Scars and Scar Tissue: Causes, Problems, and Possible Treatments

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 ones 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

Scars on the skin form when the dermis is damaged and collagen fibres fill the injured area.
Fibrous Connective Tissue
Scar tissue is made of fibrous connective tissue. This tissue supports and connects body structures and holds them in place. It 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 the normal form, however.

Scars on the Skin
Causes
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 the formation of scar tissue is triggered. Some people tend to form scars more easily than others, however.
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 a scar becomes paler. It may take many months or even years to reach its final form. Scarred areas are generally thicker than their surroundings and lack hair, sweat glands, and melanin (the pigment that helps to protect 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 clot may be replaced by scar tissue. 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 may 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 may not make enough of the normal skin cells needed to replace the ones that have died.
Although we can discourage our body from producing scars, it's hard to completely avoid the process. 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 its visibility.
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.

Raised scars and ones with a strange appearance or that are of concern should be checked by a doctor.
Raised and Sunken Scars
Hypertrophic
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
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
Atrophic scars look like pits in the skin and may be formed during problems such as acne and chicken pox. In this type of scar, the body doesn't make enough connective tissue to fill in the wound.
Information From a Dermatologist
Anyone who wants to improve the appearance or symptoms of a scar should seek a doctor's advice. Doctors know the safest and latest techniques for treating scars. In addition, they can recommend the best treatment for a patient's specific situation. The information given below is presented for general interest only.
Possible Treatments
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. Treatments generally require weeks or months to be effective, however. Most scars fade to some extent on their own as time passes.
Some treatments that may be recommended include the following.
- Pressure applied to a scar or silicone sheets placed over the area 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. The new scar may look better than the old one, however.
- 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.

Scar Tissue Inside the Body
Causes
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, a hepatitis B or C viral infection, accumulation of fat in the liver (nonalcoholic steatohepatitis or NASH), and other causes.
Effects
Adhesions often cause no symptoms, but they sometimes produce pain and other problems. They 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 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 underside, four lobes can be seen.
Possible Treatments for Internal Scar Tissue
Adhesions may improve on their own. They can also be removed surgically. There is a risk that new adhesions will develop after the surgery, however. 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 often hard to manage. Cirrhosis of the liver is especially serious. Once the process starts, the replacement of liver tissue with fibrous tissue is often progressive. Treatments that may help the condition exist. It's much easier to prevent cirrhosis than to treat it, however.
Dealing With Scarring
Scar tissue formation in our bodies is often 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 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 treatments that may be more effective than the current ones.
References and Resources
- The National Institutes of Health has created a webpage containing information about different types of scars. The page contains a link to a list of clinical trials of new treatments.
- The Columbia University MedIcal Center also has a webpage with information about types of scars and their treatment.
- In addition, the website of the NHS (National Health Service) has a page describing scars and their treatment.
- WebMD has an overview of cirrhosis of the liver.
Questions & Answers
© 2011 Linda Crampton
Comments
I have adhesions that are attached to my intestines and they cause me a lot of pain and distress I am 80 years old and the doctors say that until I have a complete blockage they will not operate do you have any advice for me
Hi, I have discoid lupus scar (atrophic) scar on my scalp and it is disfiguring. Does platelet rich plasma (PRP) therapy help to improve the condition of the scar ?
I have scars that are 50 years old and you could not really see them. Then they all decided to puff up and turn red very noticeable . Then it goes away then a few years later it comes back .any idea.
Hello, I was wondering if vitamin deficiency could be the cause for easy scarring?
can you get scare tissue from lazar surgery?
Can a twenty year old scar form additional tissue?
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......
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
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.
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
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.
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
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?
iwant to know duration of healinng process of scar &its medicolegal importance
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
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?
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.
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.
Tina
I have a few scars that I would love not to see so much of! Very interesting article. Thanks!
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