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This article was reviewed and co-authored by Dr. John Tiberi, M.D.,OS (board-certified orthopaedic surgeon)

Although it’s not something that’s widely discussed with care teams and surgeons, the size and appearance of a scar is something that patients think about. Whether you’ve had a hip replacement, knee replacement, meniscus surgery, ACL reconstruction, shoulder or back surgery, a scar is inevitable. Although you won’t have a whole lotta control over how your body will scar, there are things you can do when it comes to breaking up scar tissue and adhesions. You can also play a role in healing your scar with scar tissue massage.

Read on as we:

  • Break down your FAQ about scarring and scar tissue
  • Share the basics of scar tissue massage (like when is it safe)
  • And how to massage your scar tissue at home.

But first, class is in session! Pull up your chair for ‘Scarring 101’ and learn the basics.

Scar 101: FAQ About Scars

surgery scars FAQ

Did you know scars don’t tan…they burn? The structural properties of a scar are different from regular skin. Scar tissue doesn’t have melanin (which is responsible for skin pigmentation). In fact, scars are more susceptible to UV damage and get sunburned more easily than regular skin. Always put sunscreen on and cover your scar in the sun!

Q: What is a Scar?

A: A scar is a mark left on your skin after an injury or an incision. Scar tissue forms during the healing process as the body produces collagen fibres to close and heal a wound. These collagen fibres do not grow in the same, consistent direction, and therefore are discoloured and can have an uneven texture. A scab forms over the wound to protect the area from germs. Once healed, the scab will fall off and your newly formed scar will reveal itself. Is the human body cool or what?!

Q: When Does a Scar form?

A: There are three phases of wound healing and scar formation after an incision is made during a surgery or a deep wound is inflicted.

3 Phases of Wound/ Incision Healing:

  • Inflammatory Phase: Blood clotting begins and the incision/ would will look red and inflamed. This only lasts a few days after surgery or injury.
  • Proliferation Phase: New tissue (collagen fibres) form to close and heal the wound. The area will feel raised and scabbed. This phase lasts 2-10 days. There area may feel warm, have some draininess and numbness.
  • Remodelling Phase: This is the final phase where your scar forms. As scar tissue forms, nerves heal, feeling returns to the area and the scar feels less proliferated (textured). Your scar may feel itchy and be more sensitive than regular skin. At first your scar may appear purple, then white, then eventually become closer to skin colour.

Your scar will be visible after scabbing is gone. This usually happens 10+ days after an incision or a deep cut/ wound.

Q. What Determines the Appearance of My Scar?

A: In an interview with Dr. John Tiberi, orthopedic surgeon, he shared that the appearance of a scar largely has to do with your genetics. According to Dr. Tiberi the most determining factors when it comes to how visible your scar will be: genetics, history of scarring, and location on the body. In other words, if you have a history of bad scarring and your immediate relatives do as well, chances are your scar will be more noticeable. In addition, if your incision or wound is on part of the body that is under tension, is tighter, more stretched, and is less fleshy or fatty (like a shoulder, shin, or knee) your scar will be more pronounced than say, if on your buttocks.

Q: How Long Will My Scar Heal For?

A: Scars will continue to heal and fade for up to two years after an incision or injury. The remodelling phase in your incision healing involves the lightening of your scar as the scar heals.  A mature scar is smaller, flatter, and paler. During the healing process, there are ways to improve how your scar heals and for larger scars over joints, it’s critical that you “work” your scar to prevent tightness.

For tips on healing your scar faster, check out our article “Scar Healing, Size & Treatment After Joint Replacement Surgery”.

Enough about the basics! Let’s get into massaging scar tissue.

Scar Tissue Massage: When, Why & How?

Before you start massaging your scar or enlisting a professional to perform scar tissue massage, your scar has to be in a good place. Do not massage until your incision has fully healed and is a scar (not just a wound or scab). If you massage your scar prematurely you could cause it to reopen or tear, leading to an infection.

Do not massage a scar until at least 2 weeks after a surgery or injury. Massaging scar tissue is most effective in the first 2 years while the scar is still forming and healing.

Why Scar Tissue Massage?

Massaging scar tissue has many benefits. Here are of the main reasons to regularly scar massage (especially in the first two years after surgery/scarring):

  • Decrease scar tissue build-up. Excess scar tissue can make muscles stiff and weaker, and in some cases can require scar tissue removal surgery.
  • Helps improve blood flow, which promotes healing and the scar’s pliability.
  • Drains excess fluid to reduce swelling and proliferation.
  • Helps regain feeling in the area and decrease numbness, tingling, soreness.
  • Increases range of movement and the scar’s flexibility. This makes movements feel less restrictive and “tight”.
  • May help with the appearance of your scar.

How to Massage Your Scar

As listed above, there are lots of benefits to scar tissue massage. When scar tissue is broken down through massage, you can help your body heal faster, and possibly reduce the appearance of your scar. Here’s how we recommend you massage your scar tissue at home:

  • In early healing phases, try and massage your scar for 10-15 minutes a day (2-3 times a day for 5 mins).
  • Apply a non-perfumed Vitamin E lotion or oil to your scar area. Vitamin E is proven to help build collagen and massaging with lotion lubricates the skin, cutting down friction.
  • Using the pad of your thumb or finger, firmly massage in a circular motion. You should be pressing hard enough that your fingernail turns from pink to white, but it should not be painful. First go up the scar clockwise, work your way up and around your scar slowly but maintaining a firm pressure. Switch it up by massaging counter-clockwise. This will help to drain excess fluid from the area.
  • Next, stretch the skin apart around your scar, and repeat your massaging with a firm circular motion using your thumb or finger.
  • With pressure, slowly slide your finger up the scar while apply pressure. Change direction by slowly sliding down.
  • Repeat the process several times for 5 minutes or so.

Have pain and worried about surgery? Sign-up for PeerWell and get to the root cause of your pain!

John Tiberi, M.D.,OS is a board-certified orthopaedic surgeon who specializes in minimally-invasive hip and knee replacement surgery and reconstructions. He attended medical school at the Harbor-UCLA Medical Center in Torrance, California. Dr. Tiberi completed his fellowship at Massachusetts General Hospital and Harvard Medical School in Boston, Massachusetts. He is a published orthopedic in journals such as The Journal of Arthroplasty, Journal of Bone Joint Surgery (JBJS), and Clinical Orthopaedics and Related Research. Dr. Tiberi is the winner of Dana M. Street Orthopaedic Research Award.

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