What Causes Surgical Scar Tissue?
Surgical scar tissue is a natural part of the body's healing process after surgery. When a surgical incision is made, the body goes into repair mode sending fibroblasts, specialized cells, to the affected area to produce collagen fibers, which is the protein that helps rebuild soft tissue.
Collagen gives scar tissue its strength, but sometimes too much collagen is produced, or it's laid down in disorganized patterns rather than aligning with healthy tissue. The result is more pronounced scar tissue that may feel firm, tight, or restrictive compared to the surrounding tissue.
Different Types of Scar Tissue
While most scars fade over time, the different types of scars vary in appearance, texture, and behavior. Understanding which type you're dealing with matters because some respond better to certain treatments than others. Here's a breakdown of the most common types.
Keloid
Keloid scars are raised, red, and often itchy, and they grow beyond the boundaries of the original wound. An overproduction of collagen causes them during the wound-healing process, which doesn't stop when healing is complete. Keloid scars are more common in people with darker skin tones and require specific treatment planning, as some approaches (like massage) can stimulate further growth.
Hypertrophic Scars
Like keloid scars, hypertrophic scars are raised and red. Unlike keloids, they stay within the boundaries of the original wound and tend to flatten and fade over time. They're more responsive to conservative scar management strategies.
Atrophic Scars
Atrophic scars are pitted or sunken. They occur when the body doesn't produce enough collagen during the healing process, resulting in tissue loss that leaves a depression in the skin.
Scar Contractures
Scar contractures occur when elastic tissue is lost due to a deep wound, burn, or surgical incision. As the new tissue heals, it contracts, tightening the skin in the affected area and limiting movement. This can lead to functional limitations such as difficulty bending a joint, which is a serious concern after procedures like knee replacement surgery.
Adhesions (Internal Scar Tissue)
Unlike surface scars, adhesions are internal scar tissue that forms bands connecting organs or soft tissue structures that aren't normally attached. They can develop after surgery or inflammation and may cause pain, restricted movement, or organ dysfunction. Adhesions are among the most functionally significant types of scar tissue and often require targeted interventions.
Common Areas for Post-Surgical Scar Tissue to Develop
Scar tissue can develop anywhere on the body where a surgical incision has been made, but some areas of the body are more prone to excessive scar tissue formation.
Joints
The knees, shoulders, hips, and elbows are all common sites for scar tissue formation after surgery. These areas are in near-constant motion, and that repetitive movement can irritate healing tissue, causing it to grow thicker and less pliable. Scar tissue after knee replacement surgery, for example, is a well-documented challenge and a key reason physical therapy begins so quickly post-procedure.
Upper Torso
The upper torso, including the chest and back, is another common area. The skin here is under significant tension with daily movement, which can pull on a healing incision and make scar tissue more pronounced.
Abdomen
The abdomen is a frequent surgical site, and both surface scars and internal adhesions can develop here. Abdominal surface scars tend to be less noticeable than scars elsewhere on the body, but internal adhesions following abdominal surgery are a leading cause of chronic pain and post-surgical complications.
Risk Factors for Developing Scar Tissue After Surgery
Several factors influence how much scar tissue forms after a surgical procedure, including the size and location of the incision, the type of surgery, the patient's age and overall health, and genetics. Younger people tend to form more scar tissue than older adults, and people with a family history of keloid scars are more likely to develop them. Infection, prolonged inflammation, and wound tension can all contribute to more significant scar tissue formation.
Can Scar Tissue Cause Pain or Other Problems?
Yes, scar tissue can cause pain, and more often than people expect. While scar tissue is often considered a cosmetic issue, it can cause pain and functional limitations in some cases.
Scar tissue can be painful for several reasons. It may be tight and restrict movement, causing discomfort in the affected area. Nerves can become trapped in scar tissue, leading to burning or aching sensations. Additionally, scar tissue may be hypersensitive, making the surrounding area tender to the touch. Internally, adhesions can tether soft tissue structures to areas they're not normally connected to, causing pulling or chronic pain with everyday movement.
Scar tissue can also be stiff and inflexible, limiting a joint's full range of motion. This is particularly problematic after surgeries involving the knees, shoulders, or elbows—joints that depend on flexibility and blood flow to surrounding tissue to function well.
Not everyone experiences these problems. Some wounds heal smoothly with no long-term issues. But if you're dealing with pain, stiffness, or reduced mobility after surgery, talk to your healthcare provider sooner rather than later. Early intervention produces significantly better outcomes.
How Long Does It Take for Surgical Scars to Fade?
A surgical scar typically takes 6 to 18 months to fully mature and reach its final appearance. During this time, the scar will gradually remodel, becoming flatter, softer, and paler as the collagen fibers reorganize.
Initial Stage (First 3 Months)
Right after surgery, the scar will likely be red, raised, and possibly itchy. This is a normal part of the healing process as the body actively produces collagen and responds to the incision site.
Maturation Stage (3 Months to 18 Months)
Over the following months, the scar tissue will remodel and soften. Generally, redness will fade, and the scar will become flatter and less noticeable. If scar tissue is causing pain or limiting mobility during this phase, this is the window where treatment interventions are most effective. Waiting too long can allow scar tissue to become rigid and more difficult to address.
Treatment Options for Reducing Scar Tissue After Surgery
There's no one-size-fits-all treatment plan for scar tissue. The right approach depends on the type of scar, its location, severity, and your overall health. While there's no way to prevent scar tissue formation completely, the following options can meaningfully reduce its impact.
At-Home Scar Tissue Treatments
- Silicone Gel: Silicone gel applied to healing scars helps keep them hydrated and reduce scar formation. It's one of the most evidence-supported at-home scar management tools available. Look for gels that contain silicone dioxide as an active ingredient, and apply consistently. Daily use over several months produces the best results.
- Sunscreen: Sun exposure darkens scar tissue, making scars more noticeable. Apply a broad-spectrum SPF 30 or higher sunscreen every day to any exposed scar throughout the maturation stage.
- Moisturizer: Keeping the skin hydrated supports scar remodeling and can improve the texture and appearance of scar tissue. Choose a gentle, fragrance-free moisturizer and apply it consistently.
- Scar Massage: Once a wound has fully closed—typically 2 to 3 weeks post-surgery, though you should confirm with your healthcare provider—gentle massage of scar tissue can be beneficial. Massage can help break up scar tissue, improve blood flow to the healing area, reduce adhesion formation on the surface, and improve range of motion. Use two to three fingers and apply firm circular pressure to the scar and surrounding tissue for several minutes daily.
*Important: Do not massage scar tissue that is still open or in the early stages of healing. And as noted above, massage is not appropriate for keloid scars. Always check with your physical therapist or healthcare provider before starting a massage routine.
Medical Treatments for Scar Tissue
Physical Therapy and Manual Therapy
Physical therapy is one of the most effective and underutilized tools in scar tissue management, particularly for post-surgical recovery involving joints. A physical therapist can build a treatment plan that combines targeted stretching, strengthening, and manual therapy techniques to address scar tissue and restore range of motion.
Manual therapy approaches used in physical therapy include:
- Tissue Mobilization: This is a direct hands-on technique to break up adhesions and improve scar tissue flexibility
- Myofascial Release: This addresses restrictions in the connective tissue surrounding muscles and joints to improve mobility and reduce pain
- Graston Technique: This is an instrument-assisted soft tissue mobilization method that uses specialized tools to detect and break down scar tissue and adhesion patterns in deeper soft tissue layers
A 2025 review published in PLOS One identified massage therapy as the most effective non-surgical intervention for improving overall scar quality—specifically, scar pliability, vascularity, and thickness—reinforcing the value of hands-on, manual therapy approaches in any scar management plan.
A 2025 scoping review in PMC also confirmed that non-invasive physical therapy interventions are widely supported for scar management across scar types, though noted the need for more standardized protocols, further evidence that working with an experienced physical therapist who can tailor your treatment plan makes a meaningful difference.
Corticosteroid Injections
Corticosteroid injections can be administered directly into raised scars, particularly keloid scars and hypertrophic scars, to reduce inflammation and flatten the scar over time. Possible side effects include skin thinning or lightening at the injection site.
Cryotherapy
Cryotherapy involves freezing scar tissue with liquid nitrogen to flatten and soften it. It's most effective for minor, more superficial scars. Side effects can include blistering and, in rare cases, nerve damage.
Laser Treatment
Laser therapy is an increasingly effective option for treating scar tissue. Two primary types are used:
- Fractional Lasers: These create microscopic controlled injuries in the scar, stimulating new collagen production and improving scar texture over time
- Vascular Lasers: These target redness and discoloration associated with healing scar tissue
Laser therapy is typically performed in a series of sessions and works best during the scar maturation stage. It may cause temporary redness and swelling. Consult a qualified healthcare professional to determine whether laser treatment is appropriate for your scar type.
Surgical Treatments for Scar Tissue
Surgery offers a more direct approach to scar tissue treatment, particularly for severe scars that significantly impact appearance or mobility. Surgical scar revision is typically recommended when conservative treatments haven't provided adequate relief, or when scar tissue is causing significant functional problems or cosmetic concerns.
- Scar Excision: The scar tissue is surgically removed and the wound is closed using techniques appropriate for the size and location of the scar.
- Skin Grafting: When there isn't sufficient healthy tissue near the excision site, a skin graft may be necessary, taking a thin layer of skin from a donor site (typically the buttocks, thighs, or behind the ear) and transplanting it to the area where the scar was removed.
- Z-plasty and W-plasty: These techniques involve strategically cutting scar tissue in a Z- or W-shaped pattern and rearranging surrounding skin flaps to create a less noticeable, more functional closure. They're particularly useful for linear scars that limit movement near joints.
- Contracture Release: For contracture scars that restrict movement, surgery can release the tight tissue and restore flexibility. Skin grafts or tissue expanders may be used in conjunction with contracture release depending on the extent of the restriction.
What Are the Risks of Scar Treatment Procedures?
At-home remedies such as silicone gel and moisturizer are generally well-tolerated and carry minimal risk. Those with sensitive skin may experience mild irritation.
For medical scar treatments, some side effects are possible. Corticosteroid injections may cause thinning or lightening of the skin around the injection site. Cryotherapy can cause blistering and nerve damage. Laser treatments can cause temporary redness and swelling.
Surgical interventions carry the same risks as any surgical procedure, including infection, bleeding, and anesthesia complications. If you're weighing scar reduction options, discuss the risks and benefits in detail with your healthcare professional before moving forward.
When to See a Doctor for Scar Tissue
Reach out to your healthcare provider if:
- You're experiencing significant pain at or near the scar site
- The scar is limiting your range of motion or making daily activities difficult
- The scar is growing larger, becoming more raised, or getting redder, especially weeks to months after the initial healing period (this may indicate a keloid)
- You're experiencing symptoms that could suggest internal adhesions, such as unexplained abdominal discomfort after abdominal or pelvic surgery
- You have cosmetic concerns that are affecting your confidence or quality of life
Early intervention is almost always more effective than waiting. Scar tissue that is addressed during the maturation window responds significantly better to both conservative and medical treatments. Consult a doctor if you have any concerns about your scar tissue.
Worried About Your Post-Surgical Scar Tissue? Contact Alexander Orthopaedics
If you’re having issues with post-surgical scar tissue, consult the experts at Alexander Orthopaedics to learn about your options. Schedule an appointment today.
