Scar tissue may become hard and raised. Massage can help to soften and flatten the scar tissue. Scar tissue may stick to the underlying muscles, tendons, blood vessels, nerves and bones. Massage can prevent this from happening and helps to keep the scar tissue flexible.
Research has shown that gently massaging a scar may break down scar tissue as it forms. It may also prevent hypertrophic scars or keloids from developing after an injury.
Massaging your scars is important. It keeps the tissue around the incision loose so it doesn't “stick” to the tissue underneath. Wait until after your skin has healed before you start massaging your scar. Your skin will be healed when the edges of the scar are well closed with no gaps, and have no drainage.
Corticosteroid injections: This is a main treatment for hypertrophic scars. Injections are made into the scar tissue. They flatten and soften scar tissue and ease pain and itch. Several shots may be needed, each given a few weeks apart.
Unlike keloid scars, hypertrophic scars do not extend beyond the boundary of the original wound. They may continue to thicken for up to 6 months before gradually improving over a few years.
In addition, it is accepted that application of pressure commonly alleviates the itch and pain associated with active hypertrophic scars42,43.
Hypertrophic scars usually start to develop within weeks after the injury to the skin. Hypertrophic scars may improve naturally, although this process may take up to a year or more. In treating hypertrophic scars, steroids may be the first line of therapy with this type of scar, although there is not one simple cure.
Hypertrophic scars are usually raised, although rarely elevated more than 4 mm above the skin; red or pink in color; hard; and pruritic. Additionally, these scars do not extend beyond the general geographic margins of the wound and tend to regress over time.
The resulting hypertrophic scar can be raised, red, uncomfortable, and potentially limit movement. Though they generally flatten out and resolve within weeks to months, hypertrophic scars that cause pain or limit movement can benefit from treatment.
If a patient massages their scar prematurely it could cause the wound to tear or reopen, risking an infection. It's therefore important to advise them to not begin massaging until the wound is fully healed.
Scars generally only reach about 70 to 80% of skins normal strength and therefore can easily be injured. During your scar massage, keep an eye out for blistering, open areas, or a rash. You may be applying too much pressure or being too rough. If this happens, stop massaging in this area and allow it to heal.
A deep tissue massage breaks down adhesions and collagen fibres that can be caused as a result of scar tissue. Adhesions restrict movement and increase pain resulting in an increase in stress. Breaking down scar tissue through deep tissue massage relieves restriction to decrease pain and reduce stress.
You should start massaging your scars when your wounds are healed or after your stitches are removed. Your therapist may advise you to start earlier or later depending on the surgery you have had and the condition of your skin.
Use Vaseline® Jelly for Scars
By sealing in moisture it also helps to reduce dryness of scarred skin, once your skin has healed. This may help to improve the appearance of scars, making the skin look smoother and softer, as well as help to reduce itchiness caused by dryness.
PATHOPHYSIOLOGY OF HYPERTROPHIC SCARS
The wound healing process involves the following phases, inflammation phase (the first 2 to 3 days after injury), proliferation phase (4 days to 2 weeks including ECM formation, angiogenesis, and reepithelialisation), and maturation phase (several months even lasting to one year).
Keloids and hypertrophic scars are caused by cutaneous injury and irritation, including trauma, insect bite, burn, surgery, vaccination, skin piercing, acne, folliculitis, chicken pox, and herpes zoster infection.
Limited clinical trials have failed to demonstrate lasting improvement of established keloids and hypertrophic scars with onion extract topical gel (e.g., Mederma) or topical vitamin E.
2.1. Apple Cider Vinegar As a natural astringent and exfoliator, apple cider vinegar prevents scar-promoting cells from entering the keloid site, reducing both the pigmentation and the size of the scar. Besides, the irritated skin will be calmer and reduce swelling when applied apple cider vinegar.
Hypertrophic scars and keloids may be itchy, tender, or painful. These unusual scars may occur as a result of genetics—they sometimes run in families, and typically, if one forms after an injury, it forms after your subsequent injuries, too. But why they form in some people and not others isn't known.
Hypertrophic scars are more common, but they don't get as big as keloids and often subside by themselves (a process that can take up to one year or more). They occur in all racial groups. A hypertrophic scar remains within the length of the original wound.
Products include sheets, strips, specific shapes, and two tube sizes of topical silicone gel. These products can be used for a variety of scar types, including keloids, burns, hypertrophic scars, and scars from trauma, cosmetic procedures, C-sections, and abdominoplasty.
The use of microneedling in combination with topicals, such as corticosteroids, has been described in multiple studies for acne scars, burn scars, and hypertrophic scars, resulting in a reduction of scar size and repigmentation.