what I thought was bone spurs in my toe, I come to find, it is scar tissue from a previous fracture, oddly enough I never knew it happened. I was told I may have to have the tissue removed. Working 2 jobs where I'm on my feet all day is not helping and I've literally broke down crying before because it hurts so bad. I hope one day they actually find a quick fix for this other than surgery, or just waiting.

AliciaC profile image

AliciaC 2 months ago from British Columbia, Canada Author

I hope a quick fix is found too, Nickel Quarter. I'm sorry that you've experienced such bad pain. Hopefully the treatment that you eventually get will be helpful. Best wishes.

Maribel 2 months ago

Hi I just had surgery I got my gallbladder removed but dr punctured my bile duct so I had another surgery within a week of having my first surgery I've been having strong pains whereby had my surgery I had ultrasound but everything came out negative doctor told me my scars are thick from inside that is what is cause my pain but my pain travels to my back and suffocates me could it be the scars?? Thank you

AliciaC profile image

AliciaC 2 months ago from British Columbia, Canada Author

Hi, Maribel. I'm sorry that you had to have two surgeries so close together. Since a doctor has told you that scars are causing your pain, they may well be the cause of your problem. Since I'm not a physician, however, I can't diagnose medical problems that an individual is experiencing. If the pain doesn't go away, I suggest that you see your doctor again or that you visit a different doctor if you'd like a second opinion. I hope your problem is resolved soon.

Jo1963 8 weeks ago

I had a operation 17 days ago to remove built up filler on both lips. Healing was going great, but on the 15th day I noticed my skin was getting very tight around my mouth area. This happened very rapid, I now have no motion in my lips, I can't smile and am finding it hard to clean my teeth. My opening of my mouth has become much smaller. Please tell me this isn't scar tissue :(((( I am in bits......

AliciaC profile image

AliciaC 8 weeks ago from British Columbia, Canada Author

Hi, Jo1963. You need to seek your doctor's advice as soon as you can. He or she will know what is happening in your situation and will be able to help you. I can't do this, since I'm not a physician. I hope your lip problem is solved soon.

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    Linda Crampton (AliciaC)1,244 Followers
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    Linda Crampton is a teacher with an honours degree in biology. She enjoys writing about human biology and the science of health and disease.

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