Why scars absolutely need to be treated

Unfortunately, scars almost always leave behind marks on the skin. However, good treatment options exist that can considerably improve the appearance and functioning of the areas where marks are left behind. There are many other reasons why scars should be treated besides aesthetic ones. For one thing, failure to treat scars can lead to hypersensitivity, itching, pain, skin stretching, tension and tissue adhesions. In addition, lack of treatment can lead to an impairment of function and movement in hands and joints, for example.

Depending on their location and severity, heavily raised and proliferating (hypertrophic) scars or bulging scars (keloids) in particular can also cause mental or emotional stress, or even trauma.

Scar treatment is most successful in the first two years after scar formation, which is why this time should also be used to improve the quality of the scar.

Reasons for scar treatment

Prevention of impairment of function and movement
Promotion of scar tissue flexibility
Pain reduction
Reduction of hypersensitivity and itching
Improvement of appearance
Prevention of mental or emotional effects (trauma)

What is the best way to treat scars?

Every scar is different, which is why scar treatment will vary depending on scar type, a scar’s location and other factors. In general, however, treatments usually involve different measures that complement one another.
Starting treatment soon after a medical procedure is necessary to achieve the best possible result. This way, maximum use can be made of the time in which the scar is active. For all types of scars, non-invasive (non-surgical) treatment options should therefore be started as soon as the wound has healed.
Scar revision may be necessary for scars that cause significant function and mobility restrictions. Depending on the characteristics of the scar, this revision can be carried out surgically or by using laser therapy etc.
The responsible specialist doctor will select the most suitable combination of different treatment methods in each case.

Treatment options

With regard to scar treatment and therapy, a basic distinction is made between non-invasive(or conservative) and invasive treatment methods. Conservative treatment involves all medicine-based treatment and physical therapy approaches. Invasive treatment refers to all measures that involve penetration of the body – i.e. the skin is severed. This mainly involves surgical procedures.

How does compression therapy work?

One possible treatment method in scar therapy is the application of pressure (compression) on the scarred area. This can be done using flat-knitted compression garments that are tailor-made for the respective part of the body. Compression has been used successfully in scar therapy for many years. Compression therapy can even benefit older scars as long as the scar in question is still active and is being supplied with blood.

Adjusting the compression garment

If the compression garment fits exactly, it exerts medically effective and constant pressure, considerably helping to improve the scar area. It shouldn’t be constrictive, but it shouldn’t slip either. Specially trained medical products suppliers will take body measurements, which will make it possible to manufacture a compression garment with a precise anatomical fit (such as ScarComfort). The measuring process also determines whether additional extra options like pressure pads need to be incorporated in order to achieve ideal and even pressure in the scarred area. Doctors will prescribe the right compression class – and thus the right pressure intensity – for the treatment in question .

The ideal fit for compression garments

Compression garments sit very close to the body, like a second skin. This is the only way to ensure that the desired pressure can be achieved. Particularly at the start of therapy, putting on and wearing the compression garment can therefore need some getting used to and can also sometimes be unpleasant in the case of relatively young scars. This should not put anyone off, as a satisfying result can only be achieved if one wears the compression garment continuously throughout the day and at night.

With a little practice and handy aids, putting on the garment will get easier with time and wearing it will increasingly become part of everyday life.

Effectiveness of compression therapy

Fig. 1 Hypertrophic, bulging scar without compression

Fig. 2 Flattened scar below the compression knit

Compression therapy can be started as soon as a wound has closed. The uniform surface pressure applied by the compression garments over a large area can have numerous positive effects on the scarred area:

Prevention of uncontrolled growth
Prevention of extensive growth of the scar
Fading of the scar
Softer scar tissue
Reduced thickness of the scar
Protection of the sensitive skin or skin graft
Reduced itching in the scar area
Pain relief
Increased mobility of scars in joint areas
Minimised risk of scar shrinkage and resulting joint stiffness

Pads made of silicone

Silicone pads can be worn under compression garments at points of the body where compression alone is not enough to build up the required pressure on the scar tissue. This can be the case on the ankle or in cleavage areas, for example.

Duration of compression therapy

The required length of compression therapy depends on several factors and can therefore range from six months to two years. One’s own commitment to the therapy, as well as patience and support and encouragement from family and friends, can significantly contribute to the success of the therapy. Wearing the compression garment consistently (in accordance with the doctor’s instructions) is the only way to ensure that the scar heals well without restricting any functions.

Other factors that influence the duration of the therapy:

The severity of the scars

The site of the scar and the size of the surface affected

Healing responses that may vary from person to person

Good to know

In many cases, compression therapy can eliminate the need for surgical scar revision. However, this must be determined on a case-by-case basis.

Silicone therapy

Treating scars using silicone is another effective option in scar therapy. Silicone retains the skin’s natural moisture, preventing the scar area from drying out. Silicone products are made of 100% medical silicone. They are soft, highly elastic and very adaptable, which means people find the wearing experience to be pleasant rather than disruptive. Compression pads – like the Juzo ScarPad – are self-adhesive and can be worn either alone or in combination with a compression garment. Other silicone products – like Juzo Silon®-TEX – are sewn directly into the compression garment. Using silicone products early in conjunction with compression therapy can be an ideal supplement and can boost therapeutic effectiveness:

Improvement in the softness of scar tissue
Reduction of uncontrolled and excessive growth of the scar
Additional protection of fresh scar tissue or skin grafts
Prevention of direct rubbing on the skin

Good to know

Silicone products are not used until a wound has closed completely. It’s important to clean silicone sheets on a regular basis in order to ensure proper hygiene and prevent irritation of the sensitive newly formed skin.

Physical therapy and occupational therapy

The replacement tissue in a scar unfortunately does not display all the characteristics of the original skin. Scar tissue on hands and feet especially, but also on all joints, can result in restricted mobility and functionality. The main goal of physiotherapy-based scar treatment is to maintain mobility and functionality as much as possible, or to restore such mobility and functionality as has been lost. The use of manual movement and massage techniques improves regional circulation, loosens adhesions from structures underneath the skin, reduces feelings of tension and hypersensitivity and generally makes scars softer and more elastic.

Mother and daughter at a medical retailer

Scar care

One can begin scar care themselves once a wound has closed completely. Because scar tissue tends to dry out, creams and gels with a silicone additive are recommended for scar care. These creams and gels form a thin film on the scar surface and keep the scar from drying out. Rubbing in these products intensively and regularly makes the scar tissue more flexible and more supple.

In order to prevent inflammation, the scar area should be cleaned on a regular basis and always kept hygienically clean.

There are numerous invasive treatment methods that can be used in line with different scar types and treatment goals. Whereas some methods are geared mainly towards restoring mobility and functionality, others are designed primarily to remove or reduce visible deformations and noticeable skin changes.

Surgical scar removal

Relatively small scars, hypertrophic scars and keloids can be surgically removed. The gaps that form as a result are usually filled with surrounding tissue.

A diverse range of treatment options are available for larger scars as well. In a serial excision, larger gaps are closed gradually in several surgical procedures. Alternatively, missing skin can be replaced by skin taken from another part of the body.
Full-thickness skin grafts (skin grafts consisting of an area of skin detached in the subcutis, with a complete epidermis component) are used in most cases for the face and areas subject to particular stress, such as joints. On the other hand, split-thickness skin grafts are often used when wounds are deep and extensive. These skin grafts use only the outer layer of the skin and parts of the middle layer. The grafts here can also be cut additionally and then fanned out like a net in order to cover a larger area.

Dermabrasion

In this procedure, a specialised rotating grinding head with diamonds is used to “sand” away the outer layer of the skin (epidermis), whereby the patient is given a local anaesthetic before the procedure begins. This method is mainly used on acne scars in order to improve skin appearance.

Microneedling

Microneedling is a process in which the skin is perforated using a roller with thin needles attached to it. This leads to the creation of numerous tiny injuries that trigger repair and growth processes. Microneedling is not recommended for people whose injured skin tends to form keloids, as this treatment could lead to the formation of new keloids.

Subcutaneous injections (filler)

Collagen, hyaluronic acid or autologous fat can be used to fill in sunken scars (e.g. from severe acne) in particular.

Cortisone injections

Glucocorticoid injections are used to reduce the excessive scar growth caused by heightened connective tissue production in the case of hypertrophic scars and keloids.

Laser treatment

Various forms of laser treatment can be used on scars, thereby making it possible to treat different types of scars in a targeted manner. Here, high-energy laser light causes thermal damage to tissue – the scar tissue is thus removed and discolouration lessens. So-called blood vessel lasers, as well as pigment lasers and fractional lasers, are used for laser treatments.

Cryotherapy

Cryotherapy involves using liquid nitrogen to freeze hypertrophic scars and keloids, after which parts of the excess tissue from the scars die and the scar itself sags and become flatter. Depending on the exact method used, the nitrogen is either applied to the scar externally or else injected directly into the scar tissue using a special needle.

Radiation therapy

In the case of keloids that do not respond to conventional treatment methods, the early-stage use of radiation therapy (X-rays targeted at the scar surface) can stop the continuation of uncontrolled growth and even lead to partial regression.

Possible invasive treatment methods, depending on the type of scar in question

	Hypertrophic scars (raised scars)	Keloids (bulging tissue proliferation)	Atrophic scars (sunken scars, acne scars)	Sclerotic scars (shrunken scars)
Surgical scar removal	+	+		+
Dermabrasion	+		+
Microneedling			+
Subcutaneous injections			+
Cortisone injections	+	+
Laser treatment	+	in combination with surgical removal	+
Cryotherapy	+	+
Radiation therapy		+

Tips for successful scar treatment and therapy

We have put together a few helpful tips that can promote the success of your scar therapy. It is often the small things that don’t require too much effort that can support the progress of therapy and make treatment easier for you.

Wearing period
Wear your compression garment exactly as prescribed by your doctor. This is the only way to guarantee an optimum treatment outcome. Normally, your garment should also be worn at night and only removed when it needs to be washed.

Sunlight
Do not expose your scars to direct sunlight and protect yourself sufficiently with sun cream. Direct sunlight promotes the formation of hypertrophic scars. The scar tissue can also darken. Compression garments from Juzo (Juzo ScarComfort) guarantee you UV Protection Factor UPF 30. Juzo silicone sheets (Juzo ScarPad) offer additional protection as they have a UV Protection Factor of UPF 50.

Cleaning compression garments
Your compression garment can be washed in the washing machine on a gentle or delicate wash cycle (40°C or less). Residue of skin scaling, ointments, dirt and dust particles can collect in the fabric. You should therefore wash your compression garment every day – this is the only way to ensure that the elastic properties will be retained over the long term, and it will also increase your compression garment’s already high level of durability. We recommend using the gentle Juzo special detergent every time you wash your garment.. Please do not use any fabric softener as the plasticisers it contains damage the compression fabrics!

Physical therapy / occupational therapy
Targeted movement through physical and occupational therapy plays an important role in the effectiveness of scar therapy. Such movement mobilises the scar tissue and improves circulation, making the connective tissue softer. Furthermore, it allows joint deformities or limb stiffening to be treated in the best possible way, leading to the achievement of optimum results. Always follow the treatment recommendations provided by your doctor.

Cleaning silicone sheets
Clean your ScarPad every day – this is the only way to ensure the hygiene required in the scar area and that the product remains firmly in place. The ScarPad should be washed using a special soap (Juzo ScarPad Cleaning Soap). Put a couple of drops of the soap onto the ScarPad and wash it thoroughly under warm running water. After cleaning it, place it on a dry towel with the sticky side facing upwards. It is ready to be used again when it has completely dried.

Scar care
Scarred skin can be kept supple by massaging it and applying a cream every day. Hygiene is very important here: keep the scar area clean to prevent inflammation. Follow the skincare recommendations provided by your doctor.

Fit
Compression garments must fit perfectly and should not be constrictive or slip. Body measurements may change due to weight gain or loss, or due to growth in children. In this case, please consult your medical retailer. They will check the fit of the garment and, if required, measure a new garment for you.

Open wounds
Silicone sheets must never be worn on open wounds! Be sure to consult your doctor before wearing compression garments over existing wounds. If your doctor approves, compression garments may be worn on smaller wounds over a bandage or dressing. Compression can help residual defects to heal particularly quickly and without any complications.

Frequently asked questions about scar treatment and therapy

Putting on garments and ensuring the right fit

Why does a scar-care garment have to be so tight?

The term compression garment itself indicates that the effect it has is a result of pressure (compression). Here, pressure affects scars in such a way that the new tissue that forms is arranged in the most structured manner possible and doesn’t proliferate uncontrollably. The scar thus remains flatter, softer and also more flexible than would otherwise be the case. In addition, scar-care garments serve as a type of protective layer during the initial healing phase, and they also reduce scar itching.

Is it normal that compression garments leave marks after they are removed?

Compression decongests tissue. This effect becomes much more visible after a compression garment is removed. Marks are completely normal and they also show that the compression is having the intended effect.

Scar care

Should cream be applied to skin under a scar-care garment?

Scars should not be allowed to dry out. Scarred skin can be kept supple by massaging a cream into it every day. We recommend the use of specially designed care products such as moisturising Juzo Lymph Lotion with 4% urea and 30% lipids.

Is it also okay to use ointments that contain paraffins?

A compression garment should not be put on again until ointments that contain paraffins have been completely absorbed.

Which scar creams does it make sense to use?

Creams that contain silicone prevent scars from drying out and thus support the healing process.

Is it okay to use soap when you wash if you have a scar?

Once a wound has completely healed, scars should also be washed with soap for hygienic reasons. After washing, a lipid replenishing cream should be applied to ensure the scar does not dry out too much.

Duration of wearing; replacing garments

How frequently will a new garment be provided?

Two garments are provided every year. More than one garment is needed because the garments should be worn 24 hours a day and also have to be washed every day. A new garment can be prescribed if an old garment no longer fits because the person has grown or gained or lost weight.

How can one manage to wear only one garment for 23 hours, given the fact that the garment has to be washed and dried every day?

As a rule, garments should be switched for hygiene reasons. Talk to your supplier and/or doctor.

What can one do if the compression garment breaks or is severely damaged?

A request for a new garment should be submitted to the doctor or supplier for forwarding to the health insurance provider. A frank discussion with the customer service representative at your health insurance provider can be helpful here in terms of obtaining approval for a new garment.

How long should compression garments be worn?

Scars remain active for up to two years after they form. It makes sense to use compression garments during this time. Scars that have faded and are no longer red are referred to as inactive scars. Such scars no longer change very much.

Why do compression garments have to be worn around the clock?

Only if continuous pressure is placed on the scar will the newly formed connective tissue remain soft and flat.

Washing and material care

How often do compression garments have to be washed?

Compression garments must be washed every day.

How should one wash compression garments?

Your compression garment can be washed by hand or in the washing machine on a gentle or delicate wash cycle (40°C or less). Make sure to use either a special detergent or a detergent for delicate fabrics (without a fabric softener).

Is it okay to use skin cream underneath a silicone sheet?

Skin cream is an important part of scar care, as it keeps scars soft and supple. However, the cream needs to be fully absorbed by the skin before a silicone sheet can be put on again.

Silicone sheets

How do you clean silicone sheets?

If the silicone sheet has an adhesive (sticky) side, you can clean it with warm water and soap and then hang it up to dry in an area free of dust. Specially produced silicone sheets and pads can and should additionally be placed in boiling water for a few minutes every two days.

Is it normal that silicone sheets leave marks after they are removed?

It’s normal that the compression effect serves to decongest tissue and that impressions of the silicone sheet can be seen on the skin.

Miscellaneous

Do compression garments prevent sunlight from getting through?

The sun protection effect depends on the material used in each case. Juzo ScarComfort compression garments, for example, guarantee a UV Protection Factor of UPF 30. Juzo ScarPad silicone sheets offer additional protection, as they have a UV Protection Factor of UPF 50.

When can a person with a scar start taking baths and showers again, or go swimming?

After the wound has healed.

When is physiotherapy or occupational therapy prescribed within the framework of scar treatment?

Large scars located near or on joints in particular can lead to impairment of function and movement. You should talk about this with your doctor.

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