How can you know whether a scar is evolving normally ?
A normal scar gradually changes : initially red, firm and visible, it may then flatten, soften and pale over time.
Scar maturation is slow and continues for several months. Its appearance a few weeks after surgery or injury therefore does not predict its final appearance.
Initially, slight tenderness, moderate itching or pink-to-red colour may accompany healing.
Evolution matters most : a scar gradually becoming less red, less firm and less sensitive generally follows a favourable course.
Which signs may suggest an abnormal scar ?
A scar should be assessed if it progressively thickens, extends beyond the original wound, contracts or remains painful.
Several signs may indicate unusual evolution :
• Gradual scar thickening.
• A scar becoming markedly raised.
• Scar tissue extending beyond the initial injury boundaries.
• Scar contraction that pulls on skin or limits certain movements.
• Significant or persistent itching.
• Pain that persists or intensifies.
• A scar remaining highly inflamed rather than gradually improving.
Is a red scar abnormal ?
No. A red scar is common during the first months of healing.
Recent scar tissue is highly vascularised, explaining pink or red colour. This vascularisation generally decreases gradually during maturation.
Redness becomes more concerning if it increases rather than decreases or accompanies warmth, swelling, increasing pain or discharge.
Is a thick scar always abnormal ?
A scar may be slightly firm or raised early in maturation without being abnormal.
However, a progressively thickening scar that remains raised may be hypertrophic. Scar tissue is then excessive but remains within the original wound boundaries.
If scar tissue exceeds the initial injury boundaries and continues growing, it may be a keloid.
What is a contracture scar ?
A contracture scar shortens and pulls on surrounding tissues.
It may appear particularly after certain burns or substantial skin lesions.
Depending on location, contraction may limit joint mobility or distort neighbouring tissues. The problem is then no longer solely aesthetic : the scar may have a functional consequence and hinder movement.
Is a painful or itchy scar abnormal ?
Slight itching or tenderness may occur during healing. When significant, persistent or worsening, it should be assessed.
Hypertrophic and keloid scars may particularly cause itching, tightness or pain.
Pain appearing suddenly, becoming more intense or accompanied by redness, warmth or swelling should prompt investigation of a complication rather than automatically being attributed to the scar.
Symptom evolution is therefore important : gradually diminishing discomfort is generally less concerning than persistent or worsening pain or itching.
When should a scar's appearance cause concern ?
Prompt consultation is required when a scar or wound suddenly becomes more painful, red, warm or swollen, or discharge appears.
Apart from these signs, consultation is recommended when a scar :
• Continues thickening.
• Extends beyond the original wound boundaries.
• Remains very painful or causes significant, persistent itching.
• Contracts and places substantial tension on tissues.
• Limits certain movements.
• Continues evolving unusually rather than gradually improving.
During healing, a scar remaining pink, slightly firm or visible for several months is normal. These signs may gradually diminish with maturation.
Should you wait until a scar is mature before treating it ?
No. Waiting until a scar is fully mature before treatment is not always necessary. Some treatments can be performed early, while others are more appropriate once the scar stabilises.
A recent scar becoming progressively thick, hard or raised should be assessed promptly. When hypertrophic or keloid scarring begins, early care may limit development.
A scar remaining very red may also be treated before full maturation. Treatment may then particularly target the vascular component responsible for redness.
Treatments correcting depressions, uneven contours or texture changes are generally considered according to scar evolution and degree of maturation.
Waiting a year before scar treatment is therefore not always necessary. Timing depends on appearance, evolution and the characteristic to correct.
Can an abnormal scar be improved with aesthetic medicine ?
Yes. Some abnormal scars can be improved with aesthetic medicine, but treatment must be chosen according to relief, colour, age and evolution.
Laser choice depends on the scar's dominant characteristic. Fractional lasers are mainly indicated to correct uneven texture or relief. Vascular lasers treat persistent redness associated with substantial vascularisation.
Hypertrophic and especially keloid scars need specific dermatological management because they contain excess scar tissue and may continue evolving or recur after treatment.
There is therefore no single treatment for every abnormal scar. The technique must be selected according to the characteristic to correct.
Clinical examination also distinguishes a normally evolving scar from genuinely abnormal evolution. This is essential for choosing appropriate treatment and intervening at the right time.
Article written by Dr Valeria Romano
Dr Valeria Romano supports each patient with a comprehensive approach to the aesthetics of the face, body and intimate areas, and to skin and hair quality. Every treatment is based on a personalised medical assessment.
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