Scars do grow with you, especially those acquired in infancy or childhood. As your body gets bigger, the surrounding skin stretches, and the scar tissue stretches along with it. A surgical incision on a baby’s abdomen, for instance, will be considerably longer by the time that child reaches adult height. But “growing” only tells part of the story. Scar tissue responds to body growth, mechanical forces, hormones, and time in ways that differ fundamentally from the skin around it, and those differences produce changes that can surprise people years after the original wound has healed.
How Childhood Scars Scale Up
The most straightforward way scars grow with you is proportional expansion. When a child gets a scar, the tissue that forms over the wound is embedded in skin that still has years of stretching ahead of it. As the child’s body grows, so does the scar. A case series tracking siblings who all had the same type of abdominal surgery as infants found that their scars increased substantially in size by the time the children reached adult stature. The researchers concluded that scars from surgical procedures in infancy grow more than many parents or surgeons expect, and that the initial incision size will most likely not be the length of the final scar.1PubMed Central. An Analysis of Pediatric Scar Progression Over Time
This is one reason pediatric surgeons increasingly favor smaller incisions and minimally invasive techniques when possible. A tiny port site from a laparoscopic procedure will also grow with the child, but because it starts so much smaller, the final result tends to be far less conspicuous than a traditional open incision that has been expanding for fifteen years.1PubMed Central. An Analysis of Pediatric Scar Progression Over Time
Adults are not immune to this effect, but the magnitude is smaller. An adult who gains a significant amount of weight will see scars on their abdomen or thighs widen as the surrounding skin stretches. Likewise, a scar on the abdomen of a pregnant person may look wider or more prominent as the belly expands. The underlying principle is the same: scar tissue is dragged along by whatever the surrounding skin does.
What Makes Scar Tissue Different From Normal Skin
To understand why scars behave oddly as they grow, it helps to know what makes them structurally different. Normal skin has collagen fibers arranged in a complex, basket-weave pattern that allows it to stretch in multiple directions. Scar tissue, by contrast, lays down collagen in a more parallel, disorganized fashion. This difference means scar tissue handles mechanical force differently from the skin around it.
Nanoindentation studies have shown that scar tissue in the dermis is stiffer than healthy skin and has a weaker ability to absorb and dissipate energy. The collagen fibrils in scarred dermis show a visibly altered orientation compared to normal dermis.2PubMed. Static and dynamic nanomechanical properties of human skin tissue using atomic force microscopy: effect of scarring in the upper dermis At a broader level, scar tissue has similar stiffness to normal skin under high loads but is much less resistant to tearing and less compliant under gentle stretch. It also handles directional force differently, meaning it does not stretch evenly in all directions the way healthy skin does.3PubMed Central. Biomechanics of Scar Tissue and Uninjured Skin
In practical terms, this means a scar on a growing child’s knee joint, for example, may not expand as smoothly as the surrounding skin. It can feel tight, restrict movement, or develop an uneven texture over time. The mismatch between what the scar can do and what the surrounding skin expects of it is at the root of many complications people experience as their scars age.
Mechanical Tension Shapes How a Scar Evolves
The forces pulling on your skin have a major influence on what a scar looks like months or years later. Skin is not under equal tension everywhere. The chest, shoulders, and upper back, for instance, are under significant stretch from the muscles and posture beneath. Joints are repeatedly flexed and extended. Scars in these high-tension zones tend to widen, thicken, or become raised more readily than scars in low-tension areas like the eyelids or the inner forearm.
This tension effect is especially visible in hypertrophic scars and keloids, which are scars that grow excessively beyond what was needed to close the wound. Keloids, in particular, tend to take on shapes that mirror the dominant direction of skin stretching at their location. On the anterior chest, for example, keloids often adopt a butterfly or crab-claw shape that follows the lines of greatest mechanical stress.4PubMed Central. Ideal Surgical Incision Lines Minimizing Tension: A Proposal Based on Observations of Hypertrophic Scars and Keloids The scar is literally being sculpted by the forces the skin around it exerts.
For a growing child, this matters because the forces on the skin change as the skeleton lengthens, muscles develop, and body proportions shift. A scar that was relatively flat on a toddler’s shoulder might become raised or widened during a growth spurt, when the shoulder broadens rapidly and the skin over it is stretched more aggressively.
Burn Scars and the Contracture Problem
Burn scars in children present a particularly challenging version of the growth question. Burns often damage skin over large areas and across joints, and the resulting scar tissue can contract as it matures, pulling the surrounding skin inward and restricting movement. In growing children, this contraction can worsen over time because the bones underneath are getting longer while the scar tissue resists stretching to keep up.
A large national database study of pediatric burn patients found that about one in four children developed at least one contracture by the time they were discharged from the hospital, and among those affected, the average was more than three contractures per person. The shoulder was the most commonly contracted joint, followed by the elbow, wrist, knee, and ankle.5PubMed Central. Pediatric Contractures in Burn Injury: A Burn Model System National Database Study Most contractures were mild or moderate in severity at discharge, but the concern in children is that growth can worsen them. As the child’s limbs lengthen, a tight band of scar tissue across a joint may increasingly limit range of motion, sometimes requiring surgical release and reconstruction.
This is why follow-up care for burned children often spans years. Physical therapy, pressure garments, and sometimes additional surgeries are timed around growth milestones to keep the scar tissue from falling behind the growing skeleton.
What Puberty and Pregnancy Do to Scars
Hormonal shifts during puberty and pregnancy can cause scars that had been stable for years to suddenly change. Clinicians have documented cases where a pre-existing, well-healed scar transformed into a keloid during puberty, a phenomenon attributed to the surge in hormones that accompanies sexual maturation.6PubMed Central. Adverse Effects of Pregnancy on Keloids and Hypertrophic Scars Pregnancy hormones can similarly trigger the growth of pre-existing keloids and hypertrophic scars.
The mechanism is not fully worked out, but hormones like estrogen and growth hormone are known to influence collagen production and tissue remodeling. During puberty, a child’s entire body is rapidly growing and changing, and scar tissue appears to respond to these systemic signals along with everything else. For someone who had a surgical scar as a child that looked perfectly fine for years, it can be alarming to watch it thicken or become raised around age twelve or thirteen. The timing is not a coincidence; it reflects the body’s hormonal environment activating dormant remodeling processes in scar tissue.
Why Fetuses Heal Without Scars
One of the more striking findings in wound-healing research is that fetuses in early pregnancy can heal skin wounds without forming a scar at all. In utero, fetal wounds repair rapidly and regeneratively, producing skin that is essentially indistinguishable from the surrounding tissue.7PubMed Central. Scarless fetal wound healing: a basic science review This scarless healing ability exists during early gestational stages, and the differences between fetal and later-stage skin provide clues about what drives scar formation after birth.8PubMed. Fetal Skin Wound Healing: Key Extracellular Matrix Components and Regulators in Scarless Healing
Fetal skin has a different composition of extracellular matrix components, different ratios of collagen types, and a less robust inflammatory response to injury. The immune system of a fetus is immature, which paradoxically seems to help: the aggressive inflammatory cascade that adult wounds trigger appears to be part of what drives scar formation. Fetal wounds skip much of that inflammatory phase and proceed directly to regeneration.9PubMed Central. Skin wound healing and scarring: fetal wounds and regenerative restitution
This ability is lost by the time a baby is born. Even premature infants heal with scars. Researchers have been trying for decades to understand exactly what switches off the regenerative pathway, with the hope of eventually being able to reduce scarring in children and adults. Progress has been slow, but the fetal healing model remains one of the most promising lines of inquiry in the field.
How Scar Color and Sensation Change Over Time
Growth is not the only change scars undergo. Color and sensation both shift over months and years, sometimes in ways that are more bothersome than the scar’s size.
Scar pigmentation follows a complicated trajectory. In burn scars, areas of hyperpigmentation (darker patches) tend to increase in size and darkness over time, with pigment appearing to spread inward from the scar’s edges toward its center. Some islands of darker pigment eventually merge with these peripheral zones, while others remain isolated within lighter scar tissue for months or longer.10Journal of Burn Care & Research. A Multimodal Assessment of Melanin and Melanocyte Activity in Abnormally Pigmented Hypertrophic Scar On darker skin tones, this uneven pigmentation can be more visually prominent than the scar’s texture, and it can take a year or more to stabilize.
Sensation follows its own timeline. During healing, wounds and young scars develop elevated densities of nerve-related proteins, which help explain why healing scars itch, tingle, or feel uncomfortably sensitive. Most of these markers return to normal levels by the time a scar is about three months old, but substance P, a neuropeptide involved in pain signaling, remains at roughly double its normal density even in mature scars.11PubMed Central. The reinnervation pattern of wounds and scars may explain their sensory symptoms This may be why some scars remain sensitive to touch or temperature changes long after they look fully healed. In growing children, the stretching of scar tissue during growth spurts can temporarily aggravate these sensory symptoms.
The Phases a Scar Passes Through
Every scar goes through a maturation process that unfolds over months to years, and understanding these phases explains some of the changes people notice. After the initial wound closure, scar tissue progresses through inflammatory, proliferative, and remodeling phases. During the proliferative phase, the body lays down collagen rapidly to strengthen the repair site. The scar is often raised, red or purple, and firm during this stage. Then the remodeling phase begins, during which the collagen is gradually reorganized, the scar softens, and its color typically fades. In vivo imaging of scars at different ages has confirmed significant age-dependent changes in collagen distribution, density, and organization as scars mature through these stages.12SpringerLink / Archives of Dermatological Research. Characterization of collagen in human scar tissue at various stages of scar maturation using in vivo reflectance confocal microscopy
For adults, this remodeling phase can last a year or two. For children, it overlaps with body growth, meaning the scar is simultaneously trying to mature and being stretched by a growing frame. This overlap is one reason pediatric scars sometimes look worse before they look better. A scar on a six-year-old’s arm might widen during a growth spurt right when it should be entering its remodeling phase, and the competing demands of maturation and mechanical stretch can produce a thicker, more prominent result than the same injury would leave on an adult who has stopped growing.
Managing Scars on Growing Skin
For parents and clinicians, the question of how to manage scars in children is complicated by the fact that the skin is a moving target. The two most common non-surgical approaches for pediatric scars are silicone gel sheets and pressure garments. A randomized controlled trial in burned children compared these treatments and found that silicone gel produced slightly thinner scars at six months compared to a combination treatment, though the difference was small.13PubMed Central. Effectiveness of topical silicone gel and pressure garment therapy for burn scar prevention and management in children: a randomized controlled trial At twelve months, no meaningful differences emerged between silicone alone, pressure alone, or the combination.14PubMed. Effectiveness of topical silicone gel and pressure garment therapy for burn scar prevention and management in children 12-months postburn: A parallel group randomised controlled trial
The evidence here is honestly underwhelming, and it reflects a broader challenge in pediatric scar management: the treatments we have are modest, and the natural variability in how scars behave on growing skin makes it hard to know how much credit to give any intervention versus time and maturation doing their own work. That said, silicone and pressure therapy are low-risk and widely used, and many clinicians continue to recommend them, particularly for scars across joints or in high-tension areas where the risk of contracture or hypertrophy is greater.
Surgical scar revision in children requires careful timing. Because scars continue to change during growth, many surgeons prefer to delay elective scar revision until the child is closer to adult height, when the scar has finished its proportional expansion. Operating too early risks having a revised scar stretch out again during subsequent growth.
Stretch Marks and Traumatic Scars
Stretch marks, which commonly appear during puberty and pregnancy, are sometimes called scars, but they form through a different process. Rather than resulting from an external wound, stretch marks develop when rapid stretching damages the structural proteins in the dermis from within. Studies comparing skin with and without stretch marks have found differences in collagen, collagen hydration, and elastin fibers at the dermal level.15Wiley Online Library. Unraveling the molecular and cellular mechanisms of stretch marks
Both stretch marks and traumatic scars involve disrupted collagen, but stretch marks lack the wound-healing cascade: there is no blood clot, no inflammatory rush of immune cells, no granulation tissue. They are structural failures rather than repair sites. This is why they behave differently over time. Stretch marks generally fade from red or purple to a silvery white and flatten, but they rarely thicken, raise, or contract the way surgical or traumatic scars can. They also grow with the body in a more uniform way, since they were caused by stretch in the first place.
How Children Feel About Their Scars Over Time
Beyond the physical changes, scars that grow with a child carry a psychological dimension. A study of school-aged children who had undergone major surgery in infancy found that about a third described their scars as “nice-looking,” roughly half were indifferent, and about one in eight rated their scar as “rather ugly.” The vast majority, around nine out of ten, said they had never experienced embarrassment related to their scar.16PubMed Central. Scar Perception in School-aged Children After Major Surgery in Infancy
The desire for surgical scar correction, however, increased with age: about 6% of eight-year-olds wanted revision, compared to 19% of seventeen-year-olds. Scar perception did not significantly affect overall health status or quality of life, but negative feelings about a scar were associated with lower self-esteem in girls and more negative body image in boys. These findings suggest that while most children adapt well to visible scars, the adolescent years, when body awareness intensifies, are the period when dissatisfaction is most likely to surface. For parents, this means that a child who seems unbothered by a scar at age eight may feel very differently about it at sixteen, particularly if the scar has become more prominent due to growth.