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Scar therapy: information and tips
about skin and scars

Our aspiration: your well-being

We want to help you feel good. In this brochure, you will learn everything you need to know about scars and scar therapy. Scar therapy is a complex issue that often raises many questions for those affected, but also for their family members. How is skin structured? How and why do scars form? What scar therapy options are there and how can scar therapy help you? We will try to answer many of your questions so that you can receive the best support – for Freedom in Motion!

Child sitting on armchair holding a cuddly toy

Interesting facts about our skin

Skin: the mirror of life

At a size of 1.5 to 2 square metres, the skin is the human body’s largest organ. It has the greatest number of nerves and accounts for up to 20% of your body weight. It performs various complicated bodily functions such as regulating heat, protecting the body against infections and environmental influences, and preventing it from drying out.

It is therefore extremely important that it can function properly, yet your skin is much more than “just” an organ: skin is our contact with the outside world and is an indispensable communication tool in social relationships. All types of touches are sensed by the skin’s surface and it is a means of perceiving and expressing sensations and feelings. We don’t refer to skin as the “mirror of life” for nothing. Many changes in your body, your personal lifestyle and mood as well as hormone fluctuations become visible in your skin.

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Good to know

  • A baby’s skin is around 20 to 30% thinner than in adults. Although it comprises the same number of skin layers, the individual layers are considerably thinner, making it especially delicate and sensitive. 
  • Female skin has a different composition than male skin, with a man’s epidermis being a lot thicker compared to its counterpart in women. Its connective tissue is also networked more intricately and contains considerably smaller fat deposits.
Image of layers of the skin

How is skin structured?

The structure of skin is complicated. It is the same at every point, comprising three layers (epidermis, dermis
and subcutis) that all have different functions. The thickness of the skin differs depending on the area of the body. The skin on your face or the back of your hand is much thinner than that on your thigh, for example.

Epidermis: protection and immune organ

Despite being very thin, the top layer of the skin (epidermis in Latin) acts as the body’s protective shield. The epidermis is the layer that people perceive as skin. It is responsible for protecting the body from various external influences such as UV rays or pollutants. An intact epidermis stops microorganisms like bacteria from getting into your body and prevents your body from drying out. The epidermal cells constantly renew themselves and have a life cycle of approximately one month, when they die and detach themselves from the skin’s surface layer.

Dermis: network and transport system

Attached to the epidermis, the dermis is situated directly beneath. It is thicker than the outer layer of skin and is very strong, elastic and tear-resistant owing to its collagen and elastin fibres. Unlike the epidermis, this layer comprises nerve cells, blood and lymph vessels. Among other things, the dermis is responsible for sensing touches such as stroking, pressure, pain, temperature or even itching. The blood vessels in the dermis also regulate the skin’s heat.

Subcutis: the skin’s fat storage

The subcutis primarily consists of fatty tissue, which stores energy, protects the body against the cold and acts as padding. This skin layer varies in thickness depending on where it is in the body. The body’s hair roots, sebaceous and sweat glands can also be found in the subcutis.


The scarring process: Why do scars form?

Every injury leaves behind marks in the form of scars. If an injury is only superficial or minor, these scars are often barely noticeable. If a large section of the skin is affected
or the injury extends to the deep layers of the skin, this can lead to very distinct scars and major hindrances in day-to-day life. Each patient deals with thei scars differently, with the story behind the scars playing a great role. The aim of scar therapy is not just to recover movement, but also to restore aesthetics. Be they large or small, scars can have a major effect on a person’s quality of life. Every scar can therefore be treated to have the greatest possible influence on the quality of the scar.

Formation of scars

If our skin is damaged as a result of accidents, surgeries or illnesses, our organism tries to repair it, but often does not achieve the same level of functionality as before the injury. This is only possible if there are no other accompanying illnesses that could impede the skin’s repair. In the case of superficial injuries that only affect the epidermis, wounds can heal completely without leaving any marks (epithelial wound healing). These types of injuries to the epidermis include sun burns or also superficial abrasions. If deeper layers of skin are affected, such as in the case of surgeries etc., scars are formed after the various stages of wound healing. The wound healing process depends on the type, size and depth of a wound.

Image of layers of the skin in the granulation phase

                      Fig. 1 Cleaning phase 

Image of layers of the skin in the granulation phase

                      Fig. 2 Granulation phase

Image of layers of the skin in the repair phase

                        Fig. 3 Repair phase

The wound healing phases of a scar

In order to understand how scars are formed in the final stage of wound healing, it can help to take a closer look at the wound healing process.


1. Cleaning phase

The blood clotting process begins immediately after the skin is injured. The body tries to stop the bleeding
and at the same time remove germs and bacteria from the wound or prevent them from entering. This stage can last up to three days.



2. Granulation phase

A few days after the injury, the body starts to rebuild vessels and tissue (granulation tissue) with the aim of closing the wound as quickly as possible.



3. Repair stage

The last stage – closing the wound at the epidermis – starts between five and ten days after the wound was sustained. Scars start to form during the last stage of wound healing. The repair phase can span out over several weeks or months.

Sometimes, the scars formed in the repair stage do not just give rise to an aesthetic problem. Due to thickening,
shrinkage and hardening of the skin, it has less elasticity at the scarred sites.

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Good to know

  •  Scar tissue can change for up to two years after its formation.
  •  During this time, scar therapy can have a positive effect on the formation of a scar. The therapy can somewhat reduce itching and pain, especially in the early stages of scar formation, i.e. in the case of immature scars.

Factors affecting scar quality

No two scars are the same. If you were to monitor the healing of two identical wounds on different people, the resulting scars would not be exactly the same. A scar, and its appearance and development, depends on all manner of factors – some of which can be influenced.

Factors we can influence

  • Mobilisation
    Depending on the type and severity of the injury leading to the scarring, passive mobilisation by a therapist may be necessary at first. Mobilising the scar and the surrounding areas increases circulation and makes the connective tissue looser, softer and more supple, improving the quality of the scar.

  • Avoiding the sun
    Fresh scars should never be directly exposed to the sun, otherwise they may darken. You should always be sure to cover yourself with sun-protective clothing or compression garments and/or sun cream.

  • Compression therapy
    Wearing compression garments every day has a positive effect on the quality of a scar and can support healing and prevent an overgrowth of scarring tissue.

  • Silicone products and ointments
    Using silicone products and special ointments has a positive effect on scar tissue. They keep it moist, supple and can support healing.



Factors we cannot influence  

  • Location
    Scars on parts of the body that are often moving are constantly under strain. The continuous tension can lead to the development of undesirable scar formations.

  • Age
    Wound healing is often impaired in elderly people, owing to a change in skin structure. It is less elastic, there are fewer layers of fat and blood supply decreases. Children and young people tend to have thicker, raised scars as there is often an overproduction of new connective tissue.

  • Skin thickness
    Thicker skin forms more visible and distinct scars. Skin thickness starts to increase in childhood and then decreases again from the age of 65.

  • Skin type and origin
    People of African or Asian descent are prone to scarring and an overgrowth of scar tissue resulting from an excessive production of new connective tissue.

  • Other illnesses
    Accompanying illnesses or pre-existing conditions (impaired circulation, diabetes, etc.) negatively affect scarring.
Woman with thorax compression vest is putting on a jacket

What types of scars are there?

Depending on the injury and subsequent wound healing, different types of scars may form that vary in their appearance and manifestation.


Hypertrophic scars
Raised, reddened or even bulging scars are referred to as hypertrophic scars. They arise when there is an excessive production of new connective tissue, which results in prominent and thick scars. They grow quickly within the original wound area, in other words they don’t develop uncontrollably.

Hypertrophic scars can spontaneously regress over a longer period of time, which tailored scar therapy
can support. The most common cause of hypertrophic scars are tensile forces at play when the wound is healing. This is especially the case for joints.


Keloid scars (keloids)

Like hypertrophic scars, keloids also develop due to an overgrowth of scar tissue. With keloids, however, the scar grows beyond the borders of the wound area and sometimes even continues to grow after the wound has healed. The growth can also start months later, which is a result of uncontrolled and intense growth of connective tissue. 

Although the excessive growth stops after some time, the keloid that was formed never recedes. The area is reddened or darker than the rest of the skin and can feel itchy or painful.

A keloid can even reappear after being surgically removed. Scar therapy, which sometimes combines various different treatment methods to achieve long-term positive results, is therefore important.


Atrophic scars
Unlike the two types of scars mentioned above, atrophic scars consist of sunken recesses and the scar is lower than the surrounding skin.

Not enough new connective tissue is produced to completely fill out the wound again. Atrophic scars are formed when wounds, such as acne, heal badly and they can often be found in the facial area.

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Important

  •  Scars improve with time and patience. An existing scar cannot be removed completely. Don’t be discouraged if a scar doesn’t look the way you want it to at first or if you can’t see any noticeable changes straight away during scar therapy. One way of seeing smaller progress is through documenting your therapy with photos, meaning you can compare the changes during the course of the therapy.

The 4 pillars of scar therapy

In plastic surgery

Every surgical procedure leaves behind visible marks on the skin. Targeted and comprehensive scar therapy may be necessary in many cases, but in others it may be desired to improve the visibility of scars and their structure. The end result depends on the size, type and individual characteristics of the scar. There are four pillars in plastic surgery, which will be discussed below. Plastic surgery focuses on the recovery and improvement of mobility and function and/or an aesthetic result – body shapes or functions are positively influenced by the change. There is also either a medical necessity or personal desire of the patient to undergo cosmetic change.


1st pillar: reconstructive surgery


Reconstructive surgery, a type of plastic surgery, is used after accidents (trauma surgery) and after operations, e.g. when tumours are removed in cases of cancer. Reconstructive surgery is also used to treat congenital malformations. In some cases, for example, when patients suffer from cancer or other conditions, or after accidents perhaps, the procedure involves transplanting healthy tissue from the patient’s own body to close wound surfaces or replace missing tissue. This causes scars to appear in various areas of the body. These scars are not only irritating but can also limit movement in those affected. After the wounds have healed successfully, active scarred areas should therefore be treated with suitable scar therapy.

Scar therapy encourages the scar tissue to heal evenly and, particularly in larger areas, prevents the development of bulging scars or scar shrinkage, which can lead to problems or pain. The aesthetic factor is key, especially when it comes to surgery in visible areas of the body. It is completely understandable that looking at scar tissue after surgery is not easy, especially at first, and that it can be hard to accept this new and different situation. Compression garments and supplementary products, such as silicone pads and donning aids, can provide support during the critical time of your individual scar therapy.

2nd pillar: hand surgery

Hand surgery is a special area of plastic surgery. Surgical procedures on the hand are very complicated because of the diverse structures of this extremity. The hands and individual fingers are the most important “tools” in day-to-day life and it is therefore of utmost importance to recover their functionality in the best possible and quickest way. A precise incision during a procedure is just as important as targeted scar therapy afterwards, as emerging scars can lead to major limitations, especially on the hand’s sensitive tissue. Intensive and targeted scar therapy comprising various elements and methods focuses on the function and mobility of the hand.


3rd pillar: aesthetic surgery

Aesthetic surgery is another pillar of plastic surgery. Unlike the other pillars, there are no compelling medical indications for the procedures, but rather they are of a cosmetic nature. Like in reconstructive surgery, these procedures can change the shapes of a body, but the focus is on the aesthetic result. The decision to undergo an aesthetic procedure can either be based on a personal desire for a bodily change or the need for aesthetic reconstruction after accidents or illnesses. Follow-up scar therapy is possible to improve the scarring and ensure that there is as little trace of the procedure as possible.


4th pillar: burn surgery

Burn surgery treats acute burns/scalding and burn scars. The treatment of burns and scalding mainly takes two factors into consideration: the depth of the burn, and the size of the affected bodily surface. The depth of burns is classified in degrees (I, IIa, IIb, III). Surgery is mostly necessary for IIb degree burns (damage to the deep layers of the dermis) and III degree burns (complete destruction including the dermis and damage to the subcutis). Depending on the depth and size of the burns, the patient must first receive intensive medical care. Owing to the severity of the burns, it is often necessary to remove tissue and replace it with new tissue through skin grafts. Intensive treatment is especially vital in the case of burns, as burn scars often contract or new connective tissue grows quickly. Untreated, this can lead to severe function and movement limitations.

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Important

  • The following applies to all four pillars of plastic surgery: scar therapy can be started as soon as the wound area has healed. The earlier the suitable treatment is administered, the better the end results.
Family with two children

Treatment methods in scar therapy

Unfortunately, scars cannot be made invisible. However, good therapy options exist that can considerably improve their appearance and function. Every scar is different and thus the requirements for scar therapy are manifold. Starting treatment soon after a procedure is necessary to achieve the best possible scar 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) therapy options should therefore be started as soon as the wound has healed. Scar revision may be necessary for scars causing significant function and movement restrictions. Depending on the characteristics of the scar, this revision can be done surgically or by using laser therapy, etc. Your treating medical specialist will select the most suitable therapy or a combination of various therapy methods for you.

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Important

  • Compression and silicone can also have very good results for “old” yet still active scars that were not treated at an early stage.
  • Your compression garment’s fit must be checked regularly in order to make sure it is still working properly.
Woman wearing Juzo Thorax compression vest and holding a handbag

Compression therapy in scar therapy

What are compression garments?
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 now. Compression therapy can even benefit older scars.


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 your body measurements to to manufacture a compression garment with a precise anatomical fit (such as the Juzo ScarComfort) for you. 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. Your doctor will prescribe you with a compression class (pressure intensity).

The ideal fit
Your compression garment sits very close to your body like a second skin, allowing the desired pressure to be achieved.
Particularly at the start of therapy, wearing and putting on the compression garment can therefore need some getting used to and can also sometimes be unpleasant in the case of freshly healed wounds. Please don’t let this put you off as a satisfying result can only be achieved if you wear the compression garment continuously throughout the day and at night.

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

Juzo knitted fabrics

Every injury leaves behind marks. Burns and scalding in particular, but also surgical procedures can produce sometimes extensive, unsightly scars. To prevent an overgrowth of scar tissue, it is helpful to apply external compression as soon as the wounds have healed.

Julius – the little helper

With “Julius – the little helper”, Juzo wants to help affected children and their parents through the difficult time after an accident. 


Effectiveness of compression therapy

Depiction of a hypertrophic scar

Fig. 1 Hypertrophic, bulging scar without compression

Flattened scar below the compression knit

Fig. 2 Flattened scar below the compression knit

You can start with compression therapy as soon as a wound has closed. The uniform surface pressure applied by the compression garments can have various positive effects on the scarred area:

  • Accelerated healing in the scar area

  • Prevention of uncontrolled growth 

  • Prevention of 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

Duration of compression therapy

The precise duration of your compression therapy cannot be predicted. It depends on various different factors and can therefore range from six months to two years. Your own commitment to the therapy and patience as well as support and encouragement from family and friends can significantly contribute to the success of your therapy. Wearing the compression garment consistently (as prescribed by your doctor) is the only way to ensure that the scar heals well without any restrictions with regard to function.

Other factors that influence the duration of treatment include:

  • The severity of the scars
  • The site of the scar and the surface affected
  • Healing responses that may vary from person to person
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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 retain the skin’s natural moisture preventing the scar area from drying out. Silicone products are made entirely from medical silicone. They are soft, highly elastic and very adaptable, which means people find the wearing experience to be pleasant rather than disruptive. Depending on the scar and choice of the product, silicone can also be worn in combination with a compression garment. Using the silicone products early alongside compression therapy can be an ideal supplement and can boost therapeutic effectiveness:

  • the scar tissue becomes softer
  • uncontrolled growth of the scar is reduced 
  • the fresh scar tissue or skin graft receives additional protection 
  • direct rubbing on the skin is avoided

Silicone inserts can also 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, e.g., on the ankle or cleavage.

Tips for a successful scar 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 are not too much effort that can support the progress of therapy and make treatment easier for you.

Icon Wearing period


Wearing period
Wear your compression garment exactly as prescribed by your doctor. This is the only way to guarantee an optimum treatment outcome.


Icon Sunlight


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. Juzo compression garments (Juzo ScarComfort) guarantee a UV protection factor of 80. The Juzo silicone patches (Juzo ScarPad) offer  additional protection as they have a UV protection factor of 50. 


Icon Cleaning at 40 degrees


Cleaning the compression garment

Your compression garment can be washed in the washing machine on a gentle or delicate wash cycle (40°C or less). Wash your compression garment every day – this is the only way the elastic properties are retained over the long term. Residue of skin scaling, ointments, dirt and dust particles have an abrasive effect on the yarns and fibres. Washing the garment every day is the only way to completely remove these residues, increasing the durability of the compression garment. 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!

Icon Physical therapy/occupational therapy


Physical therapy/occupational therapy

Targeted movement through physical and occupational therapy plays an important role in the effectiveness of scar therapy. This 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, achieving the optimum results. Always follow the treatment recommendations provided by your doctor.


Icon Cleaning the silicone pads


Cleaning the ScarPad

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

Icon Caring for your scars


Caring for your scars

The 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 inflammations. Follow the skincare recommendations provided by your treating doctor.

Icon Fit


Fit

Compression garments must fit perfectly and should not slip or be constrictive. 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.

Icon Open wounds


Open wounds

Silicone patches 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.