Scar tissue is your body’s natural repair material. After surgery, your body fills the wound with a dense, fibrous protein called collagen to close the gap and restore structural integrity. This new tissue is tougher and less flexible than the skin or tissue it replaces, and it can form both on the surface of your skin and deep inside your body around organs. Most surgical scars take 9 to 12 months to fully mature.
How Your Body Builds a Scar
Wound healing happens in four overlapping phases, and scar tissue is the end product. The first phase, hemostasis, kicks in within minutes as your blood clots to stop bleeding. Inflammation follows over the next one to two days, bringing immune cells to fight infection and clear debris. Then comes proliferation, starting around day three and lasting up to 30 days, when your body lays down new collagen fibers to bridge the wound.
The collagen your body produces first is a temporary, loosely organized type. Over the following weeks and months, it gets gradually replaced by a stronger, more structured form that gives the scar its final tensile strength. This last phase, called remodeling, begins around week four and continues for 9 to 12 months. During that time the scar typically fades in color, flattens, and softens. Because the process takes so long, surgeons generally won’t consider a scar revision until at least a year after the original procedure.
What Scar Tissue Looks and Feels Like
A normal surgical scar starts out red or pink, slightly raised, and firm. Over months it usually fades to a pale, flat line. But scar tissue lacks the elasticity of normal skin. It doesn’t stretch as well, and it may feel tight or stiff, especially over joints or areas that move frequently.
Many people experience itching, numbness, or tingling around a surgical scar. Research suggests this happens because the healing process disrupts small nerve fibers in the skin. Nerve-signaling chemicals accumulate in scar tissue at higher levels than in normal skin, which can trigger itch and pain sensations. The nerve fibers responsible for detecting temperature and light touch also appear to function differently in scarred skin. These sensations often improve over time but can persist in thicker or more problematic scars.
Hypertrophic Scars and Keloids
Sometimes the body overproduces collagen during healing, creating raised, thickened scars. There are two main types, and the distinction matters because they behave differently.
Hypertrophic scars stay within the boundaries of the original wound. They’re raised and firm but don’t spread beyond the incision line. Keloids, on the other hand, keep growing and invade healthy skin beyond the wound’s edges. They tend to develop in shapes that follow the direction of skin tension in that area, which is why keloids on the chest or shoulders often spread outward along tension lines.
Both types tend to worsen during puberty, pregnancy, and periods of high physical activity. They often improve naturally once a person reaches their 50s, when skin tension drops significantly.
Internal Scar Tissue: Adhesions
Scar tissue doesn’t only form on the surface. After abdominal or pelvic surgery, bands of scar tissue called adhesions can develop between organs, or between organs and the abdominal wall. Normally, your internal organs slide freely against each other as you move. Adhesions cause these surfaces to stick together.
Many adhesions never cause symptoms. When they do, chronic abdominal pain is the most common complaint. More seriously, adhesions can kink, twist, or compress the intestines, leading to a bowel obstruction. Symptoms of obstruction include abdominal pain, bloating, constipation, inability to pass gas, nausea, and vomiting. If an obstruction cuts off blood supply to part of the intestine, it becomes an emergency, sometimes signaled by fever or a rapid heart rate.
In women, pelvic adhesions can compress or block parts of the reproductive system. This is a recognized cause of infertility after pelvic surgery.
Signs a Scar Isn’t Healing Properly
Most surgical scars heal without complications, but some warning signs warrant a call to your surgeon. Wound dehiscence, where the incision partially or fully reopens, can happen in the days or weeks after surgery. It feels like something is pulling or ripping at the incision site. Even a single broken stitch is worth reporting.
Other signs of trouble include increasing pain rather than improving pain, swelling around the incision, redness or darkening of the surrounding skin, fever, or any discharge from the wound. Bleeding from a previously closed incision is always a reason to contact your surgical team promptly.
Scar Massage and At-Home Care
One of the simplest and most effective things you can do for a healing scar is massage it. Ideally, start about two to three weeks after surgery, once the wound has fully closed and the surface skin has healed. That said, it’s never too late to begin, though earlier tends to produce better results.
Two main techniques help. Circular motions over the scar break down fibrous tissue and promote better alignment of the collagen underneath. Cross-friction motions, made perpendicular to the scar line, break down adhesions between the scar and deeper tissue, improving mobility. Both help restore some of the pliability that scar tissue naturally lacks.
Silicone Sheets and Gels
Silicone sheeting is one of the most well-studied topical treatments for raised scars. It works not because of the silicone itself, but because of what it does to the skin’s surface. The sheet acts as a barrier that traps moisture, mimicking the skin’s outer protective layer. This reduces blood flow and swelling in the scar, calms the cells that produce collagen, and decreases excess collagen buildup. Over weeks of consistent use, silicone sheets can flatten and soften hypertrophic scars and keloids.
Laser and Medical Treatments
For scars that remain thick, painful, or itchy despite home care, laser treatment is an option. Fractional CO2 laser creates tiny, controlled injuries in the scar tissue, prompting the body to remodel it more normally. In a study of 167 patients with burn scars, those treated with this laser showed significant reductions in scar thickness, pain, and itching compared to a control group receiving standard care alone. Quality of life scores improved significantly in the laser group while actually worsening in controls. Complications occurred in only about 3% of treated patients and were generally mild.
Laser treatment has also shifted how surgeons approach scar revision. Combining laser sessions with simpler surgical techniques has reduced hospital stays and sped up rehabilitation, which helps with both physical and psychological recovery. Corticosteroid injections are another option for keloids and stubborn hypertrophic scars, working by suppressing the inflammatory process that drives excess collagen production.