Thick, red scar
Raised, dense scar within the boundaries of the former wound; may itch and hurt.
Hypertrophic scar
CONDITION / SKIN AND SCARS
Cicatricial deformation of the body.
Body scar deformation — large, numerous, indented, or thick scars on the torso and limbs that change contours, pull the skin, hurt or itch. They remain after injuries and wounds, burns, multiple surgeries, or severe infections. They are treated with a combination of methods and often in stages.
CONCEPTUAL VISUALIZATION- What it is
- Large or numerous scars on the torso and limbs that change contours, tighten the skin, or interfere.
- From where
- Injuries and wounds, burns, several surgeries, severe infections.
- After burns
- According to a systematic review of 48 articles, hypertrophic scars after burns occur in 32–72% (research data vary).
- How we treat
- Combination of methods: scar care, laser, autologous fat, excision and flap surgery, expanders.
01 / WHAT IS ITWhat is
What is
Body scar deformation.
Any deep wound heals with a scar. A small scar gradually lightens and becomes flatter over time, while large or numerous scars can noticeably change the body: remain wide and thick, retract and 'adhere' to deeper tissues, tighten the skin, or alter contours — for example, after injuries, burns, repeated surgeries on the abdomen or limbs.
Scars can be different. According to the NHS, a hypertrophic scar is raised and firm, but does not extend beyond the wound and usually fades and flattens over time. A keloid grows larger than the wound and usually does not shrink without treatment. An atrophic scar is sunken. A contracture scar is tight, making movement in that area difficult or painful. Scars can itch, hurt, or cause discomfort.
This page is about large scars of the trunk and limbs in general and about how their correction is planned when there are many scars. About individual types of scars and contractures that limit movement — there are separate pages, links to them below.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSWhat worries
What worries
most often
Often several types of scars are combined in one person. This affects where to start treatment.
The scar grows beyond the wound.
A hard smooth scar that extends beyond the wound and does not decrease on its own is a keloid.
Keloid scarDepressed area.
The scar sinks in or adheres to deeper tissues; nearby there is a lack of volume, and the body contour changes.
Soft tissue defectTightening and movement.
The scar pulls the skin over a joint and prevents fully straightening the arm or leg.
Post-burn contractureWounds on the scar
The scar cracks, oozes, or develops sores that do not heal — such an area should be shown to a doctor.
Unstable scarHow you feel.
According to practical guidelines, hypertrophic and keloid scars can cause severe psychosocial problems. Based on reviews of burn scar studies, the perception of one’s own body was more influenced by how a person feels among others than by the characteristics of the burn.
03 / REASONSWhere do they come from?
Where do they come from?
large scars.
Large scars remain after deep and large wounds — and where one area was operated on several times.
Injuries and wounds
Torn, gunshot, or shrapnel wounds, wounds with tissue loss that healed slowly or were sutured multiple times.
Burns
According to a systematic review, risk factors for hypertrophic scars after burns include dark skin, female sex, young age, burns on the neck and arm, multiple surgeries, mesh skin grafts, long healing time, and burn severity.
Multiple surgeries
Repeated incisions in the same area; in the same review, multiple surgeries were mentioned among the risk factors for hypertrophic scars.
Severe infections and necrosis
After removal of dead tissue, large wounds remain, which heal with a scar.
Consequences of necrotizing fasciitis
04 / SEEK MEDICAL ADVICE
When to seek urgent medical care?
Old scars — a planned situation: they usually do not require urgent care. Emergency care is needed in case of signs of severe infection.
103 immediately if:
- breathing very frequently or difficulty breathing;
- sudden confusion, unclear speech, person speaks illogically;
- blue, pale, or mottled skin or lips;
- a rash that does not fade if you press on it;
- person does not respond or has fainted.
Other levels of urgency:
Immediately - to the surgeon who operated, and if it does not work - to the reception department: after surgery, pain or swelling at the operation site increases rapidly; the transplanted flap has changed color (pale, blue, or darkened) or has become cold. On the same day: If the scar or surrounding skin turns red, is painful, feels hot to the touch, or pus is oozing from the scar — see a doctor the same day. In the coming weeks: If the wound or area on the scar hurts, itches, bleeds, or forms a scab for more than 4 weeks, or if it grows and changes color — see a doctor. Planned: If the scar hurts, itches, limits movement, changes contours, or simply interferes with life — consult a plastic surgeon; if scars affect your mood, the doctor may recommend a psychotherapist.
05 / DIAGNOSTICSAs planned
As planned
correction.
- Conversation
Where the scars came from, when they healed, which surgeries have already been done, and what bothers the most: pain, itching, movement, or appearance.
- Review
The surgeon evaluates each scar: thickness, color, mobility, whether it is depressed, whether it tightens the skin, what the surrounding skin is like.
- Types of scars
Hypertrophic, keloid, atrophic, or contracture — what to start with depends on the type.
- Priorities
First — scars that restrict movement or are constantly traumatized; appearance and contours — at later stages.
- Related specialists
Dermatologist and physiotherapist, and if necessary — psychologist.
06 / TREATMENTHow to fix
How to fix
scars on the body.
A scar cannot be completely removed: the goal is to make it thinner, softer, less noticeable, and more comfortable. According to international recommendations, for hypertrophic and keloid scars, the best chance comes from combining several methods.
01
Scar care
This is often where they start.
- Silicone
- According to practical guidelines, silicone sheets or gel are the first choice for preventing and treating hypertrophic and keloid scars. According to a meta-analysis of 6 randomized studies (375 patients), silicone gel after surgery reduced pigmentation, height, and density of the scar.
- Compression garments
- According to the guidelines, it can be prescribed for large scar areas, especially after burns. A Cochrane review (15 studies, 1179 participants) is more cautious: there is insufficient evidence to recommend it for preventing hypertrophic scars after burns, so the authors suggest also considering the patient's choice.
- Other methods
- According to the NHS, depending on the type of scar, treatment may include steroid injections or creams, cryotherapy, and laser therapy.
02
Laser
- First-line method
- An international group of 26 dermatologists and plastic surgeons from 13 countries named laser as a first-line method for traumatic scars and contractures.
- What changes
- According to the review of studies, fractional ablative laser improved function, reduced itching and pain, and enhanced the quality of life of people with scars after injuries; side effects were rare and mostly mild.
03
Own fat
- Lipofilling
- Fat is taken from another area of the body and injected under the scar. According to a meta-analysis of 45 studies (3033 patients), scars became softer and more elastic; on average, 1.4 procedures were needed, minor complications occurred in 4.8% of procedures.
- After burns
- In a review of 14 studies (885 patients) on fat grafting for burn scars, all studies reported scar improvement, but the authors note that studies with standardized measurements are needed for confirmation.
04
Surgical correction
- Excision and flap surgery
- The scar is excised and sutured so that the seam lies better; changing the direction of the scar is assisted by Z-plasty, W-plasty, and a broken line. Large scars are excised in parts, over several stages.
- Expander
- A balloon is placed under healthy skin nearby and gradually filled, and then the scar is replaced with the stretched skin. The method is widely used for scar correction; in a series of 8 patients with large burn scars, each underwent two stages.
- Satisfaction after correction
- According to a meta-analysis of 25 studies (1432 patients), on average 78.6% were satisfied with scar correction: 88.3% with traumatic scars, 74.5% with burn scars; minor complications occurred in 8.6%. The authors emphasize realistic expectations.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Scarring deformation of the body is treated at the Valikhnovskyi Institute of Surgery under the program "New Body": when there are many scars, a single staged plan is developed. Burn scars and contractures are managed together with the program "Post-Burn Reconstruction," laser, light, and scar care fall under the program "Rehabilitation after Cosmetic Surgery."
CLINIC SERVICE
New body
Restoration of several areas of the body as a single sequence of stages — after injuries, major burns, or necroses.
View service
What we do for this condition
- Excision and local tissue flap surgery — the scar is excised, the skin is redistributed; Z-plasty for scar bands.
- Lipotransfer — transplantation of own fat into depressed scars and areas lacking volume.
- Large scars — staged excision, expanders, skin grafting or dermal matrices.
- Laser and light — fractional CO2 laser for scar texture and density, IPL for redness and pigmentation.
- Scar care — silicone, compression garments, injections; selection of home care with a dermatologist.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend photos of scars and surgery records — the doctor will preliminarily assess the situation.
- ConsultationExamination of all scars, discussion about what bothers you the most, list of necessary tests.
- Plan of stagesWhat to do first, which methods to combine, and approximately how many stages will be needed.
- TreatmentProcedures and surgeries in stages, with intervals for healing.
- RecoveryScar care, compression garments, laser if needed, and follow-up examinations.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is it possible to remove the scar completely?
No. According to the NHS, it is not possible to get rid of a scar, but most scars fade over time. The goal of treatment is to make the scar thinner, softer, less noticeable, and more comfortable.
When can a scar be corrected?
The scar changes gradually: according to the NHS, most scars fade over time, and this can take up to 2 years or more. If the scar limits movement or is constantly injured, treatment is sometimes started earlier. The timing is determined by the doctor after examination.
Which is better: laser or surgery?
These are different tasks. Laser, according to reviews of studies, reduces itching and pain and improves function; depressed areas are filled with own fat, and a wide scar or contracture is corrected surgically. Often the methods are combined.
Will compression garments help?
According to guidelines, they may be prescribed for large scar areas, especially after burns. A Cochrane review did not find sufficient evidence for the prevention of hypertrophic scars after a burn, so the decision is made together with the patient.
The scar is depressed. What can be used to fill it?
With own fat: according to a meta-analysis of 45 studies, after fat transplantation, scars became softer and more elastic, on average 1.4 procedures were needed.
How many stages will be needed?
It depends on the number and area of the scars: large scars are corrected in stages, with breaks for healing. The doctor specifies the number of stages after an examination.
I am embarrassed by my scars. Is this a reason to seek help?
Yes. According to the NHS, a doctor can refer you to talking therapy if the scar affects mental health. And scar correction can be discussed with a plastic surgeon.
Sources
18 sources · guidelines, consensuses, systematic reviews, meta-analyses, and NHSshowCollapse
- Updated international clinical recommendations on scar management: part 2 — algorithms for scar prevention and treatmentDermatologic Surgery, 2014pubmed.ncbi.nlm.nih.gov/25068544 ↗
- Updated Scar Management Practical Guidelines: Non-invasive and invasive measuresJournal of Plastic, Reconstructive & Aesthetic Surgery, 2014doi:10.1016/j.bjps.2014.04.011 ↗
- Epidemiology and impact of scarring after burn injury: a systematic review of the literatureJournal of Burn Care & Research, 2012doi:10.1097/BCR.0b013e3182374452 ↗
- Pressure-garment therapy for preventing hypertrophic scarring after burn injuryCochrane Database of Systematic Reviews, 2024doi:10.1002/14651858.CD013530.pub2 ↗
- Efficacy of topical silicone gel in scar management: A systematic review and meta-analysis of randomised controlled trialsInternational Wound Journal, 2020doi:10.1111/iwj.13337 ↗
- Laser Treatment of Traumatic Scars and Contractures: 2020 International Consensus RecommendationsLasers in Surgery and Medicine, 2020doi:10.1002/lsm.23201 ↗
- Impact of Fractional Ablative Laser Therapy on Function, Symptoms, and Quality of Life in the Management of Traumatic Scars: A ReviewLasers in Surgery and Medicine, 2025doi:10.1002/lsm.23858 ↗
- Fractional CO2 laser treatment for burn scar improvement: A systematic review and meta-analysisBurns, 2021doi:10.1016/j.burns.2020.10.026 ↗
- Autologous fat transfer to treat fibrosis and scar-related conditions: A systematic review and meta-analysisJournal of Plastic, Reconstructive & Aesthetic Surgery, 2020doi:10.1016/j.bjps.2020.08.023 ↗
- The Utility of Fat Grafting to Manage Burn Scars: A Systematic ReviewJournal of Burn Care & Research, 2025doi:10.1093/jbcr/iraf146 ↗
- Post-Burn and Surgical Scar Reconstruction with Tissue Expanders: Review of the Literature and Our Local ExperienceReports, 2023doi:10.3390/reports7010001 ↗
- Patient satisfaction following scar revision: A systematic review and meta-analysisJournal of Plastic, Reconstructive & Aesthetic Surgery, 2026doi:10.1016/j.bjps.2026.01.021 ↗
- Scar revisionIndian Journal of Plastic Surgery, 2013doi:10.4103/0970-0358.118621 ↗
- Current Trends in Management of Marjolin’s Ulcer: A Systematic ReviewJournal of Burn Care & Research, 2021doi:10.1093/jbcr/iraa128 ↗
- ScarsNHS, 2023nhs.uk/conditions/scars ↗
- CellulitisNHS, 2024nhs.uk/conditions/cellulitis ↗
- SepsisNHS, 2026nhs.uk/conditions/sepsis ↗
- Symptoms of non-melanoma skin cancerNHS, 2026nhs.uk/conditions/non-melanoma-skin-cancer/symptoms ↗
The figures on the page are from these sources.
Do scars interfere
with living?
Send photos of scars and surgery records. The doctor will say what can be corrected and in what sequence.